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Results for “Directed Tissue Donation”

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PubMed2003

A nondirected kidney donation and its consequences: personal experience of a transplant surgeon.

Until 1996, living kidney donation had been neglected in Germany. To encourage potential donors and to convince them that nephrectomy is not too risky for a healthy person, the author decided to set an example with a personal nondirected donation. This donation, controversially discussed in the public domain, nevertheless succeeded in raising the percentage of living donors in Germany from 4% to 20% of renal transplants. In 1997, the new German Transplant Act prohibited nondirected donation. With the aim of allowing nondirected donation as an act of Christian charity, a plaint had been submitted to the Constitutional Court against that law on the basis that it violated several fundamental rights, but it was dismissed because of strong medical opposition. The author experienced some unpleasant professional consequences of his act but, nevertheless, is convinced that he had taken the right step when deciding to give a kidney to a stranger.

Directed Tissue Donation↗

PubMed1993

Ethics of fetal tissue transplantation.

Now that the Clinton Administration has overturned the ban on federal funding for fetal tissue transplantation, old ethical issues renew their relevance and new ethical issues arise. Is fetal tissue transplantation necessary and beneficial? Are fetal rights violated by the use of fetal tissue in research? Is there a moral danger that the potential of fetal tissue donation will encourage elective abortions? Should pregnant women be allowed to designate specific fetal transplant recipients? What criteria should be used to select fetal tissue transplants? Whose consent should be required for the use of fetal tissue for transplantation? We review the current state of clinical research with fetal tissue transplantation, the legal history of fetal tissue research, the major arguments against the use of fetal tissue for transplantation, and the new postmoratorium ethical dilemmas. We include recommendations for guidelines to govern the medical treatment of fetal tissue in transplantation.

Aborted Fetus↗

PubMed1996

Do U.S. transplant centers encourage emotionally related kidney donation?

Stimulated by a severe organ shortage and an improving ability to successfully transplant poorly matched donor-recipient pairs, many transplant centers are now willing to accept emotionally related (but genetically unrelated) people (e.g., spouses) as kidney donors. To see whether this practice is encouraged, a survey was mailed to all 209 adult renal transplant centers in the United States. Of the 154 (74%) responding centers, 90% said they accept emotionally related donors and 60% said they actually encourage this practice. Nearly 40% prefer spouses to cadavers, while only 21% prefer friends to cadavers. To further explore the degree to which emotionally related donation is encouraged, a second questionnaire was sent to a sample of centers (n = 51) that support this practice; 94% responded. While only 44% said they encourage the use of friends, nearly all of these preselected centers said they encourage spouses to donate. On the other hand, judging from their stated approach to this issue, only about half of these supportive centers seem to actively encourage emotionally related donation. These data suggest that, overall, at most only about one third of U.S. transplant centers actively encourage spousal donation and at most about one quarter encourage the use of friends. Consistent with these results, emotionally related donors contribute only a small fraction of all kidneys transplanted in this country. If the large potential contribution of emotionally related donors is ever to be realized, transplant centers must go beyond simply accepting such individuals and begin to actively encourage their participation. Medical and ethical considerations strongly support this proposal.

Adult↗

PubMedDate not supplied

[The law, medical ethics, and transplants].

A discussion of four aspects of the legislation and of the medical ethics of the transplants is presented: the concept of death, the donation of organs, the selection of receivers and the future of the therapeutic transplants. The prominent paragraphs of the General Law of Health of the country about cerebral death, the two legal forms and organs donors' ethics, the criteria and more frequent problems for the selection of receivers, and the character of medical technology of transition of the therapeutic transplants are included.

Adult↗

PubMed1991

Attitudes towards gamete donation among couples undergoing in vitro fertilization.

The attitudes of 234 anonymous couples undergoing in vitro fertilization toward sperm and oocyte donation were explored by questionnaire. All the questionnaires were returned of which 222 (95%) were complete and analysed. A high proportion of couples found the use of donor sperm acceptable for therapeutic, diagnostic and treatment purposes (77%, 90% and 97% respectively) and 72%, 84% and 90% respectively were willing to donate oocytes for these purposes. Of potential oocyte donors 41% would agree to nonanonymous donation, 12% would wish to meet the recipient couple and although only 4% wanted to choose the recipient, a quarter of the couples would prefer a relative or friend as the recipient. Provision of nonidentifying information about the donor to the recipient couple was acceptable to almost 70% whereas 40% found giving the same information to the child acceptable.

Adult↗

PubMed2006

[Ten years of laparoscopic living kidney donation. From an extravagant to a routine procedure].

Ten years ago the first laparoscopic living donor nephrectomy (LDN) was performed. Today, LDN is a routine operation in many US-American transplantation centers and an increasing number of centers in Europe are practicing LDN. In this article the different aspects of LDN for donor, kidney, recipient and operating surgeon are evaluated. We performed a literature research concerning LDN and the different aspects. Our own experience, as the largest LDN center in Germany, is part of the evaluation. Laparoscopic extraction of a kidney from a living donor is as safe for the donor as the open approach. At the same time, LDN offers multiple advantages like reduced pain and shorter convalescence. For the donated kidney and the recipient no disadvantages occur from the laparoscopic technique, as long as special intra- and perioperative demands are met. For the operating surgeon multiple developments have expanded the technical armentarium. LDN is safe for donor, recipient and kidney. Central issue of an optimal LDN is sufficient experience with laparoscopic urological techniques.

Directed Tissue Donation↗

PubMed1993

Informed consent for blood transfusion: a regional hospital survey.

Ninety-two hospitals in a three-state mid-Atlantic region were surveyed to determine their policy toward obtaining written informed consent for transfusion and to examine the content of written consent documents and the process by which consent is obtained. Of 81 hospitals responding, 50 (62%) required written informed consent. Hospitals with fewer than 200 beds were more likely to require written informed consent. The attending physicians had responsibility for obtaining consent in 28 (57%) of 49 institutions, most often on the day or evening before surgery. Twenty-seven of 48 forms mentioned complications: hepatitis in 80 percent, human immunodeficiency virus infection in 46 percent, nonhemolytic reactions in 32 percent, and hemolysis in 25 percent. Alternatives to allogeneic transfusion were mentioned infrequently; eight hospital forms listed autologous transfusion options and only two mentioned designated donation. The reading level required to comprehend 34 consent forms submitted was grade 14.6, which has been attained by only 23 percent of the adult United States population. Although the majority of respondent institutions require written informed consent, those forms, per se, do not document that the fundamental tenets of informed choice have been applied to the decision to transfuse blood.

Blood Banks↗

PubMed1997

Procuring gametes for research and therapy: the argument for unisex altruism--a response to Donald Evans.

There has been a troublesome anomaly in the UK between cash payment to men for sperm donation and the effective assumption that women will pay to donate eggs. Some commentators, including Donald Evans in this journal, have argued that the anomaly should be resolved by treating women on the same terms as men. But this argument ignores important difficulties about property in the body, particularly in relation to gametes. There are good reasons for thinking that the contract model and payment for gametes are both inappropriate, and that a model based on altruism should be applied to both sexes.

Altruism↗

PubMed1994

Psychological aspects in anonymous and non-anonymous oocyte donation.

A study, in which 110 patients were screened by a psychoanalyst, included 69 recipients who chose non-anonymous oocyte donation, i.e. they received oocytes from a known donor, most frequently a sister or a close relative. Another 41 recipients received anonymous oocytes, but had to bring a donor. Psychological motivations for either choice are reported, and significant topics such as attitudes towards confidentiality and links to the child are compared. No specific psychopathology is reported at this stage. An additional study on children born by these techniques is ongoing.

Adult↗

PubMed1990

A survey of public attitudes toward oocyte donation between sisters.

Oocyte donation offers the possibility of pregnancy for many patients with premature ovarian failure (POF) and recently a number of patients have been requesting egg donation by a sister. While patients anxious to achieve a pregnancy are favourably disposed toward egg donation, the existence of favourable attitudes in others, and thus the amount of social support such patients will receive, depends upon the wider social environment. A survey of public opinion was conducted utilizing a random sample of 501 adults in Orange County, CA in an attempt to identify demographic correlates of attitudes. Log linear analysis demonstrated no relationship between attitudes and an array of demographic data (income, political party, age), but showed a significant relationship between sex of the respondent and attitudes towards egg donation. While more than half of respondents of both sexes were favourably disposed towards egg donation, men exhibited significantly (P = 0.005) more positive attitudes towards oocyte donation by a sister than did women. Women in the general population showed markedly less support for egg donation by a sister than POF patients have been demonstrated to show. The theory is proposed that female respondents are more wary of the symbolic meaning of the reproductive connection between a sister-in-law and a husband, while the POF patient's attitude is shaped in part by her desire for a pregnancy. The results have implications for the attitudes POF couples may face in the social environment and for the type of social support which may be recommended.

Directed Tissue Donation↗

PubMed2003

Gamete donation and parental responsibility.

Unlike surrogacy and cloning, reproduction via gamete donation is widely assumed to be morally unproblematic. Recently, a number of authors have argued that this assumption is mistaken: gamete donors, they claim, have parental responsibilities that they typically treat too lightly. In this paper I argue that the 'parental neglect' case against gamete donation fails. I begin by examining and rejecting the view that gamete donors have parental responsibilities; I claim that none of the current accounts of parenthood provides good reason for ascribing parenthood to gamete donors. I then argue that even if gamete donors do have parental responsibilities for 'their' children, it is not clear that they treat these responsibilities too lightly. I conclude the paper by examining the wider question of just what kind of responsibilities gamete donors might have towards the children that they have a role in creating.

Directed Tissue Donation↗

PubMed2006

"He won't be my son": Middle Eastern Muslim men's discourses of adoption and gamete donation.

In the Sunni Muslim world, religious mandates prohibit both adoption and gamete donation as solutions to infertility, including in the aftermath of in vitro fertilization (IVF) failures. However, both of these options are now available in two Middle Eastern countries with significant Shi'ite Muslim populations (Iran and Lebanon). On the basis of fieldwork in multisectarian Lebanon, I examine in this article attitudes toward both adoption and gamete donation among childless Muslim men who are undertaking IVF with their wives. No matter the religious sect, most Muslim men in Lebanon continue to resist both adoption and gamete donation, arguing that such a child "won't be my son". However, against all odds, some Muslim men are considering and undertaking these alternatives to family formation as ways to preserve their loving marriages, satisfy their fatherhood desires, and challenge religious dictates, which they view as out of step with new developments in science and technology. Thus, in this article I examine the complicated intersections of religion, technology, marriage, and parenthood in a part of the world that is both poorly understood and negatively stereotyped, particularly in the aftermath of September 11, 2001.

Adoption↗

PubMed1989

Conceiving a fetus for bone marrow donation: an ethical problem in prenatal diagnosis.

We present a family who sought prenatal diagnosis in order to bear a healthy child to serve as an HLA-identical bone marrow donor for their son affected with Wiskott-Aldrich syndrome. They intended to abort HLA-incompatible fetuses who would have been unsuitable bone marrow donors. This case led us to conclude that prenatal diagnosis should not be used to benefit a third party or facilitate the conception or abortion of a fetus for the purpose of generating an organ for transplantation. The limits of parental autonomy and physician responsibility are discussed.

Aborted Fetus↗

PubMed1994

Donated blood--gift or commodity? Some economic and ethical considerations on voluntary vs commercial donation of blood.

The author applies the theory of public goods on donated blood. Donated blood may be taken as a 'public good' like water and air, police and fire brigades. This theory trends to imply a preference for voluntary donation and bloodbanking by public and nonprofit organisations as well as for low cost supply. An additional commercial supply of blood nevertheless is welcome. Quality as well as quantity of blood depend first of all on the willingness to donate and the honesty of the donors about their health. An altruistic motivation alone, which is not triggered by some material incentive, does not in all systems guarantee a sufficient quantity of safe blood. Both the altruistic as well as the reimbursement-oriented donor's willingness and honesty have to be guarded by sound practice in bloodbanking and adequate public control within a legal framework which reflects the vital role of blood supply. A legal implementation of product liability will certainly be an important instrument in this field.

Altruism↗

PubMed1995

Living related donation in lung transplantation. Ethical considerations.

Lung transplantation has become an established rescue therapy for patients with end-stage disease. The major problem, however, is the shortage of organ donors. Living related donation has been successful in kidney and liver transplantation and, recently, in lobar lung transplantation as well. The main ethical dilemma is whether we should risk a parent family member in order to save a child or relative. This dilemma can be taken to the extreme in a case in which pneumonectomy from a live donor can save a patient who is in need of single lung transplantation, a procedure that has not yet been performed, although technically feasible. We discuss the ethical aspects of such a procedure from the perspectives of the donor, the recipient, and the medical team.

Beneficence↗

PubMedDate not supplied

Live organ donation: social context, clinical encounter, and the psychology of communication.

Organ transplantation is increasingly available to the thousands of patients who suffer from end-organ failure. There has been an attendant increase in demand for living donor participation. This combined with a bioethical focus on autonomy increases the burden of decision on donor candidates. The authors review the history of living donor participation in organ transplantation and explore the psychological dynamics of the clinical encounter between donor and transplant surgeon. The field of communication psychology lends to the understanding of coercion and to the importance of donors possessing a status of patient-hood in the classical Hippocratic condition.

Coercion↗

PubMed1998

Do attitudes toward disclosure in donor oocyte recipients predict the use of anonymous versus directed donation?

OBJECTIVE: To compare the demographic and psychological characteristics of oocyte recipients and to determine whether the issue of disclosure about the use of a donor is a correlate of the decision to use an anonymous or directed donor. DESIGN: Cross-sectional study. SETTING: University teaching hospital. PATIENT(S): Ninety consecutive recipients of donated oocytes (64 of whom used anonymous donors and 26 of whom used directed donors). INTERVENTION(S): Pretreatment psychosocial evaluation. MAIN OUTCOME MEASURE(S): Recipient opinions and attitudes regarding the choice of donor type and disclosure to others as determined through a semistructured interview. RESULT(S): There were no statistically significant differences with regard to demographic characteristics between recipients who used anonymous and directed donors. There were statistically significant differences between the groups with regard to the issue of disclosure. Recipients who used directed donors were more likely to have told others about using an oocyte donor and were more likely to indicate that they intended to inform the child about the nature of his or her conception. CONCLUSION(S): Oocyte recipients who use known donors differ significantly from those who use anonymous donors with regard to the issue of disclosure to others. Further studies are needed to determine the causal direction of this relation.

Adult↗

PubMed2003

Audit of a paediatric directed donation programme.

OBJECTIVE: A paediatric directed donation programme (DDP) was instituted by Women's and Children's Health in conjunction with the Australian Red Cross Blood Service, Melbourne, Victoria, Australia, in response to public demand following a case of transfusion-transmitted HIV. This audit assesses the first 18 months of the programme. METHODS: Retrospective analysis, from February 2000 to July 2001, examining the number of units of blood requested, donated, and transfused, as well as the use of allogeneic (non-directed) blood. RESULTS: The DDP received 125 referrals. Most (78%) were for elective surgery. Of the 89 eligible children, 76% (68) had blood donated for them by an ABO/Rhesus-compatible parent, 81% of whom were first-time blood-donors. No donor tested positive for infectious markers. In total, 221 units of blood were requested and 116 units were collected. Non-collection was mainly a result of parent-child ABO incompatibility or medical ineligibility of the proposed donor. Of the children for whom blood was collected, 28 (41%) received no transfusion and eight (12%) received non-directed components in addition to DDP blood; thus, 32 (47%) received solely the blood from their directed donor. Of the units collected, 53 (46%) were transfused and 63 (54%) were discarded. CONCLUSIONS: While the paediatric DDP serves a community need, the programme has a high wastage rate, is time-consuming, labour-intensive and an expensive alternative when compared with the provision of non-directed volunteer blood. In continuing the programme, appropriateness of referral needs to be refined to reduce wastage rates.

Blood Banks↗