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PubMed1998

Cancer of the colon in an egg donor: policy repercussions for donor recruitment.

This paper describes the tragic case of a young woman who died of cancer of the colon after successfully donating eggs to her younger sister. Although there is no direct link between her operation and the subsequent development of bowel carcinoma, this case imparts a feeling of unease when seen in conjunction with other cases reported during the last few years. It is a reminder that little is known of the long-term consequences of some aspects of assisted conception. Women undergoing ovarian stimulation for themselves or a matched recipient have the right to be advised, in an agreed format, that there is some concern about unproven potential risks from the stimulatory drugs. The safety of egg donors must assume priority over all other considerations, including lack of donors or any moral position. The recent decision by the Human Fertilisation and Embryology Authority (HFEA) to withdraw any form of payment or recompense to egg donors does not seem to us to be based on a balance of scientific advances, patient needs and the ethics of gamete supply. They state that the intention to withdraw payments was implicit in the 1990 Human Fertilisation and Embryology (HFE) Act. However the Act was based on the Warnock report made 6 years earlier. Even in 1990 ovum donation was uncommon and fertility drugs had not yet caused any unease. The Act provided the HFEA with discretionary powers to issue directions so that the future policies would be consistent with any emerging new medical evidence. It is imperative that the HFEA provide convincing evidence on how the current policy of payment to donors harms society, donors or recipients, and how in the UK the new policy will improve medical practice in assisted conception. Successful pilot studies must precede the implementation of any new policy. Failure to do this could cause irreversible harm to the practice of assisted conception using donor gametes, which will ultimately be against the basic aims of the 1990 HFE Act.

Adult↗

PubMedDate not supplied

Public attitudes towards end-of-life treatment decisions: implications for nurse clinicians and nursing administrators.

As medical technology becomes more sophisticated, end-of-life treatment decisions become more complex for patients and for the professionals who care for them. The authors surveyed 448 members of the general public to determine their attitudes regarding end-of-life treatment decisions and attitudes towards the provision of advance end-of-life directives. A slight minority of respondents indicated they would leave major decisions to their physicians. An overwhelming majority believe that living wills are important. Most respondents indicated they would not wish their lives to be prolonged if elderly and ill or if their minds failed. A majority of respondents also were in favour of donating their organs after death. The article reports the socio demographic variables which significantly influenced these responses and suggests the implications of these results for nurse clinicians and for nursing administrators. Enhancing clients' abilities to communicate their wishes and being sensitive to social-cultural differences in perspectives about these issues, are key implications for nurse clinicians. Ensuring sound policies and guidelines are developed and that adequate education is provided in ethical and legal dimensions surrounding end-of-life treatment directives, as well as multi-cultural orientation, are responsibilities for nursing administrators.

Adult↗

PubMed2006

The influence of religion on organ donation and transplantation among the Black Caribbean and Black African population--a pilot study in the United Kingdom.

Currently the demand for transplant organs, particularly kidneys, far outstrips the supply in the United Kingdom. This problem is particularly severe for the Black African and Black Caribbean populations who have a higher predisposition to end-stage renal failure. Several commentators have suggested that religious and cultural traditions may be the major determinant preventing Black Africans and Black Caribbeans from donating organs. An exploratory qualitative study using focus groups was undertaken with the aim of examining the influence of religion, among other things, on the extent and direction of public attitudes toward organ donation in a cross-section of the Black African and Black Caribbean populations in Lambeth, Southwark, and Lewisham. In almost every focus group, religion and faith were expressed as issues that could prevent Black people from becoming organ donors. Organ donation was debated with caution on the basis of how their religious experience had influenced them. This finding suggests that the church and faith leaders could play a greater role in raising awareness of organ donation in these communities. Religious leaders can reach large numbers of people in a short space of time and will assist members of any group to understand more fully the religious stance on the subject matter. This education, in the long term, may lead to more people becoming organ donors.

Adolescent↗

PubMed1998

An exploratory study examining the influence of religion on attitudes towards organ donation among the Asian population in Luton, UK.

Currently the demand for transplant organs far outstrips the supply in the UK. This problem is even more severe for the Asian population, who have been shown to be disproportionately over-represented on transplant waiting lists in some regions of the UK. Several commentators have suggested that religious and cultural traditions may be the major determinant preventing Asians from donating organs. An exploratory qualitative study was undertaken with the aim of examining the influence of religious beliefs, amongst other things, on the extent and direction of public attitudes towards organ donation in a cross-section of the Asian population in Luton. This study indicates that, in the population studied, culture and religion play a much less prohibitive part in determining the level of organ donation than previously suggested. However, there is a desire to be aware of the religious stances so that people can make a more informed decision. The emphasis should clearly been a reconsideration of the presently inadequate approaches to organ procurement and on devising and supplementing these with more appropriate ones. An example of the failure to inform effectively the relevant populations about important developments is that only two of the 32 Muslims in the survey had heard of the 'fatwa' by the Muslim Legislative Council permitting organ donation.

Adolescent↗

PubMed1992

Renal transplants. Kidney and pancreatic transplantation.

1. Specific criteria for pancreas donation are few. A donor history of diabetes mellitus is an absolute contraindication, as well as any direct trauma to the pancreas with severe pancreatitis. Extracranial malignancy and active infection rule out retrieval of both pancreas and kidneys. 2. A combined pancreas/kidney transplant requires two completely separate instrument setups. The instruments used to implant the pancreas are considered contaminated by the segment of duodenum containing the pancreatic duct. 3. In addition to those questions routinely asked of a patient on admission to the operating room, the perioperative nurse needs to know when the patient last underwent dialysis and when the last dose of insulin was given. Lab work should be quickly reviewed with special notice given to the hematocrit, hemoglobulin, and glucose levels.

Graft Rejection↗

PubMed2004

Fate of stored embryos: our 10 years experience.

Couples accepting embryo cryopreservation signed an informed consent in which directives were given in case of death, divorce or absence. In this study, we tried to analyse our experience in terms of benefits achieved and to understand the feelings of couples about their embryos. (1) The majority of couples decided, or simply let, their embryos be discarded. In fact, a considerable proportion of them (25.1%) did not want to assume the responsibility of signing the disposal of their embryos. (2) Embryo donation is the most uncommon and difficult choice to make (6.0%) and this ought to be an important point to think over while dealing with law design. (3) An unexpected proportion of couples, who did not conceive, still have their embryos stored and this forces us to reflect on the difficulty of getting over the treatment failure.

Cryopreservation↗

PubMedDate not supplied

Increasing the supply of kidneys for transplantation.

Kidney transplantation confers a survival advantage for patients with end-stage renal disease (ESRD) when compared to dialysis and improves the quality of life in a cost-effective manner. Currently there are more than 60,000 patients on the U.S. waiting list for kidney transplantation. In 2004, 16,879 kidney transplants, including 880 simultaneous kidney and pancreas transplants, were performed in this country. Recent strategies for increasing the supply of kidneys hold promise, such as systematic programs designed to improve consent rates for deceased donor organ procurement. Efforts to increase donation after cardiac death (DCD) have been highly successful and now account for more than 5% of all deceased organ donors. Transplantation of kidneys from DCD donors yields 1-year graft and patient survival rates equivalent to kidneys from brain-dead donors. Expanded criteria donor (ECD) kidneys from donors > or = 60 years of age (or donors age 50-59 years with certain comorbidities) confer a survival benefit for end-stage renal disease (ESRD) patients compared to remaining on dialysis on the waiting list. The number of live donor kidney transplants, both from biologically related and unrelated donors, is increasing. Paired live donor kidney transplants provide yet another transplantation opportunity for ESRD patients with willing but incompatible (by ABO or direct antibody) living donors.

Cadaver↗

PubMed1996

Extended criteria for cardiac allograft donors: a consensus study.

BACKGROUND AND METHODS: To achieve a consensus regarding extending the current criteria for referring potential cardiac allograft donor, we sent a detailed questionnaire to all heart transplant surgeons in the United Kingdom. RESULTS: Replies representing the opinion of 16 heart transplant surgeons (88% response rate) suggest that the majority believe that donor age could be extended up to 55 years even in the absence of a coronary angiogram or echocardiogram. Family history of ischemic heart disease, history of hyperlipidemia or smoking, and brain death caused by paracetamole or barbiturates overdose were not considered prohibitive to cardiac allograft donation. Similarly, chest trauma, prolonged mechanical ventilation, pre-referral cardiac arrest or hypotension for any length of time, and nonspecific ST-segment elevation were not considered to be contraindications. By contrast, significant Q waves in a recent electrocardiogram, the presence of hepatitis C antibodies, pulmonary capillary wedge pressure more than 20 mm Hg, and dependency on multiple inotropic support were considered definite exclusion criteria. Donor hormonal resuscitation (T3-cocktail), insertion of a Swan-Ganz catheter, and direct measurement of intracavitary pressure at the time of retrieval were considered unnecessary by more than 80% of respondents. There was no consensus of opinion regarding the use of donors above the age of 55 years, brain death caused by carbon monoxide poisoning, history of diabetes mellitus, alcohol or drug abuse, systemic infections, electrocardiographic evidence of left ventricular hypertrophy, or the maximum dose of inotropic support required to maintain satisfactory hemodynamics. CONCLUSIONS: The number of potential cardiac allograft donors can be increased by extending the donor age to 55 years. Brain death caused by Paracetamole and barbiturate overdose may not prohibit organ donation.

Adolescent↗

PubMed1995

Outcome following organ removal from poisoned donors in brain death status: a report of 12 cases and review of the literature.

Experience with organ procurement from poisoned donors in brain death status is still limited in comparison with other etiologies. From 1963 to 1993, 2769 grafts (heart 141, kidney 1922, liver 623, pancreas 43) were performed in our University Hospital. Since 1975, among 1174 patients admitted to the ICU for acute poisoning, 12 patients who developed brain death status were considered for organ donation. The toxics involved were: methaqualone (1), benzodiazepines (1), benzodiazepines plus tricyclic antidepressants (2), barbiturates (2), insulin (2), carbon monoxide (1), cyanide (1), methanol (1), and acetaminophen (1). Exclusion criteria for organ removal were applied according to the nature of the toxin and the general criteria used for organ donation. The organs removed were: heart 5, heart valves for graft bank 2, kidneys 22, liver 4, pancreas 2, pancrease islet cells 2. Pertinent follow-up was obtained in 23 of 32 recipients. Immediate outcome was favorable in 20/23 patients (85%). Three patients died either from stroke, heart failure or preexisting encephalopathy. Two patients died from either chronic hepatic or renal graft rejection. None of these events could be directly related to a toxic origin. The one year survival rate of 75% is similar to that observed in the population who received organs from nonpoisoned donors. Organ procurement can be considered in few selected cases of acute poisoning. The accuracy of the diagnosis of irreversible brain damage is essential in this setting.

Brain Death↗

PubMed2003

[Living donor liver transplantation].

Liver transplantation has evolved into the standard treatment for numerous endstage liver diseases. The increase of organ shortages led to living organ donation. In 1988 living donor liver transplantation (LDLT) was performed for the first time. Since then multiple difficulties associated with LDLT have been solved. In Kyoto we can look back on more than 900 transplantations since the initiation of our LDLT program in 1990, which is the oldest in Japan and the largest in the world. In the following we review our extensive experience with special focus on issues such as donor safety, results after LDLT, and potential complications in the recipient. Further, graft size mismatching, venous drainage from anterior segment of the right lobe graft, LDLT for hepatocellular carcinoma, AB0-incompatible transplantation, and recurrence of hepatitis C infection, which are still unsolved problems in LDLT, are described and future directions are indicated.

Cadaver↗

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↗

PubMed1999

Survey of genetic screening for oocyte donors.

OBJECTIVE: To describe current screening practices of oocyte donation programs in the Society for Assisted Reproductive Technologies (SART). DESIGN: Descriptive data from a mailed questionnaire. SETTING: Academic medical center. PARTICIPANT(S): In vitro fertilization programs in SART. INTERVENTION(S): Survey mailed to IVF programs in the SART registry. MAIN OUTCOME MEASURE(S): Current practices, opinions, and genetic criteria for oocyte donor selection. RESULT(S): Results from 159 of 229 (69%) eligible oocyte donation programs are described. Most centers (70%) completed fewer than 25 cycles and used both anonymous and directed donors. There was considerable variability in limits on numbers of cycles or births allowed per donor, with many centers having no limits. As well, the use of well-established screening tests for genetic disorders, such as sickle cell anemia and cystic fibrosis, varied considerably. Consultation with a geneticist was possible at most (89%) centers and specifically mentioned by some centers as a means to help make decisions. CONCLUSION(S): Most programs follow recommendations made by the American Society of Reproductive Medicine (ASRM) for screening of gamete donors, but a significant percentage does not use well-established testing. The widespread availability of genetic consultation should promote responsible screening practices.

Female↗

PubMed2003

The dead donor rule and the concept of death: severing the ties that bind them.

One goal of the transplant community is to seek ways to increase the number of people who are willing and able to donate organs. People in states between life and death are often medically excellent candidates for donating organs. Yet public policy surrounding organ procurement is a delicate matter. While there is the utilitarian goal of increasing organ supply, there is also the deontologic concern about respect for persons. Public policy must properly mediate between these two concerns. Currently the dead donor (dd) rule is appealed to as an attempt at such mediation. I argue that given the lack of consensus on a definition of death, the dd rule is no longer successful at mediating utilitarian and deontologic concerns. I suggest instead that focusing on a particular person's history can be successful.

Advance Directives↗

PubMed2005

Role of the independent donor advocacy team in ethical decision making.

Adult living donor liver transplantation has developed as a direct result of the critical shortage of deceased donors. Recent regulations passed by New York State require transplant programs to appoint an Independent Donor Advocacy Team to evaluate, educate, and consent to all potential living liver donors. Ethical issues surround the composition of the team, who appoints them, and the role the team plays in the process. Critics of living liver donation have questioned issues surrounding motivation and the ability of donors to provide true informed consent during a time of family crisis. This article will address issues surrounding the controversies and discuss how using the team can effectively evaluate and educate potential living liver donors and improve practice to ensure safety of living donors.

Communication↗

PubMedDate not supplied

Questionnaire regarding the knowledge of the rules of organ procurement from cadaveric donors for transplantation directed to the directors of medical institutions in Poland.

We assessed the level of knowledge of organ procurement regulations among the directors of medical institutions in Poland. We also sought to promote the objection form, and the activity of the Central Register of Objections. A questionnaire consisting of 10 questions was sent to 381 random medical health care institution directors countrywide. In 89% of surveyed institutions, the written text of the organ procurement regulations was available and 94% of directors knew the forms of objection, but in 26% of institutions the form was not available and in 14% it was never obtainable. In the medical institutions directors' opinions, the estimated number of objections is 13% of the population in Poland. Organ transplantation is a form of treatment most medical institutions are familiar with, but the matter of donation is not as well known as transplantation, as observed in 48% of questioned institutions.

Cadaver↗

PubMed2004

Optimizing the organ procurement process: organizational prerequisites and monitoring strategies in a national network.

The current project sought to collect detailed information on the Italian donation system and in particular on the organization and functioning of the local coordinating centers. The final objective was to provide local and regional institutions with the information required to improve the system. While improving the knowledge of current Italian donation system, the project had constructive purposes. Our intention was to analyze how the national system is working, what the coordinating centers are actually doing, how they are organized, to what extent existing rules are obeyed, and what are the main limits of the system. This analysis sought to lead to the development of a set of proposals that can be summarized in two categories: (1) "intrinsic" actions, that is, those established and implemented at the hospital level; and (2) supporting "extrinsic" actions, that is, those identified by the National Transplant Centre and addressed to the regional and interregional coordinating networks. Finally, the analysis of the application of the existing rules should lead to the development of practice guidelines such that each center conforms to the existing regulations established by European directives.

Brain Injuries↗

PubMed2002

Vascular endothelial growth factor protects cultured rat hippocampal neurons against hypoxic injury via an antiexcitotoxic, caspase-independent mechanism.

The authors investigated the effect of vascular endothelial growth factor (VEGF) on hypoxic injury of cultured rat hippocampal neurons. Treatment with glutamate receptor antagonists prevented hypoxic neuron death. The same magnitude of protection was observed in cultures treated with VEGF, which also reduced excitotoxic neuron death induced directly by an exposure to -methyl-d-aspartate. Vascular endothelial growth factor did not alter the activation of the transcription factor nuclear factor-kappaB during hypoxia and protected cells in a PI-3-kinase-independent manner. Vascular endothelial growth factor failed to protect against staurosporine-induced, caspase-dependent apoptosis. These data suggest that VEGF-induced protection against hypoxic injury primarily involves the inhibition of excitotoxic processes.

Animals↗

PubMed2002

Selective peroxynitrite scavenging activity of 3-methyl-1,2-cyclopentanedione from coffee extract.

It has been known that reactive oxygen and nitrogen species such as nitric oxide (NO), superoxide radical (*O2-) and their byproduct peroxynitrite (ONOO-) induce cellular and tissue injury, ultimately resulting in several human diseases. In this study, we examined scavenging effects of 3-methyl-1,2-cyclopentanedione (MCP) from coffee extract on the reactivity of those toxic molecules. MCP significantly inhibited both the oxidation of 2,7-dichlorodihydrofluorescein diacetate (H2DCFDA) by reactive oxygen species (ROS) (mainly *O2-) from kidney homogenate (41% at 100 microM) and the generation of fluorescent 4,5-diaminofluorescein (DAF-2) by NO from sodium nitroprusside (IC50 (concn producing 50% inhibition), 63.8 microM). More potently, however, MCP suppressed the oxidation of dihydrorhodamine 123 (DHR 123) to fluorescent rhodamine 123 mediated by authentic ONOO- with an IC50 value of 3.3 microM. The neutralizing effect of the reactivity of ONOO- by MCP was due to electron donation, not nitration of the compound. Additionally, MCP also decreased ONOO- formation of nitrotyrosine adducts of glutathione (GSH) reductase, and consequently protected the enzyme activity of GSH reductase against decreasing by ONOO-, indicating that MCP may prevent ONOO- -induced damage of GSH reductase. Furthermore, MCP only weakly suppressed NO production, which is one of the upstream sources of ONOO- in-vivo, suggesting that NO production may be not a pharmacological target for MCP. Taken together, our results suggest that MCP may be regarded as a selective regulator of ONOO- -mediated diseases via direct scavenging activity of ONOO-.

Blotting, Western↗