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Rossi S, Mazza G, Del Testa M, Giannotta A, Bartalini S, Testani E, Savelli L, Gabbrielli M, Vatti G, Scolletta S. Suitability of electroencephalography in brain death determination: a monocentric, 10-year retrospective, observational investigation of 428 cases. Neurol Sci 2023; 44:1369-1373. [PMID: 36508079 PMCID: PMC10023611 DOI: 10.1007/s10072-022-06547-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND We aimed to verify the usefulness of electroencephalographic (EEG) activity recording (that is mandatory according to the Italian law), in addition to two clinical evaluations spaced 6 h, among the procedures of brain death determination (BDD) in adult individuals. METHODS The study is a monocentric, retrospective analysis of all BDDs performed in the last 10 years at Policlinico Le Scotte in Siena (Italy). RESULTS Of the 428 cases revised (mean age 67.6 ± 15.03 years; range 24-92 years), 225 were males and 203 females. In total, 212 out of 428 patients (49.5%) were donors. None of the BDD procedures were interrupted due to the reappearance of EEG activity (neither for clinical reasons) at any sampling time, with the exception of one case that was considered a false negative at critical reinspection of the EEG. In 6/428 cases (1.4%), a cardiac arrest occurred during the 6 h between the first and second evaluation, thus missing the opportunity to take organs from these patients because the BDD procedure was not completed. CONCLUSIONS Once the initial clinical examination before convening the BDD Commission has ascertained the absence of brainstem reflexes and of spontaneous breathing, and these clinical findings are supported by a flat EEG recording, the repetition of a 30-min EEG twice over a 6 h period seems not to add additional useful information to clinical findings. Current data, if confirmed in other centers and possibly in prospective studies, may help to promote a scientific and bioethical debate in Italy, as well as in other countries where the EEG is still mandatory, for eventually updating the procedures of BDD.
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Affiliation(s)
- Simone Rossi
- Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, Siena Brain Investigation and Neuromodulation (Si-BIN) Lab., University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy.
| | - Gionathan Mazza
- Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, Siena Brain Investigation and Neuromodulation (Si-BIN) Lab., University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Massimiliano Del Testa
- Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, Siena Brain Investigation and Neuromodulation (Si-BIN) Lab., University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Alessandro Giannotta
- Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, Siena Brain Investigation and Neuromodulation (Si-BIN) Lab., University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Sabina Bartalini
- Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, Siena Brain Investigation and Neuromodulation (Si-BIN) Lab., University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Elisa Testani
- Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, Siena Brain Investigation and Neuromodulation (Si-BIN) Lab., University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Laura Savelli
- Department of Medicine, Surgery and Neuroscience, Unit of Anaesthesia and Intensive Care Medicine, University Hospital of Siena, Siena, Italy
| | - Mario Gabbrielli
- Department of Molecular and Developmental Medicine, Section of Forensic Medicine, University of Siena, Siena, Italy
| | - Giampaolo Vatti
- Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, Siena Brain Investigation and Neuromodulation (Si-BIN) Lab., University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Sabino Scolletta
- Department of Medicine, Surgery and Neuroscience, Unit of Anaesthesia and Intensive Care Medicine, University Hospital of Siena, Siena, Italy
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Caulfield T, Nelson E, Goldfeldt B, Klarenbach S. Incentives and organ donation: what's (really) legal in Canada? Can J Kidney Health Dis 2014; 1:7. [PMID: 25780602 PMCID: PMC4349723 DOI: 10.1186/2054-3581-1-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 05/09/2014] [Indexed: 11/12/2022] Open
Abstract
Purpose of review To date, there has been little analysis of the degree to which emerging incentive initiatives are permissible under Canadian law. The purpose of this review is to examine the relevant law – including legislation and case law – in order to clarify the legality of existing proposed incentive schemes. Sources of information Legislation and case law. Findings Organ donation is governed by provincial legislation that, in general, bans the exchange of any “benefit” or any form of “valuable consideration” in return for an organ. As such, these laws are tremendously restrictive and could have significant implications for emerging and proposed procurement policy. Implications Given the need for innovative, ethically appropriate policies to increase donation rates, we suggest that the time is right to rethink the potentially restrictive nature of Canada’s organ donation laws.
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Affiliation(s)
- Timothy Caulfield
- Faculty of Law and School of Public Health, Health Law Institute, University of Alberta, 116 St and 85 Avenue, Edmonton, AB T6G 2R3 Canada ; School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, 11405 - 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Erin Nelson
- Faculty of Law and School of Public Health, Health Law Institute, University of Alberta, 116 St and 85 Avenue, Edmonton, AB T6G 2R3 Canada
| | - Brice Goldfeldt
- Faculty of Law and School of Public Health, Health Law Institute, University of Alberta, 116 St and 85 Avenue, Edmonton, AB T6G 2R3 Canada
| | - Scott Klarenbach
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 116 St and 85 Avenue, Edmonton, AB T6G 2R3 Canada
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Kane F, Clement G, Kane M. Live kidney donations and the ethic of care. THE JOURNAL OF MEDICAL HUMANITIES 2008; 29:173-188. [PMID: 18642067 DOI: 10.1007/s10912-008-9059-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In this paper, we seek to re-conceptualize the ethical framework through which ethicists and medical professionals view the practice of live kidney donations. The ethics of organ donation has been understood primarily within the framework of individual rights and impartiality, but we show that the ethic of care captures the moral situation of live kidney donations in a more coherent and comprehensive way, and offers guidance for practitioners that is more attentive to the actual moral transactions among donors and recipients. A final section offers guidelines for the practice of live kidney transplants that emerge from an ethic of care.
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Affiliation(s)
- Francis Kane
- Philosophy Department, Salisbury University, Salisbury, MD 21801, USA.
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