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1.
Br J Nurs ; 30(19): 1127-1131, 2021 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-34723668

RESUMO

In May 2020, England adopted an opt-out approach for organ donation, also referred to as the deemed consent system, with the aim of alleviating the demand for organs in the UK. This system dictates that those who have not opted out will have their organs donated following their death, with the exception of those meeting certain criteria. This article applies the philosophical theory of utilitarianism to the deemed consent system for organ donation, focusing particularly on topics such as that of informed consent and family refusal. Utilitarianism is a consequentialist theory that attempts to determine whether an action is morally right or wrong based on whether or not it maximises the preferences of the greatest number of people, with each person's satisfaction being considered as equal to another's.


Assuntos
Transplante de Órgãos , Obtenção de Tecidos e Órgãos , Teoria Ética , Humanos , Consentimento Livre e Esclarecido , Consentimento Presumido , Doadores de Tecidos
2.
BMC Med Ethics ; 22(1): 139, 2021 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-34656108

RESUMO

BACKGROUND: Organ transplantation represents the most effective and acceptable therapy for end-stage organ failure. However, its frequent practice often leads to a shortage of organs worldwide. To solve this dilemma, some countries, such as Portugal, have switched from an opt-in to an opt-out system, which has raised concerns about respect for individual autonomy. We aimed to evaluate whether young university students are aware of this opt-out system so that they can make informed, autonomous and conscious decisions, as well as to identify the factors that determine a positive attitude toward post-mortem organ donation. METHODS: An observational, cross-sectional study was developed and a questionnaire was administered to first-year students from six faculties of the University of Porto. RESULTS: Of the 841 participants, 60% were unaware that Portugal had adopted an opt-out system. Among the informed individuals, their main sources of information included social media, internet, and family. Furthermore, only 48% of all participants agreed with the current opt-out system. Female sex (p = 0.049; OR 1.393), knowledge of the law (p < 0.001; OR 4.749) and family being the primary source of information (p < 0.001; OR 2.855) were independent factors associated with a positive attitude toward post-mortem organ donation law. CONCLUSIONS: There is a significant lack of knowledge among young university students regarding the presumed post-mortem organ donation law and how it works. Female sex, having family as a primary source of information and being aware of the presumed post-mortem organ donation law are the strongest independent factors that determine a positive attitude toward the opt-out system.


Assuntos
Obtenção de Tecidos e Órgãos , Universidades , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Consentimento Presumido , Estudantes , Inquéritos e Questionários , Doadores de Tecidos
3.
Front Public Health ; 9: 712584, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34676192

RESUMO

Background: Organ shortage is still a world-wide problem, resulting in long waiting lists for kidney, liver, and heart transplant candidates across many transplant centers globally. This has resulted in the move toward presumed consent to increase deceased organ donation rates. However, there remains a paucity of literature on public attitude and barriers regarding the opt-out system, with existing studies limited to Western nations. Therefore, this study aimed to understand public sentiment and different barriers toward organ donation from the perspective of Singapore, a highly diverse and multiethnic Asian society. Methods: A cross-sectional community semi-structured interview was conducted in a public housing estate in Singapore. Pilot test was undertaken before participants were interviewed face-to-face by trained personnel. All statistical evaluations were conducted using Stata. The χ2-test compared subgroups based on patient characteristics while multivariable logistic regression identified predictors of willingness to donate/ assent. Effect estimates were quantified using odds ratio (OR). Findings: Out of 799 individuals, 85% were agreeable to organ donation after death and 81% were willing to assent to donations of family members' organs, which declined by 16% (p < 0.001) after a clinical scenario was presented. Demographic factors including ethnicity, education, marital, and employment status affected willingness to donate and assent. Knowledge correlated significantly with willingness to donate and assent. In particular, knowledge regarding brain death irreversibility had the strongest correlation (AOR 2.15; 95% CI 1.60-2.89). Conclusions: Organ donation rates remain low albeit presumed consent legislation, due to patient-level barriers, including but not limited to knowledge gaps, cultural values, religious backgrounds, and emotional impact at relatives' death. To effectively boost donor rates, it is crucial for policy makers to invest in public education and improve transplant provisions and family protocols.


Assuntos
Consentimento Presumido , Obtenção de Tecidos e Órgãos , Estudos Transversais , Humanos , Percepção , Doadores de Tecidos
6.
J Med Philos ; 46(1): 58-79, 2021 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-33386736

RESUMO

"Opt-out" organ procurement policies based on presumed consent are typically advertised as being superior to "opt-in" policies based on explicit consent at securing organs for transplantation. However, Michael Gill (2004) has argued that presumed consent policies are also better than opt-in policies at respecting patient autonomy. According to Gill's Fewer Mistakes Argument, we ought to implement the procurement policy that results in the fewest frustrated wishes regarding organ donation. Given that the majority of Americans wish to donate their organs, it is plausible that a presumed consent policy would result in fewer frustrated wishes compared to the current opt-in policy. It follows that we ought to implement a policy of presumed consent. In this paper, I first consider and find wanting an objection to the Fewer Mistakes Argument developed recently by Douglas MacKay (2015). I also consider an objection put forth by James Taylor (2012) but argue that there is a methodological reason to prefer my own argument to Taylor's. Finally, I argue for two theses: first, that Gill's major argument in favor of the crucial premise of the Fewer Mistakes Argument is flawed, and second, that the major premise of the Fewer Mistakes Argument is false.


Assuntos
Transplante de Órgãos , Obtenção de Tecidos e Órgãos , Dissidências e Disputas , Humanos , Consentimento Livre e Esclarecido , Consentimento Presumido , Respeito , Doadores de Tecidos
9.
Eur J Health Econ ; 22(1): 5-16, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32651683

RESUMO

Legislation, in the form of presumed consent, has been argued to boost organ donation but most evidence disregards the practice of seeking relative's consent, which can either 'veto' donation decisions, or 'legitimize them', by removing any possible conflict with the donor's family. We study the effect of presumed consent alongside family consent on individuals' willingness to donate (WTD) one's own and relatives' organs, and on actual organ donation behaviours. Using data from 28 European countries for the period 2002-2010, we found that presumed consent (PC) policies are associated with increased willingness to donate organs, but this effect was attenuated once internal family discussions on organ donation were controlled for. Our findings indicate that relative's consent acts as a veto of donation intentions and attenuates the effect of regulation on actual donations. More specifically, PC increases WTD one's own and relatives' organs in countries where no family consent is required. Consistently, we find that family consent attenuates the influence of regulatory environment on actual donations. The effect is driven by the influence of family discussions which increased WTD, and in combination with presumed consent translated into higher organ donation rates.


Assuntos
Consentimento Presumido , Obtenção de Tecidos e Órgãos , Adolescente , Adulto , Idoso , Atitude , Europa (Continente) , Feminino , Humanos , Pessoa de Meia-Idade , Doadores de Tecidos , Adulto Jovem
10.
Arch Sex Behav ; 50(1): 247-262, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32642811

RESUMO

While the lack of consent is the only determining factor in considering whether a situation is rape or not, there is sufficient evidence that participants conflate wantedness with consent and pleasurableness with wantedness. Understanding how people appraise sexual scenarios may form the basis to develop appropriate educational packages. We conducted two large-scale qualitative studies in two UK universities in which participants read vignettes describing sexual encounters that were consensual or not, wanted or unwanted and pleasurable or not pleasurable. Participants provided free-text responses as to whether they perceived the scenarios to be rape or not and why they made these judgments. The second study replicated the results of the first and included a condition where participants imagined themselves as either the subject or initiator of the sexual encounter. The results indicate that a significant portion of our participants held attitudes reflecting rape myths and tended to blame the victim. Participants used distancing language when imagining themselves in the initiator condition. Participants indicated that they felt there were degrees of how much a scenario reflected rape rather than it simply being a dichotomy (rape or not). Such results indicate a lack of understanding of consent and rape and highlight avenues of potential educational materials for schools, universities or jurors.


Assuntos
Emoções/fisiologia , Prazer/fisiologia , Estupro/psicologia , Comportamento Sexual/psicologia , Atitude , Feminino , Humanos , Masculino , Percepção , Consentimento Presumido , Estudantes , Universidades
15.
Exp Clin Transplant ; 18(5): 626-632, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32799789

RESUMO

OBJECTIVES: We aimed to compare the possible outcomes of the current (opt-in) system and an opt-out system for organ donation in South Korea using a mathematical model. MATERIALS AND METHODS: A structured questionnaire was used to investigate the decision on organ donation and family consent after brain death under the current system and an opt-out system. The survey was conducted in August 2018 by means of a voluntary survey of 100 opposite-sex married couples. RESULTS: Sixty-three percent of participants wished to self-donate their organs after brain death: 69.5% were positive and 30.5% were negative regarding the implementation of the opt-out system. Among 200 participants, the total number of possible donors increased from 110 (55.0%) in the current system to 139 (69.5%) in the opt-out system. Positive autonomy was defined as obtainment of consent from the donor and the spouse, and negative autonomy was defined as concordaence of refusal between the donor and the spouse. Comparisons between the systems showed that the rate of autonomy increased from 57.0% in the current system to 61.5% in the opt-out system. Although the achievement of positive autonomy increased from 59.5% in the current system to 74.6% in the opt-out system, the achievement of negative autonomy decreased from 52.7% in the current system to 39.2% in the opt-out system. CONCLUSIONS: An opt-out system can increase the number of organ donors; however, achievement of negative autonomy can decrease.


Assuntos
Morte Encefálica , Política de Saúde , Consentimento Livre e Esclarecido , Modelos Teóricos , Consentimento Presumido , Cônjuges , Doadores de Tecidos , Adulto , Morte Encefálica/legislação & jurisprudência , Comportamento de Escolha , Relações Familiares , Feminino , Política de Saúde/legislação & jurisprudência , Humanos , Consentimento Livre e Esclarecido/ética , Consentimento Livre e Esclarecido/legislação & jurisprudência , Masculino , Pessoa de Meia-Idade , Autonomia Pessoal , Formulação de Políticas , Consentimento Presumido/ética , Consentimento Presumido/legislação & jurisprudência , República da Coreia , Cônjuges/legislação & jurisprudência , Inquéritos e Questionários , Doadores de Tecidos/ética , Doadores de Tecidos/legislação & jurisprudência , Doadores de Tecidos/provisão & distribuição , Adulto Jovem
16.
Clin Anat ; 33(6): 950-959, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32427400

RESUMO

INTRODUCTION: Recently, law No. 10 of February 10, 2020, entitled "Rules regarding the disposition of one's body and post-mortem tissues for study, training, and scientific research purposes" was introduced in Italy. Although its provisions respond to a constructive subject, some practical issues are evident in the approved text. MATERIALS AND METHODS: A systematic review of the literature was performed by searching online medical and juridical databases to identify publications and Italian law provisions related to body donation programs. RESULTS: The updated regulatory framework was outlined and compared to that in force previously, and the following features are discussed: (a) matter of law; (b) donors' information and consent; (c) reference centers and funding, and (d) procedural regulatory details. Several critical issues were detected in the approved wording with respect to teaching/training recipients, the role of university anatomy institutes, family members' exclusion from participating in the donation process in any capacity, the duration of donation, the management of corpses, partial donations, and the compatibility with organ donation. Suggestions are provided to overcome certain operational limitations in implementing the regulation, which is still being drafted to date. CONCLUSIONS: This article shares with the international scientific community the principles and controversies underlying a regulatory innovation introduced in Italy to allow legislative amendments to inadequate provisions of body donation, as well as draw the attention of the entire anatomic community to critical issues if other countries undertake the same legislative reform.


Assuntos
Anatomia/educação , Anatomia/legislação & jurisprudência , Cadáver , Consentimento Presumido/legislação & jurisprudência , Doadores de Tecidos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Humanos , Itália
18.
Healthc Manage Forum ; 33(5): 210-213, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32323580

RESUMO

In recent years, rates of deceased organ donation in Nova Scotia have remained stagnant, falling behind provinces that have invested in their organ donation programs. The Nova Scotia provincial government has recently committed to health system transformation, which will include enactment of presumed consent legislation in 2020. Although impressive rates of deceased organ donation are often observed in countries with presumed consent legislation, improvements in performance can more often be attributed to the accompanying health system transformation. Key components of high performing deceased organ donation systems include highly trained organ donation specialists, practice guidelines, healthcare professional education, performance metric reviews, accountability frameworks, and public awareness campaigns in addition to adequate legislation. For Nova Scotia's organ donation program to succeed, the provincial government must also invest the frontline financial resources required to develop and maintain adequate program infrastructure and implement key strategies to support a culture of donation.


Assuntos
Consentimento Presumido , Obtenção de Tecidos e Órgãos/organização & administração , Humanos , Nova Escócia , Consentimento Presumido/legislação & jurisprudência
20.
Transplant Proc ; 52(2): 439-442, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32029316

RESUMO

INTRODUCTION: Information provided by health care professionals is crucial to create a climate of social opinion. This is important in organ donation and transplantation (ODT), where the participation of the general public is essential to obtain organs. OBJECTIVE: To determine the attitude toward the Law of Presumed Consent (LPC) among Spanish university students and to analyze their relation with attitude toward ODT. METHODS: and design. The type of study was a sociologic, multicenter, observational study. The population included medical and nursing students in Spanish universities. Database of Collaborative International Donor Project was used stratified by geographic area and academic course. A validated questionnaire (Collaborative International Donor Project, organ donation and transplantation questionnaire in Spanish [PCID-DTO-RIOS]) was self-administered and completed anonymously. A sample of 9598 medical and 10,566 nursing students was analyzed (99% confidence and precision of ±1%) and stratified by geographic area and year of study. RESULTS: Completion rate was 90%. Regarding attitude toward LPC, 66% of the students were against the law, whereas 34% accepted it. Of the students surveyed, 9% considered the law as a gesture of solidarity, 25% as an effective way of not wasting organs, 48% as an abuse of power, and 18% as offenses against the family. Those students who were in favor of LPC also had a more favorable attitude toward ODT (86% vs 76%; P < .001). Comparing groups, nursing students were less in favor of LPC than medical students (32% vs 36%; P < .000). CONCLUSION: Sixty-six percent of Spanish university medical and nursing students were against the LPC. The favorable attitude toward ODT is associated with considering the law as a gesture of solidarity or as an effective way of not wasting organs.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Transplante de Órgãos/legislação & jurisprudência , Consentimento Presumido , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Adulto , Feminino , Humanos , Masculino , Estudantes de Medicina , Estudantes de Enfermagem , Inquéritos e Questionários , Universidades
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