Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 669
Filtrar
1.
Rev Med Suisse ; 16(682): 370-373, 2020 Feb 19.
Artigo em Francês | MEDLINE | ID: mdl-32073773

RESUMO

Following a current trend in European countries, Switzerland is about to decide to adopt (or reject) a presumed consent legislation for organ donation. In such a system, every citizen is considered as a potential organ donor except in case of expressed refusal during lifetime. The presumed consent system raises ethical and practical issues that need to be carefully understood and weighed before deciding on its fate. This article reviews the most pressing ethical issues and provides the empirical data necessary for assessing the presumed consent legislation in Switzerland. At the end of the analysis, the reader will be able to form her own informed opinion on the issue.


Assuntos
Consentimento Presumido/ética , Consentimento Presumido/legislação & jurisprudência , Doadores de Tecidos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Humanos , Transplante de Órgãos/ética , Transplante de Órgãos/legislação & jurisprudência , Suíça , Doadores de Tecidos/ética , Doadores de Tecidos/psicologia
2.
Am J Bioeth ; 19(11): 13-24, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31647757

RESUMO

Transplantation programs commonly rely on clinicians' judgments about patients' social support (care from friends or family) when deciding whether to list them for organ transplantation. We examine whether using social support to make listing decisions for adults seeking transplantation is morally legitimate, drawing on recent data about the evidence-base, implementation, and potential impacts of the criterion on underserved and diverse populations. We demonstrate that the rationale for the social support criterion, based in the principle of utility, is undermined by its reliance on tenuous evidence. Moreover, social support requirements may reinforce transplant inequities, interfere in patients' personal relationships, and contribute to biased and inconsistent listing procedures. As such, accommodating the needs of patients with limited social support would better balance ethical commitments to equity, utility, and respect for persons in transplantation. We suggest steps for researchers, transplantation programs, and policymakers to improve fair use of social support in transplantation.


Assuntos
Alocação de Recursos para a Atenção à Saúde/ética , Equidade em Saúde , Transplante de Órgãos/ética , Seleção de Pacientes/ética , Apoio Social , Adulto , Viés , Tomada de Decisão Clínica/ética , Tomada de Decisão Clínica/métodos , Alocação de Recursos para a Atenção à Saúde/métodos , Política de Saúde , Humanos
3.
Transplant Proc ; 51(9): 2899-2901, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31606182

RESUMO

At times, clinical expertise may not be sufficient to find a way out of a moral impasse, especially in the context of end-of-life and organ transplantation decisions. Advances in medical knowledge and technology, and highly pluralistic and multicultural societies, have led to the emergence of new ethical problems in daily clinical practice along with the need to manage them in a prompt and effective manner. Clinical ethics developed in the late 1970s and early 1980s in North American health care contexts with the aim of identifying, analyzing, and attempting to resolve ethical conflicts and dilemmas at the patient's bedside. At present, only a few regions in Italy have established clinical ethics committees, and Italy may count on a very small number of clinical ethics services fully devoted to ethics case consultation, guidelines development, and the education of health care providers and citizens. Despite this situation, one has to acknowledge both the increasing request for ethics support coming from health care providers who experience an "ethical vacuum" in the Italian health care system and the cultural change that is affecting Italy nowadays. By highlighting clinical examples and sharing experiences, we show and encourage the potential benefits of establishing clinical ethics services in Italian health care contexts.


Assuntos
Comitês de Ética Clínica , Ética Clínica , Transplante de Órgãos/ética , Assistência Terminal/ética , Humanos , Itália , Assistência Terminal/métodos
6.
BJOG ; 126(11): 1320-1326, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31215750

RESUMO

Absolute uterine factor infertility is the final hurdle for assisted reproductive treatments. Uterus transplant trials are happening worldwide; to advance the debate around uterine transplantation (UTx), this article considers selection criteria for clinical trials from a UK perspective and makes recommendations for future selection criteria for UTx treatment. Recommendations advanced include the use of donor eggs, access for single women and women in same-sex relationships, prohibiting participation of women who are already mothers, and a preference for deceased donors and bioengineered uteri. With UTx treatment on the horizon, it is important to proactively consider future selection criteria. TWEETABLE ABSTRACT: Review of UK selection criteria for clinical trials for uterus transplantation; recommendations for the future.


Assuntos
Imunossupressores/uso terapêutico , Infertilidade Feminina , Transplante de Órgãos/métodos , Seleção de Pacientes , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/métodos , Útero/transplante , Adulto , Ensaios Clínicos como Assunto , Feminino , Humanos , Infertilidade Feminina/cirurgia , Transplante de Órgãos/ética , Seleção de Pacientes/ética , Suécia , Reino Unido , Adulto Jovem
8.
Wiad Lek ; 72(3): 457-461, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31050998

RESUMO

OBJECTIVE: Introduction: The focus of the work is the importance of transplantation of human organs and other anatomical materials as the method of treating and a way of saving people's lives and it also attaches particular importance to solving issues of transplantations in Ukraine. The aim: To find out the problems of human organ transplantation and other anatomical materials and determine the directions of their solutions in Ukraine. PATIENTS AND METHODS: Materials and methods: The assessment and analysis of domestic and foreign experience has been developed. In addition, data collected from Ukrainian and international organizations and the results of scientific research by scientists are used in the work. RESULTS: Review and conclusions: Investigating the legislation of Ukraine in the part of transplantation of human organs and other anatomical materials, conclusions were made on the necessity of its improvement, in particular, Article 16 of the Law of Ukraine «On the application of transplantation of anatomical materials to a person¼ dated by May 17, 2018, is proposed to be worded as follows: «Any adult may give written consent or disagreement to become a donor of anatomical materials in case of his death. In the absence of such a statement of disagreement with the transplantation of his organs or other anatomical materials, consent of relatives or others is not required. In this case, the deceased person is deemed to have given consent to the transplantation of his organs or other anatomical materials¼. It is proposed to make changes and significant additions to Art. 17 of the Law of Ukraine «On the application of transplantation of anatomical materials to a person¼ of May 17, 2018 regarding the creation of the Unified State Register of persons in need of transplantation, as well as to consolidate the procedure for its administration. In the context of urgent transformations, the necessity to significantly increase state funding for the provision of medical services, raise the awareness and informality of citizens about transplantation, as well as to change their misconceptions about this issue are sometimes put forward.


Assuntos
Transplante de Órgãos , Humanos , Transplante de Órgãos/ética , Ucrânia
9.
Med Klin Intensivmed Notfmed ; 114(4): 319-326, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-30976838

RESUMO

BACKGROUND AND CHALLENGE: Injuries, especially traumatic brain injury, or specific illnesses and their respective sequelae can result in the demise of the patients afflicted despite all efforts of modern intensive care medicine. If in principle organ donation is an option after a patient's death, intensive therapeutic measures are regularly required in order to maintain the homeostasis of the organs. These measures, however, cannot benefit the patient afflicted anymore-which in turn might lead to an ethical conflict between dignified palliative care for him/her and expanded intensive treatment to facilitate organ donation for others, especially if the patient has opted for the limitation of life-sustaining therapies in an advance directive. METHOD: The Ethics Section and the Organ Donation and Transplantation Section of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI) have convened several meetings and a telephone conference and have arrived at a decision-making aid as to the extent of treatment for potential organ donors. This instrument focusses first on the assessment of five individual dimensions regarding organ donation, namely the certitude of a complete and irreversible loss of all brain function, the patient's wishes as to organ donation, his or her wishes as to limiting life-sustaining therapies, the intensity of expanded intensive treatment for organ protection and the odds of its successful attainment. Then, the combination of the individual assessments, as graphically shown in a {Netzdiagramm}, will allow for a judgement as to whether a continuation or possibly an expansion of intensive care measures is ethically justified, questionable or even inappropriate. RESULT: The aid described can help mitigate ethical conflicts as to the extent of intensive care treatment for moribund patients, when organ donation is a medically sound option. NOTE: Gerald Neitzke und Annette Rogge contributed equally to this paper and should be considered co-first authors.


Assuntos
Tomada de Decisões , Medicina de Emergência , Transplante de Órgãos , Obtenção de Tecidos e Órgãos , Cuidados Críticos , Humanos , Transplante de Órgãos/ética , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/ética
11.
BMJ Open ; 9(2): e024473, 2019 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-30723071

RESUMO

OBJECTIVES: The objective of this study is to investigate whether papers reporting research on Chinese transplant recipients comply with international professional standards aimed at excluding publication of research that: (1) involves any biological material from executed prisoners; (2) lacks Institutional Review Board (IRB) approval and (3) lacks consent of donors. DESIGN: Scoping review based on Arksey and O'Mallee's methodological framework. DATA SOURCES: Medline, Scopus and Embase were searched from January 2000 to April 2017. ELIGIBILITY CRITERIA: We included research papers published in peer-reviewed English-language journals reporting on outcomes of research involving recipients of transplanted hearts, livers or lungs in mainland China. DATA EXTRACTION AND SYNTHESIS: Data were extracted by individual authors working independently following training and benchmarking. Descriptive statistics were compiled using Excel. RESULTS: 445 included studies reported on outcomes of 85 477 transplants. 412 (92.5%) failed to report whether or not organs were sourced from executed prisoners; and 439 (99%) failed to report that organ sources gave consent for transplantation. In contrast, 324 (73%) reported approval from an IRB. Of the papers claiming that no prisoners' organs were involved in the transplants, 19 of them involved 2688 transplants that took place prior to 2010, when there was no volunteer donor programme in China. DISCUSSION: The transplant research community has failed to implement ethical standards banning publication of research using material from executed prisoners. As a result, a large body of unethical research now exists, raising issues of complicity and moral hazard to the extent that the transplant community uses and benefits from the results of this research. We call for retraction of this literature pending investigation of individual papers.


Assuntos
Revisão Ética , Fidelidade a Diretrizes , Transplante de Órgãos/ética , Publicações Periódicas como Assunto/estatística & dados numéricos , Doadores de Tecidos/ética , China , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Transplante de Órgãos/normas , Transplante de Órgãos/estatística & dados numéricos , Revisão por Pares/normas , Publicações Periódicas como Assunto/normas
12.
Anesth Analg ; 128(2): 280-285, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29787408

RESUMO

Donation after circulatory death (DCD) is an increasingly utilized practice that can contribute to reducing the difference between the supply of organs and the demand for organs for transplantation. As the number of transplanted organs from DCD donors continues to increase, there is an essential need to address the ethical aspects of DCD in institutional DCD protocols and clinical practice. Ethical issues of respecting the end-of-life wishes of a potential donor, respecting a recipient's wishes, and addressing potential conflicts of interest are important considerations in developing policies and procedures for DCD programs. Although there may be diversity among DCD programs in Europe, Australia, Israel, China, the United States, and Canada, addressing ethical considerations in these DCD programs is essential to respect donors and recipients during the altruistic and generous act of organ donation.


Assuntos
Morte , Internacionalidade , Transplante de Órgãos/ética , Obtenção de Tecidos e Órgãos/ética , Humanos , Transplante de Órgãos/métodos , Obtenção de Tecidos e Órgãos/métodos
13.
Med Health Care Philos ; 22(2): 221-230, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30105489

RESUMO

The paper argues that the idea of gift-giving and its associated imagery, which has been founding the ethics of organ transplants since the time of the first successful transplants, should be abandoned because it cannot effectively block arguments for (regulated) markets in human body parts. The imagery suggests that human bodies or their parts are transferable objects which belong to individuals. Such imagery is, however, neither a self-evident nor anthropologically unproblematic construal of the relation between a human being and their body. The paper proposes an alternative conceptualization of that relation, the identity view according to which a human being is identical with their living body. This view, which offers a new ethical perspective on some central concepts of transplant medicine and its ethical and legal standards and institutions, supports widely shared intuitive ethical judgments. On this proposal, an act of selling a human body or one of its parts is an act of trade in human beings, not in owned objects. Transfers of human body parts for treatment purposes are to be seen as sharing in another human being's misfortune rather than as giving owned objects. From the perspective of policy-making, the proposal requires, first, that informed consent for removal of transplant material be obtained from the potential benefactor. Secondly, explicit consent by the prospective benefactor is obligatory in the case of removal of transplant material from a living benefactor. Thirdly, in the case of posthumous retrieval, informed consent by the potential benefactor during their life is not ethically indispensable. Additionally, while refusal of posthumous retrieval expressed by a potential benefactor during their life must be respected, such a refusal needs ethical justification and explanation.


Assuntos
Corpo Humano , Consentimento Livre e Esclarecido/ética , Transplante de Órgãos/ética , Obtenção de Tecidos e Órgãos/ética , Humanos , Consentimento Livre e Esclarecido/psicologia , Princípios Morais , Filosofia Médica , Políticas , Estudos Prospectivos
14.
Sci Eng Ethics ; 25(2): 635-642, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29423621

RESUMO

Being inherently different from any other lifesaving organ transplant, uterine transplantation does not aim at saving lives but supporting the possibility to generate life. Unlike the kidneys or the liver, the uterus is not specifically a vital organ. Given the non-lifesaving nature of this procedure, questions have been raised about its feasibility. The ethical dilemma revolves around whether it is worth placing two lives at risk related to surgery and immunosuppression, amongst others, to enable a woman with absolute uterine factor infertility to experience the presence of an organ enabling childbirth. In the year 2000, the first uterine transplantation, albeit unsuccessful, was performed in Saudi Arabia from where it has spread to the rest of the world including Sweden, the United States and now recently India. The procedure is, however, still in the preclinical stages and several ethical, legal, social and religious concerns are yet to be addressed before it can be integrated into the clinical setting as standard of care for women with absolute uterine factor infertility.


Assuntos
Infertilidade Feminina/cirurgia , Transplante de Órgãos/ética , Reprodução/ética , Técnicas de Reprodução Assistida/ética , Útero/cirurgia , Temas Bioéticos , Feminino , Humanos , Índia , Infertilidade Feminina/etiologia , Vida , Transplante de Órgãos/efeitos adversos , Técnicas de Reprodução Assistida/efeitos adversos , Risco , Segurança , Arábia Saudita , Suécia , Doadores de Tecidos/ética , Estados Unidos , Útero/patologia
15.
Transplant Proc ; 50(10): 3775-3782, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30577269

RESUMO

Solid organ transplantation (SOT) is a surgical method used as the gold standard in end-term organ failure. Following SOT, successful results have also been achieved in vascularized composite tissue transplantation, which improves the quality of life with the success of solid organ transplants and the development of modern immunosuppressive regimens. This review discusses the preoperative, operative, postoperative, and immunological differences between vascularized tissue transplantation and SOT.


Assuntos
Alotransplante de Tecidos Compostos Vascularizados/métodos , Humanos , Transplante de Órgãos/ética , Transplante de Órgãos/métodos , Alotransplante de Tecidos Compostos Vascularizados/ética
17.
Hastings Cent Rep ; 48 Suppl 4: S39-S42, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30584844

RESUMO

Since the 1960s, organ procurement policies have relied on the boundary of death-advertised as though it were a factual, value-free, and unobjectionable event-to foster organ donation while minimizing controversy. Death determination, however, involves both discoveries of facts and events and decisions about their meaning (whether the facts and events are relevant to establish a vital status), the latter being subjected to legitimate disagreements requiring deliberation. By revisiting the historical origin of the dead donor rule, including some events that took place in France prior to the report by the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death, I want to recall that those who first promoted the DDR did not take into account any scientific rationale to support the new proposed criteria to determine death. Rather, through a process of factual re-semantization, they authorized themselves to decide about the meaning of death in order to implicitly prioritize the interests of organ recipients over those of dying people.


Assuntos
Morte Encefálica/diagnóstico , Morte , Transplante de Órgãos , Doadores de Tecidos , Obtenção de Tecidos e Órgãos , Atitude Frente a Morte , Temas Bioéticos , Tomada de Decisão Clínica , Humanos , Transplante de Órgãos/ética , Transplante de Órgãos/tendências , Formulação de Políticas , Doadores de Tecidos/ética , Doadores de Tecidos/psicologia , Obtenção de Tecidos e Órgãos/métodos , Obtenção de Tecidos e Órgãos/tendências
18.
Hastings Cent Rep ; 48 Suppl 4: S29-S32, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30584848

RESUMO

According to international scientific medical consensus, death is a biological, unidirectional, ontological state of an organism, the event that separates the process of dying from the process of disintegration. Death is not merely a social contrivance or a normative concept; it is a scientific reality. Using this paradigm, the international consensus is that, regardless of context, death is operationally defined as "the permanent loss of the capacity for consciousness and all brainstem function. This may result from permanent cessation of circulation or catastrophic brain injury. In the context of death determination, 'permanent' refers to loss of function that cannot resume spontaneously and will not be restored through intervention." The word "permanent" replaces "irreversible" (used in the United States' 1980 Uniform Declaration of Death Act) in this new definition, arguably invented to allow donation after circulatory determination of death (DCDD) while still complying with the dead donor rule. I will show that this invention fails, for at least four reasons.


Assuntos
Morte Encefálica/diagnóstico , Morte , Transplante de Órgãos , Doadores de Tecidos , Obtenção de Tecidos e Órgãos , Consenso , Dissidências e Disputas , Humanos , Transplante de Órgãos/ética , Transplante de Órgãos/psicologia , Transplante de Órgãos/tendências , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/legislação & jurisprudência
19.
Hastings Cent Rep ; 48 Suppl 4: S26-S28, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30584853

RESUMO

Despite the popularity, success, and growth of programs of organ donation after the circulatory determination of death (DCDD), a long-standing controversy persists over whether the organ donor is truly dead at the moment physicians declare death, usually following five minutes of circulatory and respiratory arrest. Advocates of the prevailing death determination standard claim that the donor is dead when declared because of permanent cessation of respiration and circulation. Critics of this standard argue that while the cessation of respiration and circulation may be permanent, it may not be irreversible at the moment death is declared because, if cardiopulmonary resuscitation were performed, it might succeed. And because irreversibility of cessation of respiration and circulation is required by both the statute and the biological concept of death, the donor must be alive. Who is correct? Making two related distinctions clarifies the cause of the disagreement over whether the DCDD donor is dead and points to a possible resolution. First, in a determination of death, there is an important distinction between the permanent and the irreversible cessation of circulation and respiration-two associated phenomena that are often confounded. Second, there is an important distinction between the medical practice standard for death determination, in which physicians certify the permanent cessation of vital functions as sufficient for death declaration, and the underlying biological concept of death that requires the irreversible cessation of vital functions because death, by definition, is an irreversible event.


Assuntos
Atitude Frente a Morte , Morte Encefálica/diagnóstico , Morte , Transplante de Órgãos , Obtenção de Tecidos e Órgãos , Atitude do Pessoal de Saúde , Temas Bioéticos , Humanos , Transplante de Órgãos/ética , Transplante de Órgãos/psicologia , Transplante de Órgãos/tendências , Percepção Social , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/legislação & jurisprudência
20.
Hastings Cent Rep ; 48 Suppl 4: S63-S66, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30584854

RESUMO

As an anthropologist, I have long been interested in highly experimental science, with my work engaging the moral underpinnings of xenoscience and, more recently, lab animal research. The possibility of employing animals as human "matches" sparks enthusiastic responses among researchers who imagine various creatures as lucrative "donor species" or "source animals" whose organs might replace the failing parts of humans and render obsolete any future need for brain-dead donors. When we attend to how xenoscientists imagine the promissory qualities of various species, we encounter a specialized logic of how and why one type of animal is valued over another. Well-established bioethical principles might assist us in framing our position in reference, say, to the limits of human suffering, or how to weigh the worth assigned to human versus animal lives, or how we conceive "the quality of life." But sadly, subjective experience can creep in to shape and cloud those very stances we regard as bioethically principled. Rather than pursue such a well-worn path, I suggest an alternative framework that privileges attentiveness to everyday thought and action over codified bioethics. This framework-described as "everyday" or "ordinary ethics" in anthropology-involves assuming a critical, self-reflexive stance in reference to quotidian ways of seeing and knowing. Like John Berger, who famously asked, "Why Look at Animals?," I ask, when we look at the lab-based baboon, chimp, or pig, what do we see? How do we think of, or presume to know, the animal in question? How do we think about human-animal relations in science?


Assuntos
Experimentação Animal/ética , Temas Bioéticos , Transplante de Órgãos , Animais , Ciências Biocomportamentais/ética , Códigos de Ética , Humanos , Transplante de Órgãos/ética , Transplante de Órgãos/métodos , Transplante de Órgãos/tendências
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA