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Biomedical subjects

M D D Bell

Publications and source records attributed to M D D Bell.

7 recordsLinked to original sources
PubMed2006

Emergency medicine, organ donation and the Human Tissue Act.

The Human Tissue Act 2004, which governs all activity relating to the human body, organs or tissues, is grounded in the principle of fully informed consent in line with societal expectations. The associated intention to deal with the current deficit of transplantable organs has paradoxically been translated into the legitimisation of non-consensual organ preservation manoeuvres after death. The procurement strategy targeted under this new statute is "uncontrolled" non-heart-beating donation, and the clinical arenas would be accident and emergency departments and acute medical wards. Practitioners in these fields need to have an understanding of the process and the associated ethical, logistical and legal hurdles to defensible implementation. In the light of these hurdles, there is an obvious need for more widespread professional and public consultation before adoption of this programme.

Brain Death↗
PubMed2004

Non-heartbeating organ donation: clinical process and fundamental issues.

This case report outlines the clinical process whereby a patient with severe traumatic brain injury became a non-heartbeating organ donor after a withdrawal-of-care decision. This process raises a series of ethical questions regarding decision-making on grounds of futility, the role of the next of kin, informed consent, the accommodation of manoeuvres directed towards organ retrieval at maximal viability, and the timing and determination of death. Although many aspects of the process can be accommodated within fundamental ethical principles and a broad interpretation of the concept of the 'best interests', the variance with established law requires authoritative clarification if a need for transplantable organs is to be responded to without compromising the reputation of practitioners involved in this area of care. Therefore, this recruitment strategy warrants wide public and professional debate to achieve longer-term sustainability and ensure the protection of all parties.

Adult↗
PubMed2004

Brainstem death testing in the UK--time for reappraisal?

BACKGROUND: A diagnosis of brainstem death in the UK is based on clinical assessment rather than technical investigations, but is considered rigorous enough to be legally synonymous with death. METHODS: A questionnaire in five sections concerning clinician details, initiation of support, criteria for testing, conduct of the tests, and the process of organ donation, was sent to all members of the Neuroanaesthesia Society. RESULTS: The survey reveals evidence of failure to apply existing guidelines accurately and a wide variation in practice where the recommendations are not specific. CONCLUSIONS: In an era of scrutiny of medical process, it is timely to consider whether the current guidelines should be revisited. Clarification of the approach to biochemical derangement, and the role of confirmatory tests when the residual effect of sedative agents cannot be excluded, are two areas worthy of debate.

Brain Death↗
PubMed2004

Handover of responsibility for the anaesthetised patient - opinion and practice.

Anaesthesia is a critical and complex process that extends from the pre-operative assessment through to the postoperative management of patients. Handover of responsibility for logistical as opposed to patient-orientated reasons may compromise that process of care. If such handover becomes inevitable with shift-based patterns of working, the implications need to be considered and procedures developed in order to minimise adverse consequences. This survey of national practice reveals little formalisation of procedure and a spectrum of opinion on the relevance of the key considerations. There is, however, a majority view amongst respondents that national guidelines would be of value and that professional defensibility would be aided by standardisation and documentation of any handover.

Anesthesiology↗
PubMed2003

Non-heart beating organ donation: old procurement strategy--new ethical problems.

The imbalance between supply of organs for transplantation and demand for them is widening. Although the current international drive to re-establish procurement via non-heart beating organ donation/donor (NHBOD) is founded therefore on necessity, the process may constitute a desirable outcome for patient and family when progression to brain stem death (BSD) does not occur and conventional organ retrieval from the beating heart donor is thereby prevented. The literature accounts of this practice, however, raise concerns that risk jeopardising professional and public confidence in the broader transplant programme. This article focuses on these clinical, ethical, and legal issues in the context of other approaches aimed at increasing donor numbers. The feasibility of introducing such an initiative will hinge on the ability to reassure patients, families, attendant staff, professional bodies, the wider public, law enforcement agencies, and the media that practitioners are working within explicit guidelines which are both ethically and legally defensible.

Attitude to Death↗
PubMed2002

Stroke after internal jugular venous cannulation.

OBJECTIVE: To alert clinicians to the stroke risk associated with carotid artery injury secondary to attempted internal jugular venous (IJV) cannulation. METHODS: Case reports and review of the literature. RESULTS: Four patients developed a stroke following carotid artery (CA) injury during attempted IJV cannulation using the landmark technique. In all cases the arterial puncture was detected immediately and firm pressure applied for several minutes. In three cases there was evidence of intimal injury and thrombus formation. Two strokes were delayed by more than 24 h. One patient died. A review of studies describing 4487 IJV line insertion attempts using the landmark technique reveals that 5.9% of attempts are associated with CA injury. CONCLUSION: Cannulation of the IJV using visible and palpable landmarks is associated with a risk of stroke. Arterial injury and stroke should be mentioned when consent is obtained for cannulation. Consideration should be given to a reduction of the arterial injury risk by using ultrasound guidance during line insertion.

Adult↗