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Despite a significant legal transformation of the organ donation system in China, the public's willingness to become organ donors remains low. This study provides the first empirical examination of how Chinese newspaper coverage reflects the complex interplay among multifaceted factors associated with the stagnant donation rate. Using framing as the primary theoretical lens, we analyzed 923 organ donation newspaper articles from 2000 to 2018 in terms of topics, facilitators and barriers, valence, and policy development. The three most common topics emphasized were: a new official information release regarding organ donation promotion; the challenges of promoting organ donation in social, cultural, and legal contexts; and the positive emotional appeals of organ donors, coordinators, and transplant surgeons. Findings suggest that the values that facilitators of and barriers to organ donation represent can be culturally favored but in conflict with each other. Sharp increases in the presence of policy development framing are associated with the official announcements of new legislation. A better understanding of trending topics and interacting influence from facilitators and barriers is imperative for developing culturally tailored messages to raise awareness about organ donation promotion. [ABSTRACT FROM AUTHOR]

Being inherently different from any other lifesaving organ transplant, uterine transplantation does not aim at saving lives but supporting the possibility to generate life. Unlike the kidneys or the liver, the uterus is not specifically a vital organ. Given the non-lifesaving nature of this procedure, questions have been raised about its feasibility. The ethical dilemma revolves around whether it is worth placing two lives at risk related to surgery and immunosuppression, amongst others, to enable a woman with absolute uterine factor infertility to experience the presence of an organ enabling childbirth. In the year 2000, the first uterine transplantation, albeit unsuccessful, was performed in Saudi Arabia from where it has spread to the rest of the world including Sweden, the United States and now recently India. The procedure is, however, still in the preclinical stages and several ethical, legal, social and religious concerns are yet to be addressed before it can be integrated into the clinical setting as standard of care for women with absolute uterine factor infertility. [ABSTRACT FROM AUTHOR]

The article discusses The Book of Ruth in the Hebrew Bible that has carved out a prominent niche throughout the history of the Western Humanities dealing with how the story proceeds with a metaphorical retelling of Ruth's story in a unique context solid organ transplantation. Topics include struggles of organ recipients and donors, American transplantation protocol and ethics, and Cartesian dualism.

The article discusses human head transplants and debates on its based on the novel "Frankenstein" by Mary Shelley indicating tha even if the procedure were to attain technical and safety feasibility, it's of importance to demonstrate now why human head transplants should never be done ethically. Topics include responsibilities of American medical-research community, use of HEAVEN (HEad Anastomosis VENture) and SCF (GEMINI3 SPINAL CORD FUSION), and sociological aspects of human head transplants.

There are over 90,000 patients in the United States waiting for a kidney transplant. Under the current allocation policy, the vast majority of deceased organs are allocated locally. This causes significant disparities in waiting times and access to transplant across different geographical areas. To ameliorate this inequity, we propose an operational solution that offers affordable jet services (OrganJet) to patients on the transplant waiting list, allowing them to list in multiple different, and possibly very distant, donation service areas (DSAs) of their choosing. First, using a fluid approximation, we formulate the patients' problem of choosing a location to multiple list as a selfish routing game in which each patient tries to minimize his 'congestion cost,' i.e., maximize his life expectancy. Through a combination of numerical, simulation, and analytical results, we show that multiple listing can lead to a significant improvement in geographic equity. In the special case when sufficiently many patients can multiple list, the geographic inequity disappears. Moreover, the supply of deceased donor organs increases under multiple listing, leading to more transplants and saved lives. We also consider a diffusion approximation and study the resulting multiple-listing game. The equilibrium outcome under the diffusion approximation is a second-order perturbation of that under the selfish routing formulation. In particular, the geographic equity metric, waiting times, and probabilities of receiving a transplant at various DSAs in equilibrium are second-order perturbations of those predicted by the selfish routing equilibrium. Hence, the analysis under the diffusion approximation also supports the finding that multiple listing leads to an improvement in geographic equity. In addition, restricting attention to the special case of sufficiently many patients multiple listing leads to an explicit characterization of the equilibria, which in turn yields additional structural insights. Last, we undertake a simulation study that supports aforementioned findings. This paper was accepted by Assaf Zeevi, stochastic models and simulation. [ABSTRACT FROM AUTHOR]

The activation of Ras-related C3 botulinum toxin substrate 1 (Rac1) is critical in the renal, hepatic and cardiac diseases that lead to the requirement for transplantation, however, no investigations have been performed in Chinese populations to determine the association between RAC1 genotypes and the activation of Rac1. In the present study, 304 solid organ transplant recipients (SOTRs), consisting of 164 renal transplantations, 85 hepatic transplantations and 55 cardiac transplantations, and 332 Chinese healthy control subjects were recruited to investigate whether differences existed in the mRNA and protein expression levels of Rac1 in the different groups. Furthermore, the present study identified and investigated associations of the RAC1 (rs702482, rs10951982, rs702483 and rs6954996) genotypes with the mRNA expression levels of RAC1, and the protein expression levels of total Rac1 and active Rac1-guanosine triphosphatase (GTP). It was identified that the healthy population had significantly higher levels of Rac1 and Rac1-GTP, compared with the kidney, liver and heart transplantation populations (P<0.001 for all comparisons). Significant associations (P<0.05) were observed between the RAC1 genotypes and the expression levels of mRNA, Rac1 and Rac1-GTP. However, the changes in the mRNA expression levels of RAC1 with genotypes were different from those of the proteins. The results of the present study represent the first, to the best of our knowledge, to report that Rac1 and Rac1-GTP proteins can be downregulated in SOTRs, and that RAC1 genetic polymorphisms can potentially affect the mRNA expression of RAC1, and the protein expression of Rac1 and Rac1-GTP. These results provide a foundation for further functional investigations to determine the biological and molecular functions of the RAC1 gene in SOTRs. [ABSTRACT FROM AUTHOR]

Adolescent organ transplant recipients have an increased risk of developing skin cancer. The aim of this study was to evaluate the technical feasibility and acceptability of short messaging service-based sun protection recommendations for adolescent patients. Sun-protective knowledge and behaviour were also evaluated using standardized questionnaires and telephone interviews. Twenty-six organ transplant recipients aged 13-22 years participated in face-to-face sun protection training. Subsequently, participants received sun protection reminders via text messages for 4 weeks. Of the participants 95% reported that they checked text messages on a regular basis. Of the 26 organ transplant recipients 19 completed questionnaires before sun protection training and 4 weeks later; 16% (3/19) knew the meaning of the UV-index before training. After training, 74% (14/19) remembered that the term UV-index describes the maximum daily level of local UV radiation. Text message-based sun protection recommendations are well accepted and technically feasible in adolescent organ transplant recipients. [ABSTRACT FROM AUTHOR]

Adverse changes in nutrition-related outcomes including quality of life (QoL) occur after PBSC transplantation. This randomised controlled trial aims to evaluate the impact of nutrition and exercise counselling provided at hospital discharge on nutritional status, body composition and QoL post transplantation. Usual care (UC) (n=19) received no intervention after discharge; extended care (EC) (n=18) received fortnightly telephone counselling from a dietitian and exercise physiologist up to 100 days post transplantation. Nutritional status (patient-generated subjective global assessment, and diet history), QoL (EORTC QLQ-C30 version 3) and body composition (air displacement plethysmography) were assessed at pre-admission, discharge and 100 days post transplantation. Intervention groups were compared using two-sample t-tests of changes in the outcomes; results were adjusted using analysis of covariance. EC exhibited clinically important but not statistically significant increases in protein intake (14.7 g; confidence interval (CI) 95% −6.5, 35.9, P=0.165), cognitive functioning (7.2; CI 95% −7.9, 22.2, P=0.337) and social functioning (16.5; CI 95% −7.3, 40.3, P=0.165) compared with UC. Relative to pre-admission, EC experienced less weight loss than UC (−3.3 kg; CI 95% −6.7, 0.2, P=0.062). Physical activity was not significantly different between the groups. Ongoing nutrition and exercise counselling may prevent further weight loss and improve dietary intake and certain QoL components in autologous PBSC transplantation patients following hospitalisation. [ABSTRACT FROM AUTHOR]

Previous research has begun to delineate the complicated reactions experienced by bone marrow and stem cell donors. The purpose of this study was to examine the influence of the donor-recipient relationship on the related donor's emotional reactions. Twenty-eight adult stem cell donors completed questionnaires before donation, 30 days post stem cell infusion, and 1 year after infusion. Questionnaires addressed the donor-recipient relationship, depression, mood, guilt and responsibility, self-esteem, ambivalence about donation and reactions to the donation itself. Results indicated that most donors reported little ambivalence about donation, and their reactions to the donation itself were generally positive. Closer and more positive donor-recipient relationships were associated with less anticipated guilt and responsibility if the transplant did not work. The relationships between the donor and the recipient did not change over time. Mood disturbance and depression were low overall, not related to the donor-recipient relationship, and did not significantly change over time. These results indicate that related stem cell donors are generally without significant emotional distress, and are comfortable with the donation process. Further, a more positive relationship with the recipient may help donors to avoid feeling guilty and responsible if the transplant does not work. [ABSTRACT FROM AUTHOR]

This paper discusses the views of 17 healthcare practitioners involved with transplantation on the ethics of live liver donations (LLDs). Donations between emotionally related donor and recipients (especially from parents to their children) increased the acceptability of an LLD compared with those between strangers. Most healthcare professionals (HCPs) disapproved of altruistic stranger donations, considering them to entail an unacceptable degree of risk taking. Participants tended to emphasise the need to balance the harms of proceeding against those of not proceeding, rather than calculating the harm-to-benefits ratio of donor versus recipient. Participants' views suggested that a complex process of negotiation is required, which respects the autonomy of donor, recipient and HCP. Although they considered that, of the three, donor autonomy is of primary importance, they also placed considerable weight on their own autonomy. Our participants suggest that their opinions about acceptable risk taking were more objective than those of the recipient or donor and were therefore given greater weight. However, it was clear that more subjective values were also influential. Processes used in live kidney donation (LKD) were thought to be a good model for LLD, but our participants stressed that there is a danger that patients may underestimate the risks involved in LLD if it is too closely associated with LKD. [ABSTRACT FROM AUTHOR]

This commentary discusses a set of essays, arguing that each examines a demand for the extraction or ‘excorporation’ of organic form to supplement a lack elsewhere, whether the apperception of that lack be located in the clinic, in national or regional politics, or in big data as databases come to promise the ground of inclusion and future life. Reading through and across the essays, it proposes a conceptual vocabulary rooted in a figure of ‘commitment’ or the ‘given over’, this given over opposed to an analytics of the gift. The argument is made that the body emerges as a ground for thought and action in its being given over to another, in its commitment. An analytics of commitment addresses the relation of parts and wholes in our attending to practices of excorporation and designations of sacrifice. [ABSTRACT FROM PUBLISHER]

Purpose: We evaluated unrelated living kidney donation in the United States and examined the characteristics of unrelated donor-recipient pairs. Materials and Methods: We accessed United Network for Organ Sharing files to identify adult living donor renal transplant recipients who received a transplant between 1997 and 2007. We evaluated factors associated with unrelated donation and compared a composite index of the socioeconomic characteristics of donor and recipient ZIP Codes between living unrelated and living related renal transplantation pairs. Spousal pairs were categorized as living related. Results: Of 39,168 adult renal transplant recipients 19% underwent living unrelated renal transplantation. These recipients were more likely white (vs black, Hispanic and other race OR 0.77–0.82, p <0.05) and more highly educated (college vs less than high school OR 0.66, 95% CI 0.54–0.77), and more commonly received care at high volume transplant centers (vs lowest volume centers OR 0.89, 95% CI 0.82–0.95). Living unrelated renal transplantation recipients and donors lived in higher socioeconomic status index ZIP Codes than living related recipients (mean ± SD recipients and donors 0.62 ± 3.74 and 0.44 ± 3.63 vs 0.03 ± 3.85 and 0.10 ± 3.87, respectively, each p <0.001). Conclusions: Living unrelated renal transplantation donors and recipients are generally of higher socioeconomic status than their living related renal transplantation counterparts. There is restricted access to unrelated donors among underserved populations. [Copyright &y& Elsevier]

The article presents the authors' insight on the role of government accountability in organ transplantation. They emphasize the use of legal framework of governments in addressing the needs of their countries in legal and ethical purchase of organs from living donors and note the implementation of medical strategies in preventing end-stage organ failure. Moreover, the authors mention the importance of regional cooperation between countries to render comprehensive transplantation service.

Organ procurement coordinators (OPCs) face a formidable communication task when making familial requests for consent to organ donation, because they must provide social support for grieving family members while seeking compliance to the donation request. Structured interviews were conducted with 102 OPCs, representing 16 organ procurement organizations (OPOs) (27.6% of national organizations) across the United States. Responses were transcribed and content-analyzed along four domain areas: (a) establishing credibility, (b) message strategies, (c) timing/setting of requests, and (d) adaptation of messages to diverse families. OPO conversion rates were used as a criterion factor for OPCs' persuasive communication success and regressed onto self-reported strategy use. Results indicate message strategies varied at the OPC level of analysis and 7 techniques significantly predicted 32% of the variance in conversion rates. Two strategies (i.e., gaining early intervention, approaching with additional support) positively influenced conversion rates, whereas 5 strategies (e.g., discussing benefits as a persuasive strategy, emphasizing the need for donation in particular racial/ethnic groups) negatively influenced conversion rates. Future research is recommended to validate the study findings toward the goal of improving OPCs' communication strategies. [ABSTRACT FROM AUTHOR]

Starting with the relevance of the Spanish experience, this study analyses the population's disposition towards organ donation after death by means of a representative survey of the adult Spanish population ( N = 1206, estimated error ±2.87%, P < 0.05). Of the participants, 8.1% were declared donors, 59.3% were likely to donate, 14.5% were against donating and 18.1% did not know or did not respond; 87.3% would donate relative's organs if the deceased favoured donation, 50.2% if the deceased's wishes were unknown and 13.1% even if the deceased opposed donation. Among people who were favourable towards donation, the main motives expressed were the will to save other people's lives, solidarity and knowing they might someday need a donation. The most important motives for not donating among participants who were against it were the fear of premature organ extraction, of premature pronouncement of death and of mutilation. Reticence to donate is associated with low socio-economic and cultural level, advanced age and high religious commitment; it is also associated with a low perception of transplant efficacy, not directly knowing any transplanted people and the lack of qualified information. The results support diverse potentially effective strategies for promoting donation in the general population. [ABSTRACT FROM AUTHOR]

Wong LP. Knowledge, attitudes, practices and behaviors regarding deceased organ donation and transplantation in Malaysia's multi-ethnic society: a baseline study. Clin Transplant 2011: 25: E22-E31. © 2010 John Wiley & Sons A/S. Malaysia's organ and tissue donation rates are among the lowest in the world. The study aims to explore the knowledge, attitudes, practices and behaviors regarding deceased organ donation and transplantation in the diverse ethnic communities in the state of Selangor, Malaysia. A cross-sectional, population-based, computer-assisted telephone interview exploring multi-ethnic participants' knowledge, attitudes, practices and behavioral on deceased organ donation and transplantation was conducted from February to April 2009. Although only 5.5% of the total participants (N = 1174) reported that they have registered to be organ donor, a further 35.2% of those who have not register for organ donation indicated willingness to donate their own. Significant socio-demographic disparities with respect to knowledge and attitudes scores were observed. In particular, Malays (20.7%) indicated lower willingness to donate organs compared to the Chinese (36.6%) and Indians (51.4%) (p < 0.001). In multivariate logistic regression analysis, willingness to donate one's own organ was associated with knowledge score (odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.13-1.22), attitude score (OR = 1.17, 95% CI = 1.05-1.31), secondary school education (OR = 1.46, 95% CI = 1.05-2.02), and Malay ethnicity (OR = 0.18, 95% CI = 0.03-0.94). Findings assist organ donation and transplantation organizations to reach out the diverse socio-demographic and ethnic communities with cultural-specific information about organ donation. [ABSTRACT FROM AUTHOR]

Purpose: An endobronchial valve developed for treatment of severe emphysema has characteristics favorable for bronchoscopic treatment of air leaks. We present the results of a consecutive case series treating complex alveolopleural fistula with valves. Description: Patients with air leaks that persisted after treatment gave consent and compassionate use approval was obtained. Bronchoscopy with balloon occlusion was used to identify the airways to be treated. IBV Valves (Spiration, Redmond, WA) were placed after airway measurement. Evaluation: During a 15-month period, 8 valve placement procedures were performed in 7 patients and all had improvement in the air leak. The median duration of air leakage was 4 weeks before and 1 day after treatment, with a mean of 4.5 days. Discharge within 2 to 3 days of the procedure occurred in 57% of the patients. A median of 3.5 valves (mode, 2.4) were used, and all valve removals were successful. There were no procedural or valve-related complications. Conclusions: Removable endobronchial valves appear to be a safe and effective intervention for prolonged air leaks. [Copyright &y& Elsevier]

Summary Angiograms of cardiac transplant (HTx) recipients were to be evaluated in a ring experiment and a joint consensus on criteria of angiographic evaluation of coronary arteries of HTx patients was to be reached. Twenty-four coronary angiograms from 11 hospitals were circulated. One hundred eighty-eight blinded evaluations were returned. A joint evaluation by six experienced cardiologists was used as reference standard and a consensus evaluation form was developed. Significant lesions (stenosis 75%, 50% in the left main coronary artery) were diagnosed in 10/23 abnormal coronary angiograms (41.7%). Interventional revascularization was recommended in 8/10 (80%). In 21 coronary angiograms distal pruning was found and in 11/21 (52.4%) cases with distal pruning occlusion of at least one peripheral vessel was detected. The best kappa value (0.7) was found for the presence of at least one clinically significant stenosis. Agreement on the site and grade of local stenosis was much less. Some agreement on remodeling was found in assessing diffuse narrowing in the LCA (kappa = 0.371, P < 0.001). The kappa value for peripheral obliteration was 0.331 ( P = 0.001). Angiographic evaluation of cardiac allograft vasculopathy, particularly of diffuse and peripheral disease and remodeling, needs standardization. This should be performed in a downward compatible improvement process. [ABSTRACT FROM AUTHOR]

In this comparative analysis of twelve focus groups conducted in Austria, France, and the Netherlands, we investigate how lay people come to terms with two biomedical technologies. Using the term ''technopolitical culture,'' we aim to show that the ways in which technosciences are interwoven with a specific society frame how citizens build their individual and collective positions toward them. We investigate how the focus group participants conceptualized organ transplantation (OT) and genetic testing (GT), their perceptions of individual agency in relation to the two technologies and to more collective forms of acting and governing, and also their understanding of the two technologies' relationship to broader societal value systems. Against the background of the sustained political effort to build common European values, we suggest that more fine-grained attention toward the culturally embedded differences in coming to terms with biomedical technologies is needed. [ABSTRACT FROM AUTHOR]

Mere observation of others' choices can be informative about product quality. This paper develops an individual-level dynamic model of observational learning and applies it to a novel data set from the U.S. kidney market, where transplant candidates on a waiting list sequentially decide whether to accept a kidney offer. We find strong evidence of observational learning: patients draw negative quality inferences from earlier refusals in the queue, thus becoming more inclined towards refusal themselves. This self-reinforcing chain of inferences leads to poor kidney utilization despite the continual shortage in kidney supply. Counterfactual policy simulations show that patients would have made more efficient use of kidneys had the concerns behind earlier refusals been shared. This study yields a set of marketing implications. In particular, we show that observational learning and information sharing shape consumer choices in markedly different ways. Optimal marketing strategies should take into account how consumers learn from others. [ABSTRACT FROM AUTHOR]

Abstract: Cell and tissue engineering are now being translated into clinical organ replacement, offering alternatives to fight morbidity, organ shortages and ethico-social problems associated with allotransplantation. Central to the recent first successful use of stem cells to create an organ replacement in man was our development of a bioreactor environment. Critical design features were the abilities to drive the growth of two different cell types, to support 3D maturation, to maintain biomechanical and biological properties and to provide appropriate hydrodynamic stimuli and adequate mass transport. An analytical model was developed and applied to predict oxygen profiles in the bioreactor-cultured organ construct and in the culture media, comparing representative culture configurations and operating conditions. Autologous respiratory epithelial cells and mesenchymal stem cells (BMSCs, then differentiated into chondrocytes) were isolated, characterized and expanded. Both cell types were seeded and cultured onto a decellularized human donor tracheal matrix within the bioreactor. One year post-operatively, graft and patient are healthy, and biopsies confirm angiogenesis, viable epithelial cells and chondrocytes. Our rotating double-chamber bioreactor permits the efficient repopulation of a decellularized human matrix, a concept that can be applied clinically, as demonstrated by the successful tracheal transplantation. [Copyright &y& Elsevier]

The purpose of this ex post facto investigation is to determine whether there are differences in a series of psychosocial variables (anxiety, depression, Type A behavior pattern, and social support), which can be assessed immediately after transplantation, between the transplanted patients who die and those who are still alive one year after the transplant. From a group of 166 transplanted patients, we selected two subgroups (22 living transplanted patients and 22 deceased transplanted patients) that were homogeneous in the main sociodemographic and clinical variables. We used a psychosocial survey, the Hospital Anxiety and Depression Scale, the Type A Characteristics Checklist, and the Scale for the Assessment of Social Support. The results showed that the patients who subsequently died, had higher levels of depression, and particularly anxiety, immediately after the transplant. In contrast, the subgroups did not differ in Type A behavior pattern or level of social support. We conclude that symptoms of anxiety and depression at that moment of the medical process, may allow us to distinguish patients who will die from those who will survive. [ABSTRACT FROM AUTHOR]

Few health policy issues in the U.S. are scrutinized as intensely as the distribution of organs for transplantation, with much effort currently underway to examine the efficacy of existing organ allocation algorithms. The design of efficient organ allocation policies depends strongly upon accurate estimates of the survival benefit of transplantation. Many organ allocation policies order patients on the wait-list based on time-dependent health status measures (internal time-dependent covariates), such that priority is given to candidates at the greatest risk for wait-list mortality. It is of great interest to measure the transplant benefit by levels of such health status measures to identify the status levels that represent either futile or unnecessary transplants. In the presence of observational data, the survival benefit of transplantation has, to date, been quantified through the parameter corresponding to a binary time-dependent transplant indicator variable. Parameters from a standard time-dependent analysis using existing methods (i.e., separate transplant indicator for each status level) are difficult to interpret because they apply while the patient is at a particular level; i.e., they account for the patient's current condition, but do not account for the possibility that the patient's condition may worsen. We propose a novel method for estimating the effect of a time-dependent treatment by levels of an internal time-dependent covariate. The method yields parameter estimates which, rather than applying to the patient's current health status, average over future potential changes in health status. The proposed method is applied to end-stage liver disease data obtained from a national organ failure registry. [ABSTRACT FROM AUTHOR]

ObjectivesTo examine the impact of a system of presumed consent for organ donation on donation rates and to review data on attitudes towards presumed consent. Design Systematic review. Data sources Studies retrieved by online searches to January 2008 of Medline, Mediine In-Process, Embase, CINAHL, PsyclNFO, HMIC, PAIS International, and OpenSIGLE. Studies reviewed Five studies comparing donation rates before and after the introduction of legislation for presumed consent (before and after studies); eight studies comparing donation rates in countries with and without presumed consent systems (between country comparisons); 13 surveys of public and professional attitudes to presumed consent. ResultsThe five before and after studies represented three countries: all reported an increase in donation rates after the introduction of presumed consent, but there was little investigation of any other changes taking place concurrently with the change in legislation. In the four best quality between country comparisons, presumed consent law or practice was associated with increased organ donation--increases of 25-30%, 21-26%, 2.7 more donors per million population, and 6.14 more donors per million population in the four studies. Other factors found to be important in at least one study were mortality from road traffic accidents and cerebrovascular causes, transplant capacity, gross domestic product per capita, health expenditure per capita, religion (Catholicism), education, public access to information, and a common law legal system. Eight surveys of attitudes to presumed consent were of the UK public. These surveys varied in the level of support for presumed consent, with surveys conducted before 2000 reporting the lowest levels of support (28-57%). The most recent survey in 2007, reported that 64% of respondents supported a change to presumed consent. Conclusion Presumed consent alone is unlikely to explain the variation in organ donation rates between countries. Legislation, availability of donors, organisation and infrastructure of the transplantation service, wealth and investment in health care, and public attitudes to and awareness of organ donation may all play a part, but their relative importance is unclear. Recent UK surveys show support for presumed consent, though with variation in results that may reflect differences in survey methods. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Kidney transplantation with a living donor has proved to be an effective solution for kidney patients on the waiting list for transplantation. Nevertheless, it may be difficult to find a living kidney donor. The purpose of this explorative study is to investigate how kidney transplant candidates may, or may not, find a living donor in the Netherlands. Methods: We compared a group of 42 patients who did not find a living donor with a group of 42 patients who did, using semi-structured interviews. Results: We found that, although almost all patients recognized the advantages of living kidney donation and were willing to accept the offer of a living kidney donor, many found it very difficult to ask a potential donor directly. This was true for both groups. Conclusion: Patients may gain from professional support to deal with this situation in ways that balance their medical needs and their personal relationships. Practice Implications: Support programs should be developed to assist patients in developing strategies for discussing living kidney donation with potential donors. [Copyright &y& Elsevier]

The article presents a study on the incidence, risk factors and management of pyridoxal-5′ -phosphate (PLP) deficiency following the multivisceral and intestinal transplantation in adult. It highlights the clinical nutritional autonomy (CNA) measurement of serum PLP and homocysteine concentrations before and after transplant to prevent deficiency. It also emphasizes the establishment of an effective repletion algorithmic protocol for the achievement of full CNA.

This article describes the experiences, feelings, and ideas of living kidney donors. Using a phenomenological, qualitative research approach, the authors interviewed 12 purposefully selected living kidney donors (eight men and four women), who were between four and 29 years since donation. Interviews were audiotaped, and transcribed verbatim, and the analysis of the data was both iterative and interpretive. Three key themes emerged. The first was how witnessing their loved ones' experience of illness and the threat of losing the recipient influenced the participants' decision to donate. The second focused on intrapersonal (philosophy of life) and interpersonal factors (comprehensive social support networks) that influenced the decision to be tested as a potential donor and the actual process of donation. The third was the impact of giving the gift of life, which was emotional and life changing. This article provides a rich description of the experiences of living kidney donors, revealing the multiple factors influencing the decision to donate, and provides insight on how social workers and other health care professionals need to identify and address the psychosocial needs of living kidney donors and their families from the process of decision making through after donation. [ABSTRACT FROM AUTHOR]

Social workers are often a primary source of education for patients in the outpatient dialysis setting, requiring these professionals to have a broad knowledge base regarding many aspects of dialysis and the various treatment modalities. Social workers are expected to be able to competently educate their patients, yet this can only be done if they themselves have been properly trained. An investigation regarding the training social workers receive and their overall knowledge about transplantation was conducted. The findings noted that formal training was almost nonexistent and exceptionally brief Many social workers had knowledge deficits and were unable to answer basic questions regarding the kidney transplantation process. [ABSTRACT FROM AUTHOR]

Objective: To explore the association between different types of knowledge related to donation and transplantation and the expression of donation intentions via one''s driver''s license, a donor card, or sharing one''s wishes with family. Methods: Cross-sectional data were gathered via self-administered questionnaire from 425 Black adults, age 18 years and older who were recruited from nine churches in a large metropolitan area in the southeast United States. Results: Results indicate that knowledge of the allocation system and experiential knowledge of a transplant recipient are associated with donation intentions after controlling for age, gender, and highest level of education. However, the following types of knowledge were unrelated to donation intentions: donation-related statistics (including an understanding of African Americans’ overrepresentation among those in need), the donation process, the process for determining medical suitability, and religious institutions’ support for donation. Conclusions: Findings suggest that the relationship between donation-related knowledge and donation intentions is complex and may depend on the specific type of knowledge being measured. Practice implications: Knowledge of the allocation system and experiential knowledge of a recipient may be critical aspects of the donation decision-making process. Research findings suggest the need for an educational approach that seeks to improve the specific types of knowledge that are most strongly associated with donation intentions. [Copyright &y& Elsevier]

The article discusses the ethical and legal concerns of social workers on organ donation and transplant. The Society for Transplant Social Workers is established to promote the availability of quality social work services to all transplant patients and their families. It is stated that the goal of saving lives through organ transplants cannot sacrifice ethical principles. Nor it cannot be done without public and professional discussion, disclosure, and oversight. It is further said that the modern world is often described as a death-denying culture, with the mass media focused only on beauty and youth of the world.

Abstract: Aim: This study examined the physical, psychological and social recovery patterns of Hong Kong Chinese patients who have undergone CABG surgery over a period of six months. Background: Recovery from coronary artery bypass graft (CABG) surgery is a dynamic process and the associated physical, psychological and social effects could lead to failure to recuperate leading to hospital re-admission and morbidity. Design: A prospective repeated measures design was used for this research. Patients were interviewed in person 5 days before surgery and at 1 week after discharge, and by telephone at 3 and 6 months after discharge. Physical recovery dimension was assessed by three categories of the Sickness Impact Profile (ambulation, sleep-rest, body movement and care). Social recovery dimension was assessed by three categories of the Sickness Impact Profile (SIP) (home management, social interaction, and recreation and pastimes). Psychological recovery was assessed using the Centre for Epidemiologic Studies—Depression (CES-D). Results: Sixty-eight patients participated in this research. The mean physical SIP-dimension score and depression level at discharge was the highest then gradually decreased at 6 months after CABG. The SIP-physical and SIP-social and depression level differed significantly across the four-assessment time within-group. There were no gender differences in physical and social recovery and depression levels. Patients who had poorer physical and social recovery had more depression at one week and three months after CABG surgery. Conclusion: Patients should be prepared for discharge after CABG surgery. Cultural factors may have influenced the similar recovery patterns between genders. These factors contributing to early recovery must be further examined. Relevance to clinical practice: Because of the large number of patients who undergo CABG worldwide, and because of healthcare cost related to this intervention, it is important for both patients and healthcare providers to have realistic expectations about the recovery process and to recognise deviations from the norm. The results provided some insights into the Hong Kong Chinese patients’ recovery from CABG surgery that would guide the development of culturally appropriate pre-operative and discharge teaching for this group of patients. [Copyright &y& Elsevier]

Australia has one of the worst organ donation rates in the western world. The consequence of this is that the waiting list for life-saving transplants is increasing. Australia has a highly successful transplant programme, but a limited number of organs are donated. Unfortunately, Aboriginal people are over-represented in the organ-failure patient group – particularly in end-stage renal disease. Renal transplantation has the potential to improve quantity and quality of life for Aboriginal people with renal failure. Aboriginal people have a right to be given the same opportunities as non-indigenous people to donate their organs at the end of life and improve the transplantation rates among their own people. The most effective way to improve indigenous donation rates will be through improving the knowledge of Aboriginal people about organ donation. There are cultural complexities and end-of-life rituals that make the decision to donate organs difficult, but these issues do not preclude a family from making the decision to donate organs at the end of life. We need to provide Aboriginal communities with appropriately presented information to give them a basis for making an informed decision about organ donation. Equity of access is important. Cultural competence of requestors is important. Consultation, communication and education are the way forward. [ABSTRACT FROM AUTHOR]

The article provides a discussion on organ transplant in Egypt. It mentions that Islamic countries have guidelines and laws on obtaining on organ transplants. However, the article discusses that Egypt is struggling with appropriate definitions and policies on obtaining organs from cadavers. It describes the practice of organ transplant in Egypt wherein organs are obtained from living donors. The article mentions that recipients of organs which include kidneys, cornea, and liver, are not related to donors. Organ transplants in Egypt involve the selection of donors through solicitation and compensation agreements. A discussion on the experiences of doctors involved in organ transplants is provided as well as an examination of the culture of Egypt.

The timing of the referral and listing of patients for lung transplantation remains a difficult decision. Life expectancy and quality of life with and without transplantation are the pivotal issues that need to be considered by physicians and presented to prospective transplant candidates. The recognition of recent advances in the understanding of the various primary diseases, other potential therapies, and the latest posttransplant statistics are essential for a balanced discussion or decision about lung transplantation. This article provides a review of these and other pertinent issues for patients with various forms of advanced lung disease. [ABSTRACT FROM AUTHOR]

The article presents information on the 5th European Transplant Fellow Workshop. The European Transplant Fellow Workshop (ETFW) is an official educational activity of the European Society for Organ Transplantation (ESOT). The ETFW is sponsored through an unrestricted educational grant by Fujisawa. The article also presents information on the Advanced Training in Organ Transplantation, an Official ESOT Training Course. The course is conducted by the European College of Transplantation.

Explores the factors influencing the decisions of the cadaveric organ families during the pre-donation transition in Taiwan. Potential needs of cadaveric donor families; Donor family's expectations of health care providers; Religious belief related to the particular organs and tissues; Consent from the important persons in the family.

Through a phenomenological framework, the authors attempt to shed light on the communication processes of organ transplant recipients when discussing transplantation and related topics. Eight essential themes (awareness, support, commitment, pride, education, mentoring, comparison, and community) emerged from 37 participants as central to the communicative experiences of transplant recipients and their families. Additional insight was generated through a 2nd tier of focus group discussions resulting in a proposed model of transplant recipient communication. An interpretation of the model, implications for future research, and implications for praxis are presented. [ABSTRACT FROM AUTHOR]

ABSTRACT. Context. Renal transplantation is the treatment of choice for pediatric patients with end-stage renal disease (ESRD). Black patients wait longer for kidney transplants than do white patients. Objective. To determine whether the increased time to transplantation for black pediatric patients is attributable not only to a shortage of suitable donor organs, but also to racial differences in the time from a child's first treatment for ESRD until activation on the cadaveric kidney transplant waitlist. Design. National longitudinal cohort study. Setting. US Medicare-eligible, pediatric ESRD population. Patients. Children and adolescents is less than or equal to 19 years old at the time of their first dialysis for ESRD between 1988 and 1993, followed through 1996. Patients who received living donor renal transplants were excluded from study. Main Outcome Measures. Time from first dialysis for ESRD until activation on the kidney transplant waiting list, relative hazard of activation on the waiting list for black compared with white pediatric patients. Results. Comparisons of the time from first dialysis for ESRD to waitlisting among the 2162 white (60.7%) and 1122 black (31.5%) patients studied using survival analysis revealed that blacks were less likely to be waitlisted at any given time in follow-up. In multivariate analysis, even after controlling for patient age, gender, socioeconomic status, geographic region, incident year of renal failure, and cause of ESRD, blacks were 12% less likely to be waitlisted than were whites at any point in time (relative hazard: .88: 95% confidence interval: .79-.97). Conclusions. Racial disparities in access to the renal transplant waiting list exist in pediatrics. Whether these disparities are attributable to differences in time of presentation to a nephrologist, physician bias in identification of transplant candidates, or patient preferences warrants further study. Pediatrics 2000;106:756-761; children, race, renal ... [ABSTRACT FROM AUTHOR]

This longitudinal, qualitative study investigated the genesis and transformation of the social representations of organ transplants. A search of the West Australian newspaper, from 1954 to 1995 found 672 articles pertaining to organ transplants. Two distinct, but conflicting, representations emerged in the analyses. In the first representation, found from 1967/68, the surgeon was paramount and organ transplants were iconised as ‘spare part surgery’. In the second representation, found from 1984/85, the role of the donor was emphasised and transplants iconised as a ‘gift of life’. Both representations were discernible in 1994/95. We consider the question whether there are now two conflicting representations or one representation with two conflicting sets of beliefs at its core. The results are discussed in terms of anchoring, objectification, transformation, and structure, as well as Moscovici’s (1993) notion of canonic themata. [ABSTRACT FROM AUTHOR]

Background Some members of the general public feel that patients who cause their own organ failure through smoking, alcohol use, or drug use should not receive equal priority for scarce transplantable organs. This may reflect a belief that these patients (1) cause their own illness, (2) have poor transplant prognoses or, (3) are simply unworthy. We explore the role that social acceptability, personal responsibility, and prognosis play in people's judgments about transplant allocation. Methods By random allocation, we presented 283 prospective jurors in Philadelphia county with one of five questionnaire versions. In all questionnaires, subjects were asked to distribute transplantable hearts between patients with and without a history of three controversial behaviors (eating high fat diets against doctors' advice, cigarette smoking, or intravenous drug use). Across the five questionnaire versions, we varied the relative prognosis of the transplant candidates and whether their behavior caused their primary organ failure. Results Subjects were significantly less willing to distribute organs to intravenous drug users than to cigarette smokers or people eating high fat diets (p < 0.0005), even when intravenous drug users had better transplant outcomes than other patients. Subjects' allocation decisions were influenced by transplant prognosis, but not by whether the behavior in question was causally responsible for the patients' organ failure. Conclusion People's unwillingness to give scarce transplantable organs to patients with controversial behaviors cannot be explained totally on the basis of those behaviors either causing their primary organ failure or making them have worse transplant prognoses. Instead, many people believe that such patients are simply less worthy of scarce transplantable organs. [ABSTRACT FROM AUTHOR]

Focuses on how advances in technology are contributing to human suffering and misery. Warnings from writers on technology as a source of human misery; Effect of suffering on developments in biomedical technology; Focus on disputes in North America and Japan that are associated with the transplantation of major organs, together with the required redefinition of death to implement this technology.

Examines racial equity in renal transplantation for patients with end-stage renal disease (ESRD). Racial disparity in ESRD and transplantation; Organ allocation in the United States; Racial impact of human leucocyte antigen-based allocation; Racial implications of equity and efficiency in allocation; Accommodation between the goals of racial equity and efficiency.

Recent break-throughs in surgery and the discovery of an effective immunosupressive drug called cyclosporin, have brought a Renaissance in organ transplants. These medical advances have also heightened concern over the already critical shortage of body organs. Several alternatives have been suggested which may help alleviate the organ shortage. One such alternative is to allow commerce in human organs. This article discusses the morality of commercialization of human organs within the framework of several ethical theories. [ABSTRACT FROM AUTHOR]

As a new medical technology, organ-transplantation has created unanticipated adjustment problems for the government, the general public, medical organization, and the patient and his family. This article discusses some of these problems with a focus on kidney transplantation since renal transplantation is the only type of organ transplantation that has moved from the realm of experimentation to therapeutics; that is, it is the only type that can be considered a viable cure. Several mechanisms seem to prevent suitable patients dying from kidney disease from being treated at a transplant or dialysis center. Arbitrary factors such as state of origin or socioeconomic status restrict many patients from being able to receive financial help or themselves afford these expensive therapies. Normative uncertainties related to the donorship of organs also increase the stress of this therapy for physicians, patients, and their families. The economically disadvantaged patient from such an outlying community appears to be the one who suffers most from the shortage of facilities and resources and from the communication gaps within medicine.

In this article, the authors reflect on the development in the field of xeno-transplantation and its related consequences to the human beings, animals and the society. The authors point out the transplant recipient's immunosuppressed state and say that this state of the recipient makes him more prone to zoonoses, infection and pathologic results. The authors also emphasize the need for post-operative monitoring under article 5 and 8 of the European Convention of Human Rights.

Abstract: Introduction: The concept of brain death (BD) is not well understood among the general public, rendering it one of the main psychosocial barriers to favorable attitudes toward donation. Individuals from the British Isles are among the most important migratory groups in southeastern Spain. We sought to analyze the level of understanding of the concept of brain death among the British and Irish populations living in southeastern Spain, and to determine factors affecting their attitudes. Material and Method: A random sample of the British and Irish population resident in Murcia was stratified according to nationality as part of the “International Collaborative Donor Program” (n = 1611). The self-administered survey in English was completed anonymously. For the statistical analysis, we used the χ2 test and a logistical regression analysis. Results: Approximately half of the respondents (45%; n = 692) understood the concept of BD; they considered it to mean the death of an individual. Among of the other respondents, 39% (n = 605) did not understand this concept, and the remaining 16% (n = 240) erroneously believed that it did not imply a person''s death. Respondents coming from Great Britain showed a greater knowledge of the BD concept than did the Irish (46% vs 34%; P < .001). Those who understood the concept of BD were more in favor of deceased donation than those who had an erroneous understanding (49% vs 36%; P < .001). Significant associations were also noted among variables directly or indirectly related to donation and transplantation (P < .05). Conclusion: The level of understanding of the concept of BD among the population from the British Isles resident in southeastern Spain was limited. Taking into account that the BD concept is a psychosocial factor that affects attitudes toward organ donation, information campaigns should be applied to this emerging population group in southeastern Spain. [Copyright &y& Elsevier]