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The 1968 Uniform Anatomical Gift Act--in keeping with a legal (and medical) concern for individual autonomy--bypassed the family in establishing the legal requirements for cadaveric organ donation, but current practice wisely recognizes a role for families in the decision making.
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Brain death is an anatomically and physiologically complex process. The societal and psychological implications of brain death and organ donation are equally complex, and they have profound ramifications. Because the vast majority of organ donors die as a consequence of catastrophic intracranial processes, neurosurgeons are in a unique position to positively influence the supply of transplantable organs. Enhanced knowledge of the physiology of evolving brain death will improve the care of potential organ donors and increase the probability of successful transplantation. Likewise, better information about patient and family directives, beliefs, grieving, concurrent exposure to other health care workers, and experiences in the hospital environment will assist the neurosurgeon in providing the family with the opportunity for donation. Neurosurgeons can also play a leading role in the multidisciplinary approach required to support the families of potential organ donors during the transition from neurointerventional therapy to somatic support. New federal regulations on organ donation and a review of the literature about the "art of asking" are presented.
The frequency and success rate of organ donation and transplant surgery has dramatically increased over the past several years. Since organ donors are drawn primarily from the traumatically brain-injured population this increase has a direct impact on neuroscience nurses. This article addresses the organ procurement process, nursing care of the organ donor and the interrelationship of organ donation and neuroscience nursing.
Primary health care providers may increase the number of organ donations by providing an opportunity for authorization during a health care visit. Lack of authorization prevents many recipients from the benefits of life saving transplants.
OBJECTIVE: As the cost and degree of training necessary to provide state of the art health care has increased throughout the world, the present challenge in health care is to establish institutions that are financially sound and responsive to the dynamic needs of the communities in which they exist. As public funds have diminished, the role of the private sector in estabhshing innovative health care institutions has increased. SETTING AND STUDY PARTICIPANTS: This paper reviews the case of the LV Prasad Eye Institute (LVPEI), an ophthalmologic institute in Hyderabad, India, that is financially sound and medically vital. With an annual budget of US$3 million, 180 000 patients are seen and 23 000 surgeries are performed at the Institute and its satellites each year. MAIN MEASURES: The Institute provides patient care at a ratio of 1:1 non-paying to paying patients through fee cross-subsidization. The Institute uses a combination of financial modalities, including donations, grants and fees to administer its non-patient care programs. Non-clinical programs of the Institute include a paramedical training program and a fellowship in ophthalmology, an internationally accredited eye bank for the preservation of corneal tissues, a rural out-reach and education program, a basic science and epidemiology program that directs health policy activities of the Institute and a rehabilitation program for patients with incurable visual deficits. To evaluate its effectiveness, LVPEI uses quality improvement measures, including patient surveys, post-operative outcomes studies and service utlization reviews. CONCLUSION: This case report of a privately-funded medical institution describes a successful model through which high-quality, equitable health care can be provided in a developing country. The LVPEI's active program of quality management, its academic commitment and programmatic relevance to the needs of its community should be modularized and replicated to establish equitable, efficient and effective health care institutions in the developing world.
This final rule addresses only provisions relating to organ donation and transplantation. It imposes several requirements a hospital must meet that are designed to increase organ donation. One of these requirements is that a hospital must have an agreement with the Organ Procurement Organization (OPO) designated by the Secretary, under which the hospital will contact the OPO in a timely manner about individuals who die or whose death is imminent in the hospital. The OPO will then determine the individual's medical suitability for donation. As well, the hospital must have an agreement with at least one tissue bank and at least one eye bank to cooperative in the retrieval processing, preservation, storage, and distribution of tissue and eyes, as long as the agreement does not interfere with organ donation. The final rule requires a hospital to ensure, in collaboration with the OPO with which it has an agreement, that the family of every potential donor is informed of its opinion to donate organs or tissues or not to donate. Under the final rule, hospital must work with the OPO and at least one tissue bank and one eye bank in educating staff on donation issues, reviewing death records to improve identification of potential donors, and maintaining potential donors while necessary testing and placement of organs and tissues take place. In addition, transplant hospitals must provide organ-transplant-related data, as requested by the OPTN, the Scientific Registry, and the OPOs. The hospital must also provide, if requested, such data directly to the Department.
The shortage of cadaveric donors is a universal problem that imposes a severe limit on the number of patients who can benefit from transplantation. At the same time, there is an ever-increasing demand for cadaveric solid organs all over the world. The organ shortage is not due to a lack of potential donors, but rather to a failure to turn many potential into actual donors. Spain is the only example in the world of continuous improvement in cadaveric organ donation registered in a large country during more than 10 years. This success is due to a proactive donor detection program performed by well-trained transplant coordinators, introduction of systematic death audits in hospitals, and the combination of a positive social atmosphere, an adequate management of mass media relations, and on adequate economic reimbursement for the hospitals. This model can be partial or totally adapted to other countries or regions, if basic conditions are guaranteed. A careful study of local characteristics, which influence organ donation in a direct or indirect way, should be performed before planning specific actions to improve organ donor rates. The principle factors that influence the development of this type of program are described in this article.
How is the essential micronutrient, selenium (Se), transported in the serum and then donated to tissues? In this issue of the Biochemical Journal, Schweizer and colleagues demonstrate, using conditional and total mouse knockout models, that SePP (selenoprotein P) is the major transporter of Se in the serum. Moreover, in the sanctuary area of the brain, SePP was shown to play a hitherto unexpected role as a local Se storage and recycling protein that directly maintains brain Se levels. Considering the function of Se in normal brain metabolism, these results are crucial for our understanding of the role of selenoproteins in redox regulation, antioxidant defences, thyroid hormone metabolism and the development of neurodegenerative conditions.
The process of obtaining organs and tissues includes a series of procedures and skills that are fundamental to obtain a large number and high quality of transplants. Health professionals involved in transplant coordination require robest and comprehensive training to integrate the donation-transplantation process within the clinical health care field. Based on a learning-through-experience model, Transplant Procurement Management (TPM) designed various courses adapted to local educational need to train transplant coordinators, to increase active donor detection, and to promote a positive attitude towards donation; namely, Advanced, Introductory and New Life Cycle courses respectively. Moreover, TPM has coordinated international programs (INTERCATT and INTERITALY). Since 1991, the model has included 29 Advanced courses (1215 participants), 22 Introductory courses (575 pupils), and 7 New Life Cycle courses (more than 400 attendees). The Advanced courses were attended by medical (intensive care unit, nephrology, and others) and nursing professionals. Assessment of the educational program showed achievement of teaching objectives. The evaluation averages above 3.5 (scale, 1-5) for content, presentation, and ability to answer questions. Likewise, the program's organization showed an average score of 4.4. The acquired knowledge was assessed by means of a self-evaluation test (correct answers >69%). Practical skills assessed through direct observation showed an average of 7 (scale, 1-10). The TPM educational program offers a range of necessary knowledge and skills to increase organ donation. Health professionals concerned about the organ shortage may find TPM training useful to increase their knowledge.
OBJECTIVE: Through a population-based study, it was identified the prevalence of people's willingness to donate their own organs and from their relatives, evaluating associated factors in an adult population. It was also identified their understanding of cerebral death. METHODOLOGY: Cross-sectional study, with people aged 20 yr or older in the urban area of Pelotas, State of Rio Grande do Sul, Brazil. The instrument used was a structured questionnaire, filled out in individual interviews. Chi-squared and linear trend test were used in the bivariated analysis. Multivariated analysis was conducted according to a hierarchical classification model using Poisson regression. It was considered meaningful the value for p < or = 0.05 two-sided. RESULTS: Amid 3159 participants, the prevalence to donate organs was 52%, amongst which 58% had expressed such willingness to a relative. Most respondents (80.1%) would authorize the donation of relative's organs who had previously declared their willingness to do so. When the subject had not been discussed, only a third of the total number of people interviewed would authorize the donation of a relative's organ. After adjustment to confusing factors, higher willingness was characterized among the youngest, the higher educated and those belonging to families with income over 10 minimum wages. The Evangelical and Jehovah's Witnesses practitioners showed to be less prone to donate. CONCLUSION: According to the study, when the peoples had not enough information regarding family member's donation wishes the rate of willingness to donate organs is lower. Sociodemographic characteristics influence the rate of public willingness to donate organs and campaigns educational should be directed to improve rates of donation the organs.
The effect of the race of the donor on organ donation and on the outcome of clinical liver transplantation has not been addressed previously. The aims of this study were to determine: (1) the number of organs donated by each of the major racial groups of the United States, (2) the outcome of transplantation of these organs across racial groups, and (3) the pattern of liver disease that required transplantation in each of these racial groups. A significantly higher proportion of organs were donated by white non-Hispanic Americans than either black or Hispanic Americans. There was no significant difference in survival when an organ was transplanted between black and white Americans and vice versa. Postnecrotic cirrhosis from a variety of causes was the most common indicator affecting black and white recipients, while primary biliary cirrhosis and primary sclerosing cholangitis were uncommon in the black population. While the number of organs donated by blacks was low, it was, however, proportional to the number of black recipients in this study. Reasons for the low rate of donation by the black and white Hispanic population are discussed. It is concluded that race is not a criteria to be used in selection of donors for liver transplantation. Educational programs addressing issues of organ donation and transplantation directed towards the black and Hispanic populations are recommended.
Revealing possible clinical scenarios to potential anonymous donors for their donated oocytes appears to uncover ambivalence in the majority of prospective candidates about their donation and unwillingness in some to proceed. Full disclosure to a prospective donor candidate of the program's policies for directives of donated oocytes and embryo management emphasizes the importance of the informed consent process and how it may affect the decision to donate.
Bovine Spongiform Encephalopathy was discovered in 1986 in the United Kingdom and relatively rapidly spread into its trading partners in Europe via contaminated cattle feed supplements. The practice of using the discarded bovine carcass as cattle feed supplements led to the recycling of the prion agent and the consequent generation of new point source epidemics in the recipient countries. The advent of rapid diagnostic tests and more widespread testing has led to the identification of BSE in countries not previously reporting cases and the recognition of larger numbers of infections in countries previously only reporting clinical cases. The recognition of the wider spread of BSE and the 1996 recognition of vCJD as a human disease caused by consumption of BSE agent led to international concerns regarding the threat to human health and the demand for stricter controls on human food derived from cattle. Major shifts in food safety policy have occurred as a direct result. The recommendation that risk assessments for BSE infectivity and human exposure pathways be conducted rather than reliance upon rates and simple enumeration of BSE cases is one of the most prominent changes in the basis of policy regarding human health. The movement of BSE into human populations has a wider impact than seen in food safety--surgical procedures, blood, cells, tissues and organ donation programs are all affected. The World Health Organization has recommended that 'the eradication of BSE must remain the principle public health objective of national and international animal health control authorities'. The opinions expressed in this chapter are those of the author and do not necessarily reflect the views of Health Canada. This review was written while the author was employed at the WHO.
OBJECTIVE: The refusal to permit organ sampling is of around 30% and is one of the principle causes for the lack of sampling. This study was aimed at establishing the frequency of decisions taken with regard to donations and the factors associated with refusal. METHOD: A prospective study was conducted between April 2, 2000 and March 31, 2001 in hospitals authorised to perform organ sampling in the Western area of France. For each potential donor identified, a questionnaire was filled in after each interview. A logistical model was used in order to identify the independent and statistical factors associated with the refusal to allow sampling of an organ or tissue. RESULTS: Among the potentials donors, 265 brain dead donors, and 868 donors with ceased heart beats for tissue sampling, were included. The refusal rate was of respectively 32.8 and 45 %. Only 2.4% of potential donors carried cards identifying them as such. While living, the rate of refusal expressed by the two types of potential donors was similar (9%). The brain dead potential donors had more frequently expressed their consent for donation (20.7 vs. 9%). In the organ donors, the interviews were conducted by two persons in only 37.9% of cases, and in 2.4% of cases of potential tissue donors. In the potential organ donors, only those with a card identifying them as such and the hesitations of the family at the start of the interview were significantly associated with a lesser frequency of refusal. In potential tissue donors, the hesitations of the family reduced the refusal rate but age, religious beliefs, death etiology and the person conducting the interview increased it. CONCLUSION: The encouraging efforts made for the awareness of donation during a person's lifetime must continue and the use of a donor card extended. The development of co-ordination posters in the hospitals would enhance the development of binomial interviews with the families.
BACKGROUND: The background of this study was the inadequate supply of donor organs in Germany. In Spain, by contrast, a strong increase of organ donors over the past years has created a satisfactory supply situation. Because both countries have similar legal situations, the causes for the drastic differences in organ donation rates remain unclear. The main issue of our study was to investigate the intellectual attitudes toward various aspects of postmortem donations in the populations of both countries as a causative factor for the observed differences. METHODS: We studied 726 persons by questionnaire. Probands, matched for age and gender, were recruited among medical students, in a public library and in a general medical practice in both Germany and Spain. RESULTS: We found no differences in the attitudes toward postmortem organ donation between the two countries. Differences among the social groups within the countries were apparent in the expected direction. CONCLUSION: A higher level of knowledge or a difference in attitudes toward organ donation is probably not the reason for the higher donation rate in Spain. The cause appears to be rather at the organizational level.
It was shown that the rate of organ donation depends not only on the attitudes of the public but also of the predisposition of the health care staff. An opinion poll has interested 702 physicians, nurses and technicians. It comes out from this study that 59% of the sample are favorable to the organ donation. The reason of the most quoted acceptance is "humane reason" (46%). Concerning the refusal of the organ donation by the professionals of health, 3 reasons are held: (i) religious reserves (26.4%), (ii) without reasons (22.8%) and (iii) personal reasons (20.9%). For approximately 10% of the doctors the refusal is ethical. In conclusion, the Tunisian physicians adopt an attitude favorable to the organ donation, whereas nurses and technicians are rather reticent. Refusal reasons identified during this study could direct the organizers of the public awareness campaigns for the promotion of organs donation.
OBJECTIVE: To review the factors involved in determining the availability of solid organs for transplantation in Hong Kong and to identify methods that have been used in other countries to increase organ donation rates. DATA SOURCES: Medline and non-Medline search of the relevant English literature, local data, and personal experience. STUDY SELECTION: Articles describing approaches to solid organ procurement for transplantation. DATA EXTRACTION: Data were extracted and analysed by the author. DATA SYNTHESIS: There is a severe shortage of solid organ donors in Hong Kong, which is compounded by an ever-increasing pool of potential recipients. Limited local data suggest public support for organ donation. The most common reason for objection to organ donation is a lack of knowledge of the wishes of the deceased. Despite the implementation of numerous legislative models worldwide, none has been shown to be superior as a facilitator of organ donation. Despite the lack of legislation in Hong Kong, the medical profession has adopted the expressed consent model. The use of non-heart-beating donors, elective ventilation of futile cases, and financial incentives pose significant ethical and legal barriers as well as resource implications for intensive care. CONCLUSION: Greater effort should be directed through public education at the importance of telling one's family what one's wishes are concerning organ donation. More information is required in Hong Kong as to why families agree to organ donation and how best to approach families to request organ donation.