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Cignarella A, Marshall A, Ranse K, Opdam H, Buckley T, Hewitt J. Identity Disclosure Between Donor Family Members and Organ Transplant Recipients: A Description and Synthesis of Australian Laws and Guidelines. JOURNAL OF BIOETHICAL INQUIRY 2023:10.1007/s11673-023-10287-y. [PMID: 38060147 DOI: 10.1007/s11673-023-10287-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 07/20/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION The disclosure of information that identifies deceased organ donors and/or organ transplant recipients by organ donation agencies and transplant centres is regulated in Australia by state and territory legislation, yet a significant number of donor family members and transplant recipients independently establish contact with each other. AIM To describe and synthesize Australian laws and guidelines on the disclosure of identifying information. METHOD Legislation and guidelines relevant to organ donation and transplantation were obtained following a search of government and DonateLife network websites. Information about the regulation of identity disclosure was extracted and synthesised using a process guided by Walt and Gilson's (1994) policy analysis framework. FINDINGS Nineteen documents were examined. Six guidelines refer to and were consistent with current legislation. Four documents did not address identity disclosure. All jurisdictions prohibit healthcare professionals from disclosing identifying information. In three states, the prohibition extends to all members of the public including donor family members and transplant recipients. CONCLUSION Restrictions on identity disclosure have implications for public promotion of donation and transplantation where sharing of stories and images of organ donors and transplant recipients is common. Further research is required to understand the perspective of donor family members, transplant recipients, and healthcare professionals impacted by the current laws.
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Affiliation(s)
- Anthony Cignarella
- School of Nursing and Midwifery, Griffith University, 1 Parklands Drive Southport, Gold Coast, QLD, 4222, Australia.
- Peninsula Health, Frankston Hospital, Learning Hub, 2 Hastings Road Frankston, Melbourne, VIC, 3084, Australia.
| | - Andrea Marshall
- School of Nursing and Midwifery, Griffith University, 1 Parklands Drive Southport, Gold Coast, QLD, 4222, Australia
| | - Kristen Ranse
- School of Nursing and Midwifery, Griffith University, 1 Parklands Drive Southport, Gold Coast, QLD, 4222, Australia
| | - Helen Opdam
- Intensive Care Unit, Austin Health, The Austin Hospital, 145 Studley Road Heidelberg, Melbourne, VIC, 3084, Australia
- Australian Organ and Tissue Authority, 14 Childers Street Level 3, Canberra City, ACT, 2601, Australia
| | - Thomas Buckley
- School of Nursing and Midwifery, The University of Sydney, Susan Wakil Health Building Level 8, D-18 Western Avenue Camperdown, Sydney, NSW, 2006, Australia
| | - Jayne Hewitt
- School of Nursing and Midwifery, Griffith University, 1 Parklands Drive Southport, Gold Coast, QLD, 4222, Australia
- Law Futures Centre, Griffith University Law School, 170 Kessels Road, Nathan, QLD, 4111, Australia
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Marcus K, Berner D, Hadaya K, Hurst S. Anonymity in Kidney Paired Donation: A Systematic Review of Reasons. Transpl Int 2023; 36:10913. [PMID: 36819123 PMCID: PMC9931741 DOI: 10.3389/ti.2023.10913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023]
Abstract
The objective of this study was to investigate reasons for or against anonymity that are pertinent to kidney paired donations (KPD). We conducted a systematic review of reasons using PubMed and Google Scholar until May 2022 and through snowballing. Inclusion criteria were publications that: 1) discussed organ donation anonymity; 2) was peer-reviewed; 3) presented at least one reason on anonymity. Exclusion criteria: 1) not published in a scientific journal; 2) grey literature and dissertations. Four researchers independently reviewed and selected papers based on the criteria, extracted text passages and coded them into narrow and broad reason types, selected reasons that were valid for kidney paired donations. 50 articles were included, 62 narrow reasons (n = 24 for; n = 38 against) and 13 broad reasons were coded. Broad reasons were: protection against harm, general benefits, gratitude, curiosity, unrealistic to implement, fundamental rights, respect people's wishes, professional neutrality, timing is important, information disclosure, altruism, reciprocity and donation pool. We did not find reasons that justify legal prohibition of donor-recipient interactions for KPD, if they consented to meet. Professional counselling, follow-up and careful evaluations to prevent potential harm.
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Affiliation(s)
- Kailing Marcus
- Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Delphine Berner
- Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Karine Hadaya
- Service of Nephrology and Hypertension, Geneva University Hospitals and Clinique des Grangettes-Hirslanden, Geneva, Switzerland
| | - Samia Hurst
- Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Azuri P, Tarabeih M. Standing on Both Sides: Analysis of a Transplant Coordinator's Ethical Position Between the Recipient and the Donor's Family. Transplant Proc 2022; 54:1683-1689. [PMID: 35909012 DOI: 10.1016/j.transproceed.2022.03.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/16/2022] [Accepted: 03/26/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND When an organ is harvested from a deceased donor, how should transplant coordinators handle the issue of contact between the donor's family and the organ recipient? METHODS The authors-qualified both by their own considerable practical experience and theoretical investigation-discussed various aspects of the problem, relating to the bioethical issues as well as the practical dilemmas that must be clarified and decided. RESULTS They proposed a strategy whereby transplant coordinators can analyze their own philosophical attitude toward the issue and respond accordingly in their work to the needs and preferences of both parties. CONCLUSIONS The professionals handling the transplant process need training tailored to the bioethical issues relevant to the challenges they are likely to confront. This training must consist not only of theoretical and ethical guidance but also simulations designed to clarify the clinician's own personal belief system and raise awareness and self-reflection of their own biases.
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Affiliation(s)
- Pazit Azuri
- School of Nursing Science, Tel Aviv-Yafo Academic College Israel.
| | - Mahdi Tarabeih
- School of Nursing Sciences, Tel Aviv-Yafo Academic College, Jaffa, Israel.
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Cignarella A, Ranse K, Hewitt J, Opdam H, Romero L, Marshall A. Identity disclosure between donor families and organ transplant recipients: an integrative review of the international literature. PSYCHOL HEALTH MED 2022:1-23. [PMID: 35272546 DOI: 10.1080/13548506.2022.2050272] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Anonymity of deceased organ donation is a legal requirement in many international jurisdictions where legislation prohibits health professionals from disclosing identifiable information about donors, recipients or their families. Written correspondence between donor families and transplant recipients that is coordinated by healthcare professionals must remain anonymous. Internationally, an increasing number of donor families and transplant recipients have advocated for law reform and policy amendment to enable the exchange of identifiable written correspondence and/or face-to-face meetings. This paper aims to synthesise and critically evaluate published, peer-reviewed literature on the perceptions, benefits and challenges of identifiable communication or anonymity between donor families and organ transplant recipients in the international context. Analysis of the findings revealed two major themes: (1) views held by donor families, transplant recipients and healthcare professionals towards identity disclosure in the context of organ donation are diverse across and within groups (2) there are benefits and burdens associated with connecting donor families and transplant recipients through written correspondence. Less is known about the impact of face-to-face meetings between donor families and transplant recipients. However, what is known is that for some donor families, meeting with the transplant recipient(s) may provide a range of positive emotions.
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Affiliation(s)
- Anthony Cignarella
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,The Alfred Hospital, Alfred Health, Nursing Education, Melbourne, Victoria, Australia.,The Alfred Hospital, Alfred Health, Intensive Care Unit, Melbourne, Victoria, Australia
| | - Kristen Ranse
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jayne Hewitt
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Griffith Law School, Griffith University, Gold Coast, Queensland, Australia
| | - Helen Opdam
- Australian Organ and Tissue Authority, Canberra, NSW, Australia.,The Austin Hospital, Austin Health, Intensive Care Unit, Melbourne, Victoria, Australia
| | - Lorena Romero
- The Alfred Hospital, Alfred Health, Melbourne, Victoria, Australia
| | - Andrea Marshall
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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Legislative proposal in Italy to facilitate contacts between deceased organ donor families and transplant recipients. J Nephrol 2020; 33:1333-1342. [PMID: 32776279 DOI: 10.1007/s40620-020-00824-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
Contacts between organ donors and recipients might be possible in the near future in Italy. As suggested by The Italian Committee of Bioethics "anonymity is requested by the Italian National Transplant Centre" before transplantation anonymity shall be strict in order to grant privacy, gratuity, justice, solidarity and benefits and avoids organ trafficking. Following a period that is ethically correct and justifiable, organ donor families and recipients can meet after signing a valid declaration of consent, expressed on a template valid for the whole country. A third party within the body of the National Health Systems shall control the validity of the consent. The opinion stresses that contacts are not a right but a possibility justifiable on ethical grounds if the procedure is followed appropriately. A legislative proposal has been presented before the Chamber of deputies incorporating all suggestions made by the National Committee of Bioethics. The agreement between parties might be signed a year after transplantation. This is a long enough period of time for the recipients to fully appreciate the benefits of the procedure and for the donor families to see the effects of their decision (the opinion and the Law proposal hit the Zeitgeist, and keep Italy in the regulation of European Union).
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Łuków P. Pure Altruistic Gift and the Ethics of Transplant Medicine. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:95-107. [PMID: 31823186 PMCID: PMC7260251 DOI: 10.1007/s11673-019-09951-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
The article argues that altruistic giving based on anonymity, which is expected to promote social solidarity and block trade in human body parts, is conceptually defective and practically unproductive. It needs to be replaced by a more adequate notion which responds to the human practices of giving and receiving. The argument starts with identification of the main characteristics of the anonymous altruistic donation: social separation of the organ donor (or donor family) from the recipient, their mutual replaceability, non-obligatoriness of donation, and non-obligatoriness of reciprocation on the recipient's part. Since these characteristics are also central to typical market relations, anonymous altruistic donation not only cannot promote solidarity but may encourage proposals for (regulated) markets of transplantable organs. Thus, transplant ethics needs to be reframed. It needs to be rooted in, rather than promote, the practices of giving and receiving known to human societies. As the basis for such reframing, the idea of sharing in another's misfortune is proposed. It relies on the human practices of giving and receiving and, with appropriate regulatory safeguards, can provide a better conceptual basis for blocking commercial exchanges of human body parts.
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Affiliation(s)
- Paweł Łuków
- Instytut Filozofii, Uniwersytet Warszawski, Krakowskie Przedmieście 3, 00-927, Warszawa, Poland.
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Dicks SG, Northam H, van Haren FMP, Boer DP. An exploration of the relationship between families of deceased organ donors and transplant recipients: A systematic review and qualitative synthesis. Health Psychol Open 2018; 5:2055102918782172. [PMID: 30083368 PMCID: PMC6069040 DOI: 10.1177/2055102918782172] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Following deceased organ donation and transplantation, the narratives of families of donors and organ recipients become connected. This is acknowledged when parties receive anonymous information from donation agencies and transplant centres, when they exchange correspondence or when they meet in person. This article reviews literature describing the experience from the points of view of donor families, recipients, and other stakeholders to explore the dynamic system that evolves around this relationship. Findings highlight a link between identity development and ongoing adjustment and will assist those supporting donor families and recipients to make decisions that fit meaningfully.
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Affiliation(s)
| | | | - Frank MP van Haren
- University of Canberra, Australia
- Australian National University,
Australia
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Gewarges M, Poole J, De Luca E, Shildrick M, Abbey S, Mauthner O, Ross H. Canadian Society of Transplantation Members' Views on Anonymity in Organ Donation and Transplantation. Transplant Proc 2016; 47:2799-804. [PMID: 26707291 DOI: 10.1016/j.transproceed.2015.09.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 09/17/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anonymity has been central to medical, psychosocial, and societal practices in organ donation and transplantation. The purpose of this investigation was to explore transplant professionals' views on anonymity in the context of organ transplantation. METHODS The study consisted of an electronic 18-item survey distributed to the Canadian Society of Transplantation membership, asking about anonymity vs open communication/contact between organ recipients and donor families. RESULTS Of the 541 members surveyed, 106 replied. Among respondents, 71% felt that organ recipients and donor families should only communicate anonymously, yet 47% felt that identifying information could be included in correspondence between consenting recipients and donor families. When asked whether organ recipients and donor families should be allowed to meet, 53% of respondents agreed, 27% disagreed, and 20% neither agreed nor disagreed. With social media facilitating communication and eliminating the ability to maintain donor/recipient anonymity, 38% of respondents felt that a reexamination of current policies and practices pertaining to anonymity was necessary. CONCLUSION In conclusion, there was no dominant position on the issue of anonymity/communication between donor families and transplant recipients. Further research and discussion concerning the views of healthcare professionals, organ recipients, and donor families on the mandate of anonymity is needed and may influence future policy.
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Affiliation(s)
- M Gewarges
- Division of Cardiology and Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
| | - J Poole
- School of Social Work, Faculty of Community Services, Ryerson University, Toronto, Ontario, Canada
| | - E De Luca
- Division of Cardiology and Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
| | - M Shildrick
- Tema Genus, Linköping University, Linköping, Sweden
| | - S Abbey
- Department of Psychiatry, Toronto General Hospital, Toronto, Ontario, Canada
| | - O Mauthner
- Division of Cardiology and Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
| | - H Ross
- Division of Cardiology and Transplantation, Toronto General Hospital, Toronto, Ontario, Canada.
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Opinions of Dutch Liver Transplant Recipients on Anonymity of Organ Donation and Direct Contact With the Donors Family. Transplantation 2015; 99:879-84. [DOI: 10.1097/tp.0000000000000394] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Azuri P, Tabak N, Kreitler S. Contact between deceased donors' families and organ recipients. Prog Transplant 2014; 23:342-9. [PMID: 24311398 DOI: 10.7182/pit2013708] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The benefits and disadvantages of posttransplant contact between a donor family and the organ recipient are disputed. In this study far more contacters reported benefits rather than disadvantages and noncontacters reported the opposite. The dissatisfaction of noncontacters with no contact was high: no less than 60% wanted some form of contact in the future. The authors conclude that contact has more benefits for the donor family than disadvantages, evidenced by families' desire to maintain contact with the organ recipient. Both donor families and organ recipients need the transplant coordinator's initiative and guidance on this issue.
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Affiliation(s)
- Pazit Azuri
- Israel Ministry of Health, Jerusalem, Israel
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