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Humar SS, Jung J, Krause S, Selzner N, Abbey S. Gift Discourse in Transplant and Its Implications in Anonymous Living Liver Donation. Transplant Proc 2023; 55:274-278. [PMID: 36822887 DOI: 10.1016/j.transproceed.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/24/2023] [Indexed: 02/25/2023]
Abstract
The Gift of Life metaphor is prevalent in pro-donation dialogue, aiming to promote transplant programs and conceptualize the act of organ donation. To obtain a better understanding of living donor perceptions on the term Gift of Life, we analyzed thematic views presented by anonymous living donors (ALLDs). Twenty-six ALLDs completed a semi-structured qualitative interview consisting of questions regarding their motivations, experiences, and perceptions on donation. The following 5 major themes relating to the Gift of Life terminology were elucidated: (1) Complete agreement with the term and its relevance to donation. (2) Their donation did not represent a Gift of Life. (3) The term was too grandiose. (4)A belief that the term has more meaning for the recipient rather than donor. (5 )That the "gift" goes both ways, with the donor also benefiting from the experience.
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Affiliation(s)
- Sapna S Humar
- Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada; Center for Mental Health, University Health Network, Toronto, Ontario, Canada.
| | - Judy Jung
- Multi-Organ Transplant & Medical Specialties, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sandra Krause
- Center for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Nazia Selzner
- Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan Abbey
- Center for Mental Health, University Health Network, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Meng MD, Clarke RN. Filling the Organ Donor Pool by Giving Priority. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2020; 45:49-71. [PMID: 31675063 DOI: 10.1215/03616878-7893567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CONTEXT Many of the alternatives for procuring donor organs are considered either ineffective, unethical, or illegal. One possibility that may not face such challenges is a priority system whereby individuals who register as an organ donor are given priority to receive an organ over those who have not registered. However, providing extrinsic rewards can sometimes paradoxically reduce the target behavior, especially for those who are more altruistically motivated. METHODS Two behavioral experiments were employed and data were analyzed using regressions as well as examining open-ended responses. FINDINGS The results suggest that giving priority to receive an organ to those who register to donate postmortem could increase overall registration rates. Further, the effect of providing priority appears to work by inducing anticipated regret, which can be used to overcome common obstacles to registration. Finally, it was found that a priority system is most effective in increasing donor rates for those individuals who are less altruistically motivated and does not reduce registration rates for those who are more altruistically motivated. CONCLUSIONS Given the unabated shortage of transplant organs, the finding that a priority system could increase the willingness to register as a donor without crowding out altruistically motivated individuals is highly encouraging.
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‘Be the match’. Predictors of decisions concerning registration in potential bone marrow donor registry in a group of Polish young adults as an example of prosocial behaviour. CURRENT PSYCHOLOGY 2019. [DOI: 10.1007/s12144-019-00319-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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GOUDET V, ALBOUY-LLATY M, MIGEOT V, PAIN B, DAYHOT-FIZELIER C, PINSARD M, GIL R, BELOUCIF S, ROBERT R. Does uncontrolled cardiac death for organ donation raise ethical questions? An opinion survey. Acta Anaesthesiol Scand 2013; 57:1230-6. [PMID: 24028284 DOI: 10.1111/aas.12179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Organ donation after uncontrolled cardiac death raises complex ethical issues. We conducted a survey in a large hospital staff population, including caregivers and administrators, to determine their ethical viewpoints regarding organ donation after uncontrolled cardiac death. METHODS Multicenter observational survey using a questionnaire, including information on the practical modalities of the procedure. Respondents were asked to answer 15 detailed ethical questions corresponding to different ethical issues raised in the literature. Ethical concerns was defined when respondents expressed ethical concerns in their answers to at least three of nine specifically selected ethical questions. RESULTS One thousand one hundred ninety-six questionnaires were received, and 1057 could be analysed. According to our definition, 573 respondents out of 1057 (54%) had ethical concerns with regard to donation after cardiac death and 484 (46 %) had no ethical concerns. Physicians (55%) and particularly junior intensivists (65%) tended to have more ethical issues than nurses (52%) and hospital managers (37%). Junior intensivists had more ethical issues than senior intensivists (59%), emergency room physicians (46%) and transplant specialists (43%). CONCLUSION Only 46% of hospital-based caregivers and managers appear to accept easily the legitimacy of organ donation after cardiac death. A significant number of respondents especially intensivists, expressed concerns over the dilemma between the interests of the individual and those of society. These results underline the need to better inform both healthcare professionals and the general population to help to the development of such procedure.
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Affiliation(s)
- V. GOUDET
- Medical Intensive Care Department; Poitiers University and Poitiers University Hospital; Poitiers France
| | - M. ALBOUY-LLATY
- Department of Quality; Poitiers University and Poitiers University Hospital; Poitiers France
| | - V. MIGEOT
- Department of Quality; Poitiers University and Poitiers University Hospital; Poitiers France
| | - B. PAIN
- Faculty of Medicine Poitiers; University of Poitiers; Poitiers France
| | - C. DAYHOT-FIZELIER
- Neurosurgical Intensive Care Department; Poitiers University and Poitiers University Hospital; Poitiers France
| | - M. PINSARD
- Organ Donation Coordinating Department; Poitiers University and Poitiers University Hospital; Poitiers France
| | - R. GIL
- Neuropsychological Unit; Poitiers University and Poitiers University Hospital; Poitiers France
| | - S. BELOUCIF
- Department of Anesthesiology and Critical Care Medicine; Paris 13 University and Avicenne University Hospital; Paris France
| | - R. ROBERT
- Medical Intensive Care Department; Poitiers University and Poitiers University Hospital; Poitiers France
- Inserm Unit U927; Poitiers University and Poitiers University Hospital; Poitiers France
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Matesanz R, Coll E, Domínguez-Gil B, de la Rosa G, Marazuela R, Arráez V, Elorrieta P, Fernández-García A, Fernández-Renedo C, Galán J, Gómez-Marinero P, Martín-Delagebasala C, Martín-Jiménez S, Masnou N, Salamero P, Sánchez-Ibáñez J, Serna E, Martínez-Soba F, Pastor-Rodríguez A, Bouzas E, Castro P. Benchmarking in the process of donation after brain death: a methodology to identify best performer hospitals. Am J Transplant 2012; 12:2498-506. [PMID: 22682056 DOI: 10.1111/j.1600-6143.2012.04128.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A benchmarking approach was developed in Spain to identify and spread critical success factors in the process of donation after brain death. This paper describes the methodology to identify the best performer hospitals in the period 2003-2007 with 106 hospitals throughout the country participating in the project. The process of donation after brain death was structured into three phases: referral of possible donors after brain death (DBD) to critical care units (CCUs) from outside units, management of possible DBDs within the CCUs and obtaining consent for organ donation. Indicators to assess performance in each phase were constructed and the factors influencing these indicators were studied to ensure that comparable groups of hospitals could be established. Availability of neurosurgery and CCU resources had a positive impact on the referral of possible DBDs to CCUs and those hospitals with fewer annual potential DBDs more frequently achieved 100% consent rates. Hospitals were grouped into each subprocess according to influencing factors. Hospitals with the best results were identified for each phase and hospital group. The subsequent study of their practices will lead to the identification of critical factors for success, which implemented in an adapted way should fortunately lead to increasing organ availability.
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Affiliation(s)
- R Matesanz
- Organización Nacional de Trasplantes, Madrid, Spain.
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de la Rosa G, Domínguez-Gil B, Matesanz R, Ramón S, Alonso-Álvarez J, Araiz J, Choperena G, Cortés JL, Daga D, Elizalde J, Escudero D, Escudero E, Fernández-Renedo C, Frutos MA, Galán J, Getino MA, Guerrero F, Lara M, López-Sánchez L, Macías S, Martínez-Guillén J, Masnou N, Pedraza S, Pont T, Sánchez-Rodríguez A. Continuously evaluating performance in deceased donation: the Spanish quality assurance program. Am J Transplant 2012; 12:2507-13. [PMID: 22703439 DOI: 10.1111/j.1600-6143.2012.04138.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The Spanish Quality Assurance Program applied to the process of donation after brain death entails an internal stage consisting of a continuous clinical chart review of deaths in critical care units (CCUs) performed by transplant coordinators and periodical external audits to selected centers. This paper describes the methodology and provides the most relevant results of this program, with information analyzed from 206,345 CCU deaths. According to the internal audit, 2.3% of hospital deaths and 12.4% of CCU deaths in Spain yield potential donors (clinical criteria consistent with brain death). Out of the potential donors, 54.6% become actual donors, 26% are lost due to medical unsuitability, 13.3% due to refusals to donation, 3.1% due to maintenance problems and 3% due to other reasons. Although the national pool of potential donors after brain death has progressively decreased from 65.2 per million population (pmp) in 2001 to 49 pmp in 2010, the number of actual donors after brain death has remained at about 30 pmp. External audits reveal that the number of actual donors could be 21.6% higher if all potential donors were identified and preventable losses avoided. We encourage other countries to develop similar comprehensive approaches to deceased donation performance.
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Affiliation(s)
- G de la Rosa
- Organización Nacional de Trasplantes, Madrid, Spain.
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Baumann A, Claudot F, Audibert G, Mertes PM, Puybasset L. The ethical and legal aspects of palliative sedation in severely brain-injured patients: a French perspective. Philos Ethics Humanit Med 2011; 6:4. [PMID: 21303504 PMCID: PMC3041748 DOI: 10.1186/1747-5341-6-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 02/08/2011] [Indexed: 05/16/2023] Open
Abstract
To fulfill their crucial duty of relieving suffering in their patients, physicians may have to administer palliative sedation when they implement treatment-limitation decisions such as the withdrawal of life-supporting interventions in patients with poor prognosis chronic severe brain injury. The issue of palliative sedation deserves particular attention in adults with serious brain injuries and in neonates with severe and irreversible brain lesions, who are unable to express pain or to state their wishes. In France, treatment limitation decisions for these patients are left to the physicians. Treatment-limitation decisions are made collegially, based on the presence of irreversible brain lesions responsible for chronic severe disorders of consciousness. Before these decisions are implemented, they are communicated to the relatives. Because the presence and severity of pain cannot be assessed in these patients, palliative analgesia and/or sedation should be administered. However, palliative sedation is a complex strategy that requires safeguards to prevent a drift toward hastening death or performing covert euthanasia. In addition to the law on patients' rights at the end of life passed in France on April 22, 2005, a recent revision of Article 37 of the French code of medical ethics both acknowledges that treatment-limitation decisions and palliative sedation may be required in patients with severe brain injuries and provides legal and ethical safeguards against a shift towards euthanasia. This legislation may hold value as a model for other countries where euthanasia is illegal and for countries such as Belgium and Netherlands where euthanasia is legal but not allowed in patients incapable of asking for euthanasia but in whom a treatment limitation decision has been made.
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Affiliation(s)
- Antoine Baumann
- Département d'Anesthésie Réanimation, Hôpital Central, Centre Hospitalier Universitaire de Nancy, 29 avenue du Maréchal de Lattre de Tassigny, C.O. n°34, 54035 Nancy Cedex, France
| | - Frédérique Claudot
- Service de Médecine légale et de Droit de la Santé, Faculté de médecine de Nancy, 9 avenue de la Forêt de Haye, 54505 Vandoeuvre-les-Nancy Cedex, France
| | - Gérard Audibert
- Département d'Anesthésie Réanimation, Hôpital Central, C.H.U. de Nancy, Unité INSERM 961, Faculté de médecine de Nancy. France
| | - Paul-Michel Mertes
- Département d'Anesthésie Réanimation, Hôpital Central, C.H.U. de Nancy, Unité INSERM 961, Faculté de médecine de Nancy. France
| | - Louis Puybasset
- Service de Neuroréanimation, Centre Hospitalier Universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 boulevard de l'Hôpital, 75651 Paris Cedex 13, France
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Matesanz R, Domínguez-Gil B, Coll E, de la Rosa G, Marazuela R. Spanish experience as a leading country: what kind of measures were taken? Transpl Int 2011; 24:333-43. [PMID: 21210863 DOI: 10.1111/j.1432-2277.2010.01204.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A recent call for self-sufficiency in transplantation issued by the WHO faces variable worldwide activity, in which Spain occupies a privileged position, with deceased donation rates of 33-35per million population (pmp) and 85 transplants pmp. An evaluation of current challenges, including a decrease in deaths because of traffic accidents and cerebrovascular diseases, and a diversity of cultures in Spain, has been followed by a comprehensive strategy to increase organ availability. Actions include an earlier referral of possible donors to the transplant coordination teams, a benchmarking project to identify critical success factors in donation after brain death, new family approach and care methods, and the development of additional training courses aimed at specific groups of professionals, supported by their corresponding societies. Consensus documents to improve knowledge about safety limits for organ donation have been developed to minimize inappropriate discarding of organs. Use of organs from expanded criteria donors under an 'old for old' allocation policy has resulted from adaptation to the progressive decline of optimal organs. National strategic plans to deal better with organ shortage, while respecting solid ethical standards, are essential, as reflected in the WHO Guiding Principles and the Istanbul Declaration on Organ Trafficking and Transplant tourism.
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