We want to feel valued: eggs donors' experiences of donation

Egg donation in New Zealand is identity-release, with donor-conceived individuals having the right to access donors' identifying information at the age of 18. It also allows donors and previously unknown recipients to meet prior to donation. Further, donation is altruistic, although reimbursement of costs is possible. In our previous paper we explored the motivations of 21 egg donors in this context and reported that they are motivated to donate as an act of personal gift-giving to recipients who may become known to them through donation, and that they do not want to be compensated for this financially. In this paper, drawing on in-depth interviews, we report on donors' experiences of the donation process and subsequent to donation. Donors understood their donations to be a significant act, both for the recipients and their families, but also for themselves, particularly given the multiple sacrifices which they willingly made. Donors wished for their gift and their role to be valued and acknowledged through being appreciated, informed, involved and supported by recipients and clinics before, during and after their donations. These findings have implications for clinical practice and care, offering insight into how best to support donors prior and subsequent to donation.

Maximizing utility of nondirected living liver donor grafts using machine learning

Objective

There is an unmet need for optimizing hepatic allograft allocation from nondirected living liver donors (ND-LLD).

Materials and method

Using OPTN living donor liver transplant (LDLT) data (1/1/2000-12/31/2019), we identified 6328 LDLTs (4621 right, 644 left, 1063 left-lateral grafts). Random forest survival models were constructed to predict 10-year graft survival for each of the 3 graft types.

Results

Donor-to-recipient body surface area ratio was an important predictor in all 3 models. Other predictors in all 3 models were: malignant diagnosis, medical location at LDLT (inpatient/ICU), and moderate ascites. Biliary atresia was important in left and left-lateral graft models. Re-transplant was important in right graft models. C-index for 10-year graft survival predictions for the 3 models were: 0.70 (left-lateral); 0.63 (left); 0.61 (right). Similar C-indices were found for 1-, 3-, and 5-year graft survivals. Comparison of model predictions to actual 10-year graft survivals demonstrated that the predicted upper quartile survival group in each model had significantly better actual 10-year graft survival compared to the lower quartiles (p<0.005).

Conclusion

When applied in clinical context, our models assist with the identification and stratification of potential recipients for hepatic grafts from ND-LLD based on predicted graft survivals, while accounting for complex donor-recipient interactions. These analyses highlight the unmet need for granular data collection and machine learning modeling to identify potential recipients who have the best predicted transplant outcomes with ND-LLD grafts.

Donating a Kidney to a Stranger: Are Healthcare Professionals Facilitating the Journey? Results From the BOUnD Study

Unspecified kidney donors (UKDs) are approached cautiously by some transplant professionals. The aim of this study was to interrogate the views of UK transplant professionals towards UKDs and identify potential barriers. A purposely designed questionnaire was validated, piloted and distributed amongst transplant professionals at each of the 23 UK transplant centres. Data captured included personal experiences, attitudes towards organ donation, and specific concerns about UKD. 153 responses were obtained, with representation from all UK centres and professional groups. The majority reported a positive experience with UKDs (81.7%; p < 0.001) and were comfortable with UKDs undergoing major surgery (85.7%; p < 0.001). 43.8% reported UKDs to be more time consuming and 52% felt that a mental health assessment should take place before any medical tests. 77% indicated the need for a lower age limit. The suggested age range was broad (16-50 years). Adjusted mean acceptance scores did not differ by profession (p = 0.68) but higher volume centres were more accepting (46.2 vs. 52.9; p < 0.001). This is the first quantitative study of acceptance by transplant professionals to a large national UKD programme. Support is broad, however potential barriers to donation have been identified, including lack of training. Unified national guidance is needed to address these.

Dissociating the Multiple Psychological Processes in Everyday Moral Decision-Making with the CAN Algorithm

In previous research frameworks, researchers used an everyday dilemma to test people's altruistic versus egoistic inclination. However, there are at least three different psychological processes that could induce altruistic over egoistic decisions, i.e., stronger altruistic sensitivity, weaker egoistic sensitivity, and stronger overall action versus inaction preference. To dissociate these different psychological processes, we developed new materials and applied the CAN algorithm from traditional moral dilemma research in two studies. In Study 1, we designed scenarios varying with a 2 (egoistic/non-egoistic) × 2 (non-altruistic/altruistic) structure. Then, we recruited 209 participants to validate the scenarios and filtered six scene frameworks with 24 scenarios in total. In Study 2, we recruited 747 participants to judge whether they would conduct behavior that is simultaneously altruistic (or non-altruistic) and egoistic (or non-egoistic) in the filtered scenarios obtained from Study 1. They also filled in the Social Isolation Scale, Distress Disclosure Scale, and some other demographic information. As we dissociated the psychological processes using the CAN algorithm, significant correlations between social isolation and distress disclosure and three parameters (i.e., altruistic tendency, egoistic tendency, and overall action/inaction preference) underlying the altruistic choice were revealed to varying degrees. Other individual differences in the psychological processes in everyday moral decision-making were further demonstrated. Our study provided materials and methodological protocols to dissociate the multiple psychological processes in everyday moral decision-making. It promotes our insights on everyday moral decisions from a differential psychological processes perspective.

Altruistic acting caused by a touching hand: neural underpinnings of the Midas touch effect

Giving and receiving touch are some of the most important social stimuli we exchange in daily life. By touching someone, we can communicate various types of information. Previous studies have also demonstrated that interpersonal touch may affect our altruistic behavior. A classic study showed that customers give bigger tips when they are lightly touched by a waitress, which has been called the Midas touch effect. Numerous studies reported similar effects of touch on different kinds of helping or prosocial behaviors. Here, we aim to examine the neural underpinnings of this effect by employing a functional magnetic resonance imaging approach. While lying in the scanner, participants played different rounds of the dictator game, a measure of prosocial behavior. Before each round, participants were touched (or not touched in the control condition) by an experimenter. We found that touching the hand increased the likeliness to behave prosocial (but not the general liking of control stimuli), thereby confirming the Midas touch effect. The effect was predicted by activity in the primary somatosensory cortex, indicating that the somatosensory cortex here plays a causal role in prosocial behavior. We conclude that the tactile modality in social life may be much more important than previously thought.

Motivations for egg donation to previously unknown recipients: donation as a personal, relational act of giving

Egg donation has becoming increasingly common however there is a shortage of donors in many countries, including New Zealand. Research regarding motivations to donate in the context of New Zealand's open-identity and altruistic donation policy and practice is, thus far, limited. This in-depth qualitative study comprised interviews with 21 women to examine their motivations in donating to recipients previously unknown to them. Donors valued parenthood highly and had become aware of the fertility struggles of other women through their own experiences, those of friends or family, or through online personal accounts or advertising. The ability to select recipients and build a comprehensive picture of them, such as through reading recipient profiles or meeting them in person, as is possible in New Zealand, deepened their identification with recipients and thus their empathy and desire to help. They resisted commercial models, positioning themselves as by nature altruistic and regarding their donations as expressions of solidarity and acts of personal gift-giving to specific others who became known to them through donation. Donation was interpreted as a socially relational process, setting up expectations around relationships and ongoing connection. Such understandings have implications for recruitment as well as ongoing experiences and support needs.

Do Empathic Individuals Behave More Prosocially? Neural Correlates for Altruistic Behavior in the Dictator Game and the Dark Side of Empathy

Do empathic individuals behave more prosocially? When we think of highly empathic individuals, we tend to assume that it is likely that those people will also help others. Most theories on empathy reflect this common understanding and claim that the personality trait empathy includes the willingness to help others, but it remains a matter of debate whether empathic individuals really help more. In economics, a prominent demonstration that our behavior is not always based on pure self-interest is the Dictator Game, which measures prosocial decisions in an allocation task. This economic game shows that we are willing to give money to strangers we do not know anything about. The present study aimed to test the relationship between dispositional empathy and prosocial acting by examining the neural underpinnings of prosocial behavior in the Dictator Game. Forty-one participants played different rounds of the Dictator Game while being scanned with functional magnetic resonance imaging (fMRI). Brain activation in the right temporoparietal junction area was associated with prosocial acting (number of prosocial decisions) and associated with empathic concern. Behavioral results demonstrated that empathic concern and personal distress predicted the number of prosocial decisions, but in a negative way. Correlations with the amount of money spent did not show any significant relationships. We discuss the results in terms of group-specific effects of affective empathy. Our results shed further light on the complex behavioral and neural mechanisms driving altruistic choices.

New laws ban commercial surrogacy in India

Surrogacy is a controversial issue and most particularly when well-known celebrities have used it. It is a boon for couples where normal pregnancy is not possible but can be used for commercial exploitation. The Government of India passed a law on surrogacy in December 2018, which introduced many changes to the pre-existing rules, in particular, it bans commercial surrogacy and curtails the freedom of foreigners to apply for surrogacy in India. This has dealt a major blow to the agencies who organised surrogacy for foreigners. A key reason for passing this law was the unjust treatment of the women who provided surrogacy services. They had poor living conditions and often failed to receive the money that was paid by the intended parents to the agency.² There are some countries where commercial surrogacy is legal, including some states in the United States of America, Poland, Russia and many others.³ Some surrogate mothers suffer complications from the assisted reproductive technologies used; these mainly include ectopic pregnancy, psychological stress and ovarian hyper stimulation syndrome.⁴ Same sex couples, single parents and even infertile women should be encouraged to adopt children.

Global experience and perspective on anonymous nondirected live donation in living donor liver transplantation

Anonymous nondirected living liver donation (ANLLD), sometimes referred to as "altruistic" donation, occurs when a biologically unrelated person comes forward to donate a portion of his/her liver to a transplant candidate who is unknown to the donor. Here, we explore the current status of ANLLD with special consideration of published reports; US experience; impact on donor psychosocial outcomes; barriers to donation; and current global trends with respect to ethical considerations. Between 1998 and 2019, 105 anonymous nondirected living liver donor (ND-LLD) transplants have been documented in the US Scientific Registry of Transplant Recipients. Sixteen donors (15%) were reported to experience a postoperative complication. Currently, 89 donors remain alive (85%), 16 (15%) have unknown status, and none are confirmed deceased. Although there are only a handful of case series, these data suggest that ANLLD is a feasible option. While there are no liver-specific data, studies involving anonymous nondirected kidney donors suggest that anonymous donation does not adversely impact psychosocial outcomes in donors or recipients. There are substantial financial burdens and ethical considerations related to ANLLD. Further studies are required to assess donor demographics, psychosocial motivations, long-term health-related quality of life, and financial impact of ANLLD.

Influence of Self-Relevance and Reputational Concerns on Altruistic Moral Decision Making

Complex moral decision making may share certain cognitive mechanisms with economic decision making under risk situations. However, it is little known how people weigh gains and losses between self and others during moral decision making under risk situations. The current study adopted the dilemma scenario-priming paradigm to examine how self-relevance and reputational concerns influenced moral decision making. Participants were asked to decide whether they were willing to sacrifice their own interests to help the protagonist (friend, acquaintance, or stranger) under the dilemmas of reputational loss risk, while the helping choices, decision times and emotional responses were recorded. In Study 1, participants showed a differential altruistic tendency, indicating that participants took less time to make more helping choices and subsequently reported weaker unpleasant experience toward friends compared to acquaintances and strangers. In Study 2, participants still made these egoistically biased altruistic choices under the low reputational loss risk conditions. However, such an effect was weakened by the high reputational loss risks. Results suggested that moral principle guiding interpersonal moral decision making observed in our study is best described as an egoistically biased altruism, and that reputational concerns can play a key role in restraining selfish tendency.

Altruistic and self-serving goals modulate behavioral and neural responses in deception

People tell lies not only for their own self-interests but sometimes also to help others. Little is known about the ways in which different types of goals modulate behaviors and neural responses in deception. The present study investigated the neural processes associated with spontaneous deception that occurs with altruistic reasons (i.e. the money would be donated to charity), self-serving reasons (i.e. the participant receives all of the money) and mixed goals (i.e. the money would be equally split between the participant and the charity). Altruistic motivation for deception reduced the intensity of moral conflict and the subsequent mental cost of resolving this conflict, reflected by a smaller N2–P3 effect in the purely altruistic condition. When making decisions about whether to lie, self-interest was a stronger motivator than others’ interests, and the participants tended to lie more for themselves than for others. When the lie could be mutually beneficial for both of the self and others, the participants tended to lie even when they knew that they could be easily caught, but they actually lied for their own self-interest rather than for altruistic reasons. These findings shed light on the neural basis of ‘good lies’ and decision-making in mutually beneficial situations.

Moral Judgment and Empathic/Deontological Guilt

BACKGROUND

People often make complicated decisions to help or to punish perfect strangers. Harming someone or breaking some moral imperative is usually linked to feeling guilt, and several researches suggested the existence of two different kinds of guilt: altruistic/empathic and deontological.

AIM

Our study aimed to investigate the decision-making processes in moral and nonmoral judgments and assess how specific situations in which the subject is close to the victim or flanked by an authority can influence his decisions.

METHODS

We used three different moral conditions: Empathic Moral (the decision has made while physically close to the potential victims), Deontological Moral (the decision has made while flanked by an "authority"), and Standard Moral (without any influence); a fourth condition is represented by Nonmoral dilemmas (the subject must make a choice between two different things and this does not cause any harm or victims). Previously, a pilot study was carried out for validating the experimental stories to be used in the main study.

RESULTS

We observed a higher number of utilitarian/positive responses when individuals had to respond to Empathic Moral condition, with respect to Deontological Moral and Nonmoral dilemmas. Moreover, looking at the time needed to read the dilemma, under empathic guilt condition, people tended to be slower in reading the dilemmas than in other conditions and this both in case of positive and negative responses. No significant differences in time needed to effectively respond emerged.

CONCLUSIONS

These findings suggested that be physically close to potential victims or be flanked by an "authority" differentially influence the decision-making processes in moral judgment, inducing slower decisions and more utilitarian answers, particularly in the scenario of physical proximity.

Personal Development and Empowerment of Adolescents at Risk by Way of Prosocial Altruistic and Anonymous Activity: A Qualitative Perspective

Sahi is a unique program in Israel for adolescents at risk, based on the premise that altruistic and anonymous activities help and strengthen people who carry them out. The current research examines the factors leading juveniles at risk to be involved in the program and analyzes the impact of such activities on their behavior and perception of future. The findings are as follows: (a) Altruistic and anonymous activity is perceived as self-satisfying and as initiating feelings of behavioral independency, and (b) such activity is related to the development of self-confidence, empathy, and positive perception of the future. Implications of these results and limitations of the study are discussed.

Cord Blood Banking Standards: Autologous Versus Altruistic

Cord blood (CB) is either donated to public CB banks for use by any patient worldwide for whom it is a match or stored in a private bank for potential autologous or family use. It is a unique cell product that has potential for treating life-threatening diseases. The majority of CB products used today are for hematopoietic stem cell transplantation and are accessed from public banks. CB is still evolving as a hematopoietic stem cell source, developing as a source for cellular immunotherapy products, such as natural killer, dendritic, and T-cells, and fast emerging as a non-hematopoietic stem cell source in the field of regenerative medicine. This review explores the regulations, standards, and accreditation schemes that are currently available nationally and internationally for public and private CB banking. Currently, most of private banking is under regulated as compared to public banking. Regulations and standards were initially developed to address the public arena. Early responses from the medical field regarding private CB banking was that at the present time, because of insufficient scientific data to support autologous banking and given the difficulty of making an accurate estimate of the need for autologous transplantation, private storage of CB as "biological insurance" should be discouraged (1, 2, 3). To ensure success and the true realization of the full potential of CB, whether for autologous or allogeneic use, it is essential that each and every product provided for current and future treatments meets high-quality, international standards.

Selfish mothers indeed! Resource-dependent conflict over extended parental care in free-ranging dogs

Parent-offspring conflict (POC) theory provides an interesting premise for understanding social dynamics in facultatively social species. In free-ranging dogs, mothers increase conflict over extended parental care with their pups beyond the weaning stage. In this study, we investigated whether resource quality affects POC in the dogs that typically live in a highly competitive environment as scavengers. We built a theoretical model to predict the alternative options available to the mother in the context of food sharing with her pups when protein-rich food (meat) is provided, as compared to carbohydrate-rich food (biscuits). We fit the mothers' response from experimental data to the model and show that the mothers choose a selfish strategy, which can in turn ensure higher lifetime reproductive success, while depriving the current litter access to better resources. These results have interesting implications for understanding the social dynamics of the dogs, and the emergence of facultative sociality in a species that evolved from strongly social ancestors. We speculate that the tendency of increased conflict in resource-rich conditions might have driven the process of domestication in the ancestors of dogs which defected from their groups in favour of richer resources around human settlements.

Surrogacy: ethical and legal issues

Surrogacy refers to a contract in which a woman carries a pregnancy “for” another couple. Number of infertile couples from all over the World approach India where commercial surrogacy is legal. Although this arrangement appears to be beneficial for all parties concerned,there are certain delicate issues which need to be addressed through carefully framed laws in order to protect the rights of the surrogate mother and the intended parents.