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PubMed2000

The shortage of solid organs for transplantation in Hong Kong: part of a worldwide problem.

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.

Cadaver↗
PubMed2003

Commodifying life? A pilot study of opinions regarding financial incentives for organ donation.

In recent years many policy proposals have been put forward to create financial incentives to encourage families to allow the harvesting of organs from their deceased relatives. While research has focused on whether these policies would actually increase the supply of organs, no research has focused on testing the ethical concerns about such policies. This article presents the findings of a pilot study conducted to determine whether people think that families should end life support of a family member in order to harvest organs if various incentive policies are in place. While the findings do not suggest a direct effect of these inducements, they do indicate that the amount of money received from organ donation is a consideration in making the decision whether to end life support. The implications of this finding for ethical debates and health policy are reviewed.

Cadaver↗
PubMed1992

Nursing attitudes towards organ donation, procurement, and transplantation.

This survey was carried out to examine the attitudes of nurses towards organ donation, transplantation, and procurement from the perspective of their nursing unit affiliation in a tertiary care center. Overall, 62% of nurses have already signed an organ donor card or driver's license. Those nurses willing to donate, compared with those not willing to donate, perceive renal transplants as cost effective (90% vs 38%, p less than 0.001) and successful (66% vs 47%, p less than 0.001, for estimated cadaver 1 year success rate). Nurses from some units (i.e., renal dialysis nurses), perceiving renal transplantation as being cost effective and successful, were more likely to personally report signing organ donor cards or driver's license. On the other hand, nurses from other units (i.e., the operating room) perceiving lower cost effectiveness and lower renal transplant success rates were, as a group, significantly less likely to sign organ donor cards or driver's license. Across the nursing units surveyed, both perceived transplant success and support for procurement correlated with the percent of nurses who have already signed organ donor cards/license (r = 0.94, p less than 0.02). We suspect that the nursing environment and the exposure to follow-up information on transplantation greatly influences personal attitudes towards donation. Efforts must be directed from the medical staff and within nursing to correct these shortcomings in order that all units may participate fully in the procurement-transplantation process.

Attitude of Health Personnel↗
PubMed1993

The anencephalic organ donor: a challenge to existing moral and statutory laws.

OBJECTIVES: To inform physicians of the critical shortage of neonatal heart donors and to provide arguments for and against selecting brain-absent anencephalics as heart donors for brain-normal infants who are dying of hypoplastic left heart syndrome. DATA SOURCES: International scientific journals of medicine, genetics, epidemiology, bioethics, and public health; adjudicated U.S. civil court cases; and state regulations and statutes. STUDY SELECTION: Worldwide experience with anencephalics as homologous organ donors. DATA EXTRACTION: Demographic and epidemiologic data on anencephalic births and natural histories; U.S. civil, district, and appellate court case decisions directing or prohibiting organ donation; state determination-of-death acts; state uniform-anatomical-gift acts. DATA SYNTHESIS: Organization of all data into either moral challenges or legal challenges to anencephalic organ donation. CONCLUSIONS: Statutory laws pose a greater challenge to anencephalic organ donation than moral laws. Case law reviews eliminate substituted judgment rulings in directing anencephalic organ donation. A redefinition of brain death applying only to human beings born without a brain would make more donor hearts available to brain-normal infants dying of hypoplastic left heart syndrome.

Anencephaly↗
PubMed1995

Organ transplantation: contemporary Sunni Muslim legal and ethical perspectives.

The problems that organ transplantation poses to the Muslim mind may be summarized as follows: firstly, a Muslim believes that whatever he owns or possesses has been given to him as an amanah (trust) from Allah. Would it not be a breach of trust to give consent for the removal of parts of one's body, while still alive, for transplantation to benefit one's child, sibling or parent? Secondly, the Shari'ah (Islamic Law) emphasizes the sacredness of the human body. Would it not then be an act of aggression against the human body, tantamount to its mutilation, if organs were to be removed after death for the purpose of transplantation? In this paper I attempt to illustrate how the Muslim jurists have tried to resolve the dilemma of Muslims by providing them with certain guidelines based on the original sources of Islam, namely, the Qur'an and the Prophetic tradition. In order to assist the followers of other religious traditions to grasp the gravity of the problem posed by organ transplantation to the Muslim mind, I begin by discussing the opinions of Muslim jurists on the issue of utilization of human parts. Thereafter, I touch upon the resolutions taken by the various Islamic Juridical Academies on the issue in question. Finally, I shed light upon the inclusion of organ donation in a Muslim Will and the enforceable nature of such a will.

Advance Directives↗
PubMed1996

Cultural issues in death and dying.

Although all of us experience death, not all of us think about death or respond to death the same way. This study begins to explore how cultural traditions, education, and tenure in Hawaii impact views of advanced directives, organ donation, suicide, and euthanasia. This information is useful to physicians who need to engage patients and families in discussions about death and end-of-life decision making.

Asian↗
PubMed1997

Spousal and other living renal donor transplants.

Aside from HLA identical sibling donors, spousal donor transplants are the best living donors because their 3-year graft survival is comparable to that of all other living donors--with the exception of HLA identical siblings. Interestingly, the 14.5 year half-life of spousal donor kidneys was superior to the 10.8 year half-life of other living donor transplants. Better quality kidneys is the principal explanation for higher spousal donor graft survival rates when compared with cadaver donors. This was evident from the 2% anuria rate in the first post-operative day for spouse donor compared with 10% of cadaver donor transplants. Moreover, the requirement for dialysis was 6% for spouse donor grafts compared with 22% of cadaver donor transplants. The damage is not attributable to cold ischemia time but rather to agonal events and shock prior to kidney harvesting. In a survey of 176 spousal renal transplant donors, 175 of 176 said they would advise others to donate a kidney to a spouse--and only one donor advised against it. Of the "yes" responses, 28% provided additional comments enthusiastically recommending it. About 47% reported improvements in the marital relationship, 29% in the sexual relationship, and 25% described improved relations with their children. The fact that the donor reaps many direct personal benefits should make spousal donation the first consideration for living-donation (after the HLA-identical sibling donor).

Adolescent↗
PubMed1992

Assessment of costs to donor hospitals for organ transplantation.

In 1987, die Department of Health in the UK set up a working party to identify reasons contributing to a shortfall in donor organs. One recommendation was reimbursement to the District Health Authorities for costs incurred in providing the donor organs. The figure chosen was not to be seen as an incentive to donate organs, merely as an appropriate compensation for the costs incurred. There would be no direct payment to doctors, trustees or relatives of the donor. With the development of the competitive health care environment in the United Kingdom, the reimbursement of donating hospital costs is being considered with these data.

Costs and Cost Analysis↗
PubMed2006

Compensated kidney donation: an ethical review of the Iranian model.

Iran has a program of compensated kidney donation from living unrelated (LUR) donors since 1997. The aim of the program was to address the increasing demand for kidney transplantation in a morally sound manner. The program was successful in terms of increasing the number of kidneys available for transplantation. This paper presents a critical review of the program and its clinical status. Denying organ donors legitimate compensation because of the understandable fear of an organ trade is not morally justifiable, and the Iranian model of compensated LUR kidney donation offers substantial benefits that overcome these concerns. Despite its benefits, the program lacks secure measures to prevent the risk of a direct monetary relationship between donors and recipients, and it must be revised in order to be morally justifiable.

Altruism↗
PubMed2000

Organ donation and culture: a comparison of Asian American and European American beliefs, attitudes, and behaviors.

The well-known gap between organ-donor supply and demand in the United States is particularly acute for Asian Americans. Lower participation in organ donation programs by Asian Americans has been hypothesized as one explanation for this observation. This study finds that, relative to European Americans, Asian Americans hold more negative attitudes toward and participate less frequently in a large, urban organ-donor program. The study also hypothesizes and test possible reasons for subcultural differences in attitudes toward donation. Two cultural belief constructs hypothesized to more strongly predict Asian American attitudes and behaviors appear to impact both groups equally. Reasons for these results along with public policy implications and future research directions are discussed.

Black or African American↗
PubMedDate not supplied

Appraisal of the coordinator-based transplant organizational model.

In 1999, the Italian Parliament passed a law aimed at setting the standards of practice and quality in organ, tissue and cell donation, and transplantation. For the first time in the history of Italian transplantation, a coordinator-based model reproducing some of the basic principles of the Spanish system was officially enacted by the Parliament, bringing to an end years of lacking regulation. What differentiates those coordinator-based systems adopted in Southern Europe from Northern European national and multinational transplant organizations is the functional integration of donor and transplant care activities enacted by national governments. The Italian model of transplant health care consists of four levels of transplant coordination: local, regional, interregional, and national. The latter is represented by Centro Nazionale Trapianti (CNT; the Italian National Center for Transplantation). CNT objectives consist of ensuring equitable access to donation and transplant care for all citizens according to the principles of the Italian National Health System. In achieving these goals, CNT acts in cooperation with three interregional transplant agencies: the Nord Italia Transplant program, the Associazione InterRegionale Trapianti, and the Organizzazione Centro Sud Trapianti. Whereas local and interregional coordinators are at the front line of all donation and transplant activities, regional and national coordinators function to monitor, direct, and plan donation and transplant health care activities. Based on the increase in donation and transplant activities recently achieved in those countries that have adopted a governmental coordinator-based transplant care model, we believe that such a system is appropriate to serve patients' interests according to the principles of subsidiary and equity. However, it should further be improved by expansion of the governance model throughout Europe, through implementation of current standards of care, and by adopting the definition of common European objectives, health care strategies, and research integration.

Europe↗
PubMed2006

Anatomy of right recurrent nerve node: why does early metastasis of esophageal cancer occur in it?

Early, distant and/or skip metastasis of squamous-cell thoracic esophageal cancer frequently occurs in the right recurrent nerve node (recR). However, the specific lymphatic route without a nodal relay, such as the submucosal ascending route, was not known for the recR afferent. Using 20 donated cadavers, macroscopic, and histological observations were performed on the recR and its surrounding lymphatics, especially afferent routes from the esophagus to the recR. Most afferent vessels of the recR originated from the right paratracheal node. However, the recR often (12/20) received a major submucosal lymphatic drainage route ascending along the thoracic esophagus. The submucosal vessel came out of the esophagus and ran in a longitudinal connective tissue mass along the right tracheo-esophageal groove. A direct drainage route was often (13/20) seen from the recR to the venous system. Moreover, because of the specific histology, collaterals seemed to be present around the recR. In the regional nodes of the intrathoracic esophagus, the recR histology was characterized by the high proportion of lymphocyte accumulating areas or the cortex. From the midthoracic level, metastatic cancer cells seemed to reach the recR via esophageal submucosal vessels in the early stage. Large lymphocyte accumulating areas of the recR suggested higher filtration capacity than other distal nodes. However, the collateral of the recR and its direct drainage to the venous system suggested that the recR involvement often corresponds to a systemic disease.

Afferent Pathways↗
PubMed1986

Increasing kidney transplantation in Britain: the importance of donor cards, public opinion and medical practice.

The Department of Health and Social Security has recently spent over three-quarters of a million pounds advertising the merits of kidney donor cards. The advertising campaign stresses that carrying signed cards requesting the removal of kidneys and other organs after death both increases the number of kidneys available and increases the number of kidney transplants that actually take place. This paper examines the relative success of the kidney donor card campaign in Britain and the nature of the relationship between a more widespread distribution of donor cards and the frequency of kidney transplantation. This is done in two main ways: Through a review of the evidence detailing public support expressed in the media and from social surveys (including original empirical work conducted at Bath University). By an analysis of previously unpublished statistical evidence made available by the Department of Health and Social Security. The paper concludes that the battle for public sympathy towards kidney donation has largely been won and the kidney donor card campaign has been a success. However these success perhaps deflect attention away from more important issues in the transplant equation, as the link between card carrying and increased transplantation is neither direct nor simple.

Advertising↗
PubMed2002

Determinants of willingness to donate living related and cadaveric organs: identifying opportunities for intervention.

BACKGROUND: Although low rates of cadaveric organ donation have been attributed to potential cadaveric donors' concerns regarding their religious beliefs and mistrust of the health care system, it is unclear whether similar concerns are important to potential living related donors. It is also not known which factors might be most responsible for low rates of cadaveric and living related donation among the general public. METHODS: We conducted a cross-sectional study of households in Maryland, using a standardized telephone questionnaire, to assess factors associated with willingness to donate cadaveric and living related organs. We compared factors (demographic, cultural, attitudinal, and clinical) related to willingness to donate cadaveric organs with factors related to willingness to donate living related organs. In multivariate analyses, we assessed the independent relation of factors to willingness to donate cadaveric and living related organs, and we assessed the relative importance of these factors in explaining variation in the general public's willingness to donate. RESULTS: Of 385 participants (84% of randomized homes), 254 (66%) were extremely willing to donate to a sibling but only 179 (47%) had designated themselves a cadaveric donor on their drivers' licenses. In bivariate analysis, older age, comorbid conditions, mistrust in hospitals, and concerns about discrimination in hospitals were statistically significantly associated with less willingness to donate living related organs, although African-Americans, older age, lower education, lack of insurance, unemployment, comorbid conditions, and religion/spirituality were associated with less willingness to donate cadaveric organs. After adjusting for potential confounders, only mistrust in hospitals and concerns about discrimination remained strongly and independently associated with 50 to 60% less odds of willingness to donate living related organs [[relative odds [95% confidence intervals (CI)]: 0.4 (0.2-0.7) to 0.5 (0.3-1.0) and 0.4 (0.2-0.9), respectively]] although presence of dependents was associated with 70% higher odds of willingness to donate living related organs [relative odds (95% CI): 1.7 (1.0-3.0)]. In contrast, older age, employment status, religion/spirituality, and mistrust in hospitals were associated with 50 to 90% less odds of willingness to donate living related organs cadaveric organs [relative odds (95% CI): 0.3 (0.1-0.8), 0.4(0.2-0.8), 0.1 (0.1- 0.5) to 0.5 (0.2-0.9), and 0.3 (0.2-0.6), respectively]. Mistrust in hospitals and concerns about the surgical donation procedure contributed most to the variation in willingness to be a living related donor, although race contributed most to the variation in willingness to be a cadaveric donor. CONCLUSIONS: Many factors affect the general public's willingness to donate organs, but their relative contribution is different for living related versus cadaveric donation. Efforts to improve organ donation rates should be directed toward factors that are most important in explaining the existing variation in willingness to donate.

Adult↗