PubMed · 8177784
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D Payne. Unlocking anarchy?. https://pubmed.ncbi.nlm.nih.gov/8177784/
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BACKGROUND: The purpose of this study was to investigate prospectively the medical and organizational causes of nonprocurement of transplantable organs and to provide explicit information on the determining factors of family response to donation request. METHODS: Medical causes investigated were age, human immunodeficiency virus, human T-cell lymphoma virus and hepatitis C virus status, documented malignancy, and chronic cardiac or renal failure. Organizational aspects investigated were cause and place of death and number of referrals. Sociological aspects were investigated by semidirective interviews with the families of the deceased. RESULTS: A total of 105 brain-dead patients and 42 families were included. Of the 105 patients, 9 were not eligible for donation because of medical reasons; cardiac arrest occurred before organ procurement in 6 cases. Denial of consent from the coroner occurred in 7 cases. Consent was requested from the families in 82 cases, obtained in 53 cases, and denied in 29 cases. Consent to donation was associated with openness of the process, information about brain death and transplantation, previously stated will of the deceased, favorable attitude of the deceased toward the medical profession, and a generally altruistic attitude of the deceased. Denial of donation was associated with poor understanding of brain death and fear of being deprived of the deceased body. CONCLUSIONS: Practical implications of this study include encouraging people to state their attitudes toward organ donation and improving the level of information available to the general public on the meaning of brain death and on the medical aspects of organ transplantation.
This paper briefly discusses the development of some of the principles of case management as they have been applied in the community. As a clinical management system we argue that the key elements of case management could and should be applied within institutional settings. We draw as an example Ashworth Special Hospital recently criticized for its lack of co-ordinated care by a Public Inquiry Committee. The resulting discussion focuses upon a rehabilitation framework which could be used to implement case management within such a setting; the implementation of such a framework and the benefits that would be gained.
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