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Siraj S. Family-Oriented Living Organ Donation in Bangladesh: A Bioethical Defence. JOURNAL OF BIOETHICAL INQUIRY 2024:10.1007/s11673-024-10361-z. [PMID: 39037640 DOI: 10.1007/s11673-024-10361-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 03/18/2024] [Indexed: 07/23/2024]
Abstract
This study focuses on issues related to living organ donation for transplantation in Bangladesh. The policy and practice of living organ donation for transplantation in Bangladesh is family-oriented: close relatives (legal and genetic) are the only ones allowed to be living donors. Unrelated donors, altruistic donors (directed and non-directed), and paired/pooled or non-directed altruistic living donor chains-as many of these are implemented in other countries-are not legally allowed to serve as living donors in Bangladesh. This paper presents normative arguments explaining why the family-oriented nature of regulations and practices surrounding living organ donation for transplantation is essential for Bangladesh. In this article, I specifically argue that if the Bangladesh government revises the current biomedical policy robustly beyond relatives and allows unrelated donors to donate organs legally, this may foster organ selling due to the poverty and corruption problems in Bangladesh. The family-oriented requirement of the living organ donation policy and practice is defensible and morally justifiable as it preserves common notions of the family unit and family bonding in Bangladesh. Maintaining the current living-donation regulations and promoting deceased donation is the way forward, as this safely preserves the family values, protects against organ selling, and increases access to organ transplantation.
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Affiliation(s)
- S Siraj
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
- Centre for Medical Ethics and Law, Faculty of Law and Li Ka Shing Faculty of Medicine, Medical Ethics and Humanities Unit, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Shatin, Hong Kong SAR.
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2
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Rodger D, Venter B. A fair exchange: why living kidney donors in England should be financially compensated. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:625-634. [PMID: 37620641 PMCID: PMC10725849 DOI: 10.1007/s11019-023-10171-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 08/26/2023]
Abstract
Every year, hundreds of patients in England die whilst waiting for a kidney transplant, and this is evidence that the current system of altruistic-based donation is not sufficient to address the shortage of kidneys available for transplant. To address this problem, we propose a monopsony system whereby kidney donors can opt-in to receive financial compensation, whilst still preserving the right of individuals to donate without receiving any compensation. A monopsony system describes a market structure where there is only one 'buyer'-in this case the National Health Service. By doing so, several hundred lives could be saved each year in England, wait times for a kidney transplant could be significantly reduced, and it would lessen the burden on dialysis services. Furthermore, compensation would help alleviate the common disincentives to living kidney donation, such as its potential associated health and psychological costs, and it would also help to increase awareness of living kidney donation. The proposed system would also result in significant cost savings that could then be redirected towards preventing kidney disease and reducing health disparities. While concerns about exploitation, coercion, and the 'crowding out' of altruistic donors exist, we believe that careful implementation can mitigate these issues. Therefore, we recommend piloting financial compensation for living kidney donors at a transplant centre in England.
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Affiliation(s)
- Daniel Rodger
- Institute of Health and Social Care, School of Allied and Community Health, London South Bank University, London, UK.
- Department of Psychological Sciences, University of London, Birkbeck, UK.
| | - Bonnie Venter
- Centre for Health, Law, and Society, Bristol Law School, University of Bristol, Bristol, UK
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3
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Taheri S. Renal allograft procurement from living unrelated donors in Iran: What falls under the eclipse. World J Transplant 2023; 13:250-253. [PMID: 37746039 PMCID: PMC10514748 DOI: 10.5500/wjt.v13.i5.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/26/2023] [Accepted: 07/24/2023] [Indexed: 09/15/2023] Open
Abstract
Renal transplantation is the treatment of choice for end stage kidney disease. However, despite all the efforts to expand the donor pool, the shortage of donors is increasing and as a consequence, there has been a significant increase in the number of patients on transplant waiting lists globally. Societies worldwide have employed different methods to address this, each with specific ethical concerns surrounding them. Over three decades ago, a governmentally regulated program of kidney transplantation from living unrelated donors was introduced in Iran and since practiced which has been the subject of hot debate in the literature. Nevertheless, despite all these extensive discussions and publications, several key aspects of the program have still not been properly elucidated and addressed. In this article, the author aims to illuminate some dark corners related to this issue that have largely escaped the notice of ethicists.
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Affiliation(s)
- Saeed Taheri
- Medicine, New Lahijan Scientific Foundation, Lahijan 4415813166, Iran
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Dabbagh H, Mirdamadi SY, Ajani RR. Approaches to Muslim Biomedical Ethics: A Classification and Critique. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:327-339. [PMID: 37074632 PMCID: PMC10352404 DOI: 10.1007/s11673-023-10239-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 09/27/2022] [Indexed: 05/03/2023]
Abstract
This paper provides a perspective on where contemporary Muslim responses to biomedical-ethical issues stand to date. There are several ways in which Muslim responses to biomedical ethics can and have been studied in academia. The responses are commonly divided along denominational lines or under the schools of jurisprudence. All such efforts classify the responses along the lines of communities of interpretation rather than the methods of interpretation. This research is interested in the latter. Thus, our criterion for classification is the underlying methodology behind the responses. The proposed classification divides Muslim biomedical-ethical reasoning into three methodological categories: 1) textual, 2) contextual, and 3) para-textual.
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Affiliation(s)
- Hossein Dabbagh
- Department for Continuing Education, University of Oxford, Oxford, OX1 2JA UK
| | | | - Rafiq R. Ajani
- The Institute of Ismaili Studies, Aga Khan Centre, London, N1C 4DN UK
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Shadnoush M, Latifi M, Rahban H, Pourhosein E, Shadnoush A, Jafarian A, Dehghani S. Trends in organ donation and transplantation over the past eighteen years in Iran. Clin Transplant 2023; 37:e14889. [PMID: 36545788 DOI: 10.1111/ctr.14889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 12/06/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND This article will review the trends in organ donation over the past 18 years in Iran. MATERIAL AND METHODS All donation and transplantation statistics were extracted by reviewing the Organ Procurement and Transplantation database of the Ministry of Health of Iran from 2002 to 2019. RESULTS Iran's national deceased donation rate from 2002 to 2019 increased 19.06-fold from .75 to 14.3 per million population (PMP). After the beginning of the COVID-19 pandemic, the rate of organ donation in Iran decreased significantly. Although 1 year after the onset of the pandemic, due to the widespread adoption of COVID19 vaccination, the rate of organ donation began to increase again, this system is still under performing. During the years under examination, the rate of deceased kidney donation increased significantly compared to living kidney donation and reached up to 2001 kidney transplantations in 2021. From 2002 to 2019, the rate of liver transplants increased to 12.8. Likewise, the rate of heart transplants increased 8.4-fold, from 15 to 126 cases during the same time. CONCLUSSION Although a personal choice, the process of organ donation involves medical, legal, ethical, organizational, and social aspects. The trend in increasing donation rates over the past years can be attributed to multiple influences, which include rigorous team efforts in the organ donation and transplantation systems, in addition to creating a donation culture and promoting donation through media platforms. Moreover, we can say that the rising rates of deceased donor transplantation also can drive down rates of commercial living donor transplantation.
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Affiliation(s)
- Mahdi Shadnoush
- Faculty of Nutrition & Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Latifi
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Habib Rahban
- Cardiovascular Research Foundation of Southern California, Beverly Hills, California, USA.,Southern California Medical Education Consortium, Temecula Valley Hospital, Universal Health System, Temecula, California, USA
| | - Elahe Pourhosein
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Shadnoush
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Arefeh Jafarian
- Iranian Tissue Bank & Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Dehghani
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Iranian Tissue Bank & Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Gender Disparity in Asian-Pacific Countries: An Analysis of the ASTREG-WIT-KT Registry. Transplantation 2023; 107:1-5. [PMID: 36508641 DOI: 10.1097/tp.0000000000004223] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Siraj MS. How a compensated kidney donation program facilitates the sale of human organs in a regulated market: the implications of Islam on organ donation and sale. Philos Ethics Humanit Med 2022; 17:10. [PMID: 35897010 PMCID: PMC9331153 DOI: 10.1186/s13010-022-00122-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/05/2022] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Advocates for a regulated system to facilitate kidney donation between unrelated donor-recipient pairs argue that monetary compensation encourages people to donate vital organs that save the lives of patients with end-stage organ failure. Scholars support compensating donors as a form of reciprocity. This study aims to assess the compensation system for the unrelated kidney donation program in the Islamic Republic of Iran, with a particular focus on the implications of Islam on organ donation and organ sales. METHODS This study reviews secondary documents for philosophical argumentation and ethical analysis of human organ donation and sale for transplantation. RESULTS AND DISCUSSION According to Islamic law, organ donation is an act of sadaqatul jariyah, and individuals are permitted to donate organs with the intention of saving lives. The commercialization of humans as organ sellers and buyers is contrary to the Islamic legal maxim eethaar, undermining donors of 'selfless' or 'altruistic' motivations. Such an act should be considered immoral, and the practice should not be introduced into other countries for the sake of protecting human dignity, integrity, solidarity, and respect. I, therefore, argue that Iran's unrelated kidney donation program not only disregards the position of the Islamic religion with respect to the provision or receipt of monetary benefits for human kidneys for transplantation but that it also misinterprets the Islamic legal proscription of the sale of human organs. I also argue that the implementation of Iran's unrelated kidney donor transplantation program is unethical and immoral in that potential donors and recipients engage in a bargaining process akin to that which sellers and buyers regularly face in regulated commodity exchange markets. Conversely, I suggest that a modest fixed monetary remuneration as a gift be provided to a donor as a reward for their altruistic organ donation, which is permissible by Islamic scholars. This may remove the need to bargain for increased or decreased values of payment in exchange for the organ, as well as the transactional nature of 'buyer and seller', ensuring the philosophy of 'donor and recipient' is maintained. CONCLUSIONS Offering a fixed modest monetary incentive to organ donors would serve to increase organ supply while protecting donors' health and reducing human suffering without legalizing the human organ trade.
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Affiliation(s)
- Md Sanwar Siraj
- Department of Government and Politics, Jahangirnagar University, Savar, Dhaka, Bangladesh.
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Ambagtsheer F, Columb S, AlBugami MM, Ivanovski N. Kidneys for Sale? A Commentary on Moeindarbari's and Feizi's Study on the Iranian Model. Transpl Int 2022; 35:10530. [PMID: 35812157 PMCID: PMC9266991 DOI: 10.3389/ti.2022.10530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/27/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Frederike Ambagtsheer
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sean Columb
- School of Law and Social Justice, The Liverpool Law School, University of Liverpool, Liverpool, United Kingdom
| | - Meteb M. AlBugami
- Multi-Organ Transplantation Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Ninoslav Ivanovski
- Clinical Hospital Zan Mitrev, University “Sts Cyril and Methodius”, Skopje, North Macedonia
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Moeindarbari T, Feizi M. Kidneys for Sale: Empirical Evidence From Iran. Transpl Int 2022; 35:10178. [PMID: 35812160 PMCID: PMC9266983 DOI: 10.3389/ti.2022.10178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/11/2022] [Indexed: 12/22/2022]
Abstract
The kidney market in Iran is the only legal market of this sort globally. Yet, it has not been empirically studied based on real data. For the first time, we obtained data on donors and recipients from the Kidney Foundation in Mashhad, April 2011 up to March 2018, and assessed which individualistic characteristics contribute to a kidney’s price. Our findings indicate that each year of education for both donors and recipients increases the kidney price. Moreover, old patients are willing to make a higher payment to young vendors. We have also provided some policy implications to improve the efficiency of kidney allocations.
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Poursaadati M, Maarefvand M, Niyasar M, Khubchandani J. Organ donation-related psychosocial interventions: Towards a research-based guideline - A prospective observational study. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_125_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Equity or Equality? Which Approach Brings More Satisfaction in a Kidney-Exchange Chain? J Pers Med 2021; 11:jpm11121383. [PMID: 34945855 PMCID: PMC8709455 DOI: 10.3390/jpm11121383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022] Open
Abstract
In United States (U.S.), government-funded organizations, such as NLDAC, reimburse travel and subsistence expenses incurred during living-organ donation process. However, in Iran, there is a non-governmental organization called Iranian Kidney Foundation (IKF) that funds the direct and indirect costs of donors through charitable donations and contributions from participants in the exchange program. In this article, for countries outside the U.S. that currently use an equality approach, we propose a potential new compensation-apportionment approach (equitable approach) for kidney-exchange chains and compare it with the currently available system (equality approach) in terms of the apportionment of compensation in a kidney-exchange chain to cover the expenses incurred by the initiating living donor of the chain in the act of donation. To this end, we propose a mechanism to apportion compensation among all participating pairs based on the equity approach by utilizing a prediction model to calculate the probability of graft survival in each transplant operation. These probabilities are then used to define the utility of any transplantation, considering the quality of each pair’s donated and received kidney in the chain. Afterward, the corresponding cost is apportioned by a mechanism based on the normalized differences between the utility of donated and received kidneys for each incompatible pair of the chain. In summary, we demonstrate that by utilizing the equitable approach, there is more fairness and equity in the allocation of resources in organ-procurement systems, which results in more satisfaction among incompatible pairs. Additional future prospective studies are needed to assess this proposed equitable approach for kidney-exchange chains in countries outside the U.S., such as Iran, that currently use an equality approach.
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Rafati F, Mashayekhi F, Dastyar N. Caregiver Burden and Spiritual Well-being in Caregivers of Hemodialysis Patients. JOURNAL OF RELIGION AND HEALTH 2020; 59:3084-3096. [PMID: 31650381 DOI: 10.1007/s10943-019-00939-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The number of hemodialysis patients is increasing worldwide, and the caregivers of these patients experience a great burden. This study was conducted to examine the relationship between caregiver burden and spiritual well-being in caregivers of hemodialysis patients in Kerman, Iran. This correlational study was conducted on 382 caregivers of hemodialysis patients. Data were collected using the Caregiver Burden Inventory (24 items) and Ellison and Paloutzian 20-Item Spiritual Well-being Questionnaire. Data were analyzed by descriptive and inferential statistics (t test, ANOVA, Spearman correlation, and linear regression analysis) in SPSS 20 software. The findings showed that 45 (11.8%) caregivers had mild, 214 (56%) moderate, and 123 (32.2%) high caregiver burden. Furthermore, 1 (0.3%) caregiver had mild, 349 (92.4%) moderate, and 32 (8.4%) high spiritual well-being. Also, Spearman correlation test showed a significant reveres relationship between caregiver burden and spiritual well-being scores (p < 0.001, r = - 0.41). Moreover, the results of the regression analysis showed that the patient's income, frequency of patient dialysis per week, and patient's need to receive care and spiritual well-being were predictors of caregiver burden, which explained 41% of the burden in caregivers. The results of this study revealed that spiritual well-being was negatively related to caregiver burden and was one of its predictors. Therefore, spirituality can be used as a low-cost and effective intervention to reduce the caregiver's burden.
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Affiliation(s)
- Foozieh Rafati
- School of Nursing and Midwifery, Jiroft University of Medical Sciences, Sabzevaran Square, PO Box: 7861763730, Jiroft, Iran
| | - Fatemeh Mashayekhi
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Sabzevaran Square, PO Box: 7861763730, Jiroft, Iran
| | - Neda Dastyar
- Department of Midwifery, Nursing and Midwifery School, Jiroft University of Medical Sciences, Sabzevaran Square, PO Box: 7861763730, Jiroft, Iran.
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Feizi M, Moeindarbari T. Heterogeneity of Market Structures in the Iranian Model of Kidney Transplantation. WORLD MEDICAL & HEALTH POLICY 2020. [DOI: 10.1002/wmh3.330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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14
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Degheili JA, Yacoubian A, Abu Dargham R, Rkein G, Khauli R. Cadaveric Organ Donation in Lebanon: Proposed Suggestions for Improvement. Transplant Proc 2019; 52:37-41. [PMID: 31883765 DOI: 10.1016/j.transproceed.2019.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/10/2019] [Indexed: 11/26/2022]
Abstract
Organ transplantation is the treatment of choice for most end-stage diseases, despite the continuous advancements in the medical and surgical field. The dilemma of the shortage between supply and demand of organs for transplantation has been an ongoing debate and concern. The well-known "Spanish Model" was established in 1989 and adopted by the National Transplant Organization. The main commitment of the National Transplant Organization is to increase organ donation and transplantation rates. The program was also successfully adopted in countries such as Australia and Great Britain as well as Latin-American countries. The system is based on recruitment of cadaveric organs by a specialized team in hospitals at the regional and national level. Lebanon hopes to initialize a model similar to the Spanish Model but faces several obstacles. Adopting such a model could help increase cadaveric organ donation in Lebanon.
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Affiliation(s)
- Jad A Degheili
- Division of Urology & Renal Transplant, Department of Surgery, American University of Beirut-Medical Center, Beirut, Lebanon.
| | - Aline Yacoubian
- Division of Urology & Renal Transplant, Department of Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Rana Abu Dargham
- Division of Urology & Renal Transplant, Department of Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Ghiwa Rkein
- Division of Urology & Renal Transplant, Department of Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Raja Khauli
- Division of Urology & Renal Transplant, Department of Surgery, American University of Beirut-Medical Center, Beirut, Lebanon; Adjunct Professor, Department of Urology, University of Massachusetts Medical School, Worcester, Massachusetts, United States
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Timmins R, Sque M. Radical actions to address UK organ shortage, enacting Iran’s paid donation programme: A discussion paper. Nurs Ethics 2019; 26:1936-1945. [DOI: 10.1177/0969733019826362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Globally there is a shortage of organs available for transplant resulting in thousands of lives lost as a result. Recently in the United Kingdom 457 people died as a result of organ shortage in just 1 year. 1 NHS Blood and Transplant suggest national debates to test public attitudes to radical actions to increase organ donation should be considered in addressing organ shortage. The selling of organs for transplant in the United Kingdom is prohibited under the Human Tissue Act 2004. This discussion paper considers five ethical objections raised in the United Kingdom to paid donation and discusses how these objections are addressed within the only legal and regulated paid living unrelated renal donation programme in the world in Iran, where its kidney transplant list was eliminated within 2 years of its commencement. This article discusses whether paid living unrelated donation in Iran increases riskier donations and reduced altruistic donation as opponents of paid donation claim. The paper debates whether objections to paid donation based upon commodification arguments only oppose enabling financial ends, even if these ends enable beneficent acts. Discussions in relation to whether valid consent can be given by the donor will take place and will also debate the objection that donors will be coerced and exploited by a paid model. This article suggests that exploitation of the paid donor within the Iranian model exists within the legally permitted framework. However, paid living kidney donation should be discussed further and other models of paid donation considered in the United Kingdom as a radical means of increasing donation.
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Fan R, Wang M. Family-Based Consent and Motivation for Cadaveric Organ Donation in China: An Ethical Exploration1. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2019; 44:534-553. [PMID: 32479624 PMCID: PMC7263308 DOI: 10.1093/jmp/jhz022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This essay indicates that Confucian family-based ethics is by no means a stumbling block to organ donation in China. We contend that China should not change to an opt-out consent system in order to enhance donation because a "hard" opt-out system is unethical, and a "soft" opt-out system is unhelpful. We argue that the recently-introduced familist model of motivation for organ donation in mainland China can provide a proper incentive for donation. This model, and the family priority right that this model supports, is ethically justifiable in terms of Confucian family-based ethics.
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Affiliation(s)
- Ruiping Fan
- City University of Hong Kong, Hong Kong, PRC
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Bastani B. The present and future of transplant organ shortage: some potential remedies. J Nephrol 2019; 33:277-288. [PMID: 31399908 DOI: 10.1007/s40620-019-00634-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/30/2019] [Indexed: 12/24/2022]
Abstract
Transplantation remains the modality of choice for patients with end stage renal disease (ESRD). However, while there has been a steady rise in the number of patients with ESRD the supply of donors (combine living and deceased) has fallen far behind the need, resulting in an increasing number of qualified patients remaining on the wait-list, and thousands being removed from the list every year because of death or becoming too sick for transplantation. This has also fed to transplant tourism around the world. Several countries have implemented a variety of policies to overcome their organ shortage that are presented in this article. There is an urgent need for developing policies geared to the cultural norms of different societies and universally accepted ethical principles to remedy this public health issue.
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Affiliation(s)
- Bahar Bastani
- Division of Nephrology, Saint Louis University Hospital, Saint Louis University School of Medicine, 3635 Vista Avenue, Saint Louis, MO, 63110, USA.
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18
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Challenges and Future Recommendation for Kidney Transplantation in Iran: A Narrative Review. Nephrourol Mon 2019. [DOI: 10.5812/numonthly.87026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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19
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Kidney Transplantation: Local Donor and Distant Recipient, Is It Feasible? A Retrospective Cross-Sectional Study. Nephrourol Mon 2019. [DOI: 10.5812/numonthly.88665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bastani B. The iranian model as a potential solution for the current kidney shortage crisis. Int Braz J Urol 2018; 45:194-196. [PMID: 30521163 PMCID: PMC6442125 DOI: 10.1590/s1677-5538.ibju.2018.0441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/15/2018] [Indexed: 11/21/2022] Open
Affiliation(s)
- Bahar Bastani
- Division of Nephrology, Saint Louis University Health Science Center, Saint Louis, MO, USA
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Koplin J. Choice, pressure and markets in kidneys. JOURNAL OF MEDICAL ETHICS 2018; 44:310-313. [PMID: 29102919 DOI: 10.1136/medethics-2017-104192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 09/24/2017] [Accepted: 10/17/2017] [Indexed: 06/07/2023]
Abstract
We do not always benefit from the expansion of our choice sets. This is because some options change the context in which we must make decisions in ways that render us worse off than we would have been otherwise. One promising argument against paid living kidney donation holds that having the option of selling a 'spare' kidney would impact people facing financial pressures in precisely this way. I defend this argument from two related criticisms: first, that having the option to sell one's kidney would only be harmful if one is pressured or coerced to take this specific course of action; and second, that such forms of pressure are unlikely to feature in a legal market.
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Aramesh K, Arima H, Gardiner D, Shah SK. An International Legal Review of the Relationship between Brain Death and Organ Transplantation. THE JOURNAL OF CLINICAL ETHICS 2018. [DOI: 10.1086/jce2018291031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
The ethical debate surrounding transplant practices questions our societies. International recommendations set out numerous precautions which must be taken to ensure that donors act with their free will. While in most countries, including France, organ donation is a voluntary and non-commercial act, a black market exists in the world resulting in the trafficking of organs and tragic transplant tourism.
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Affiliation(s)
- Marie-France Mamzer Bruneel
- Unité fonctionnelle d'éthique médicale Hôpital Necker, AP-HP, 149 rue de Sèvres, 75015 Paris, France; Laboratoire d'éthique médicale et de médecine légale Université Paris Descartes (EA 4569) Centre universitaire des Saints-Pères, 45 Rue des Saints-Pères 75270 Paris Cedex 06, France.
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Timsit MO, Kleinclauss F, Mamzer Bruneel M, Thuret R. Le donneur vivant de rein. Prog Urol 2016; 26:940-963. [DOI: 10.1016/j.purol.2016.09.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 01/10/2023]
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26
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Bastani B. It's time to reward the gift of life. J Nephropathol 2016; 5:88-9. [PMID: 27540535 PMCID: PMC4961821 DOI: 10.15171/jnp.2016.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 03/09/2016] [Indexed: 02/01/2023] Open
Affiliation(s)
- Bahar Bastani
- Division of Nephrology, Saint Louis University School of Medicine, Saint Louis, USA
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27
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Rasti S, Hassanzadeh M, Soliemani A, Hooshyar H, Mousavi SGA, Nikoueinejad H, Abdoli A. Serological and molecular survey of toxoplasmosis in renal transplant recipients and hemodialysis patients in Kashan and Qom regions, central Iran. Ren Fail 2016; 38:970-3. [DOI: 10.3109/0886022x.2016.1172940] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Held PJ, McCormick F, Ojo A, Roberts JP. A Cost-Benefit Analysis of Government Compensation of Kidney Donors. Am J Transplant 2016; 16:877-85. [PMID: 26474298 PMCID: PMC5057320 DOI: 10.1111/ajt.13490] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 01/25/2023]
Abstract
From 5000 to 10 000 kidney patients die prematurely in the United States each year, and about 100 000 more suffer the debilitating effects of dialysis, because of a shortage of transplant kidneys. To reduce this shortage, many advocate having the government compensate kidney donors. This paper presents a comprehensive cost-benefit analysis of such a change. It considers not only the substantial savings to society because kidney recipients would no longer need expensive dialysis treatments--$1.45 million per kidney recipient--but also estimates the monetary value of the longer and healthier lives that kidney recipients enjoy--about $1.3 million per recipient. These numbers dwarf the proposed $45 000-per-kidney compensation that might be needed to end the kidney shortage and eliminate the kidney transplant waiting list. From the viewpoint of society, the net benefit from saving thousands of lives each year and reducing the suffering of 100 000 more receiving dialysis would be about $46 billion per year, with the benefits exceeding the costs by a factor of 3. In addition, it would save taxpayers about $12 billion each year.
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Affiliation(s)
- P J Held
- Department of Nephrology, Stanford University, Stanford, CA
| | - F McCormick
- U.S. Economic and Financial Research, Bank of America, San Francisco, CA (retired)
| | - A Ojo
- Department of Nephrology, University of Michigan Health Systems, Ann Arbor, MI
| | - J P Roberts
- Department of Surgery, University of California San Francisco Transplant Service, San Francisco, CA
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Bastani B. The worsening transplant organ shortage in USA; desperate times demand innovative solutions. J Nephropathol 2015; 4:105-9. [PMID: 26457256 PMCID: PMC4596293 DOI: 10.12860/jnp.2015.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 06/22/2015] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bahar Bastani
- Division of Nephrology, Saint Louis University School of Medicine. Medical director of kidney transplantation, Saint Louis University School of Medicine, Saint Louis, USA
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30
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Bruzzone P. Paid Organ Donation: An Italian Perspective. Transplant Proc 2015; 47:2109-12. [PMID: 26361655 DOI: 10.1016/j.transproceed.2015.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/11/2015] [Accepted: 01/28/2015] [Indexed: 11/30/2022]
Abstract
The only countries that have allowed financial incentives for organ donation are Iran since 1988, and later on, Singapore and Saudi Arabia. In Europe, and of course in Italy, financial incentives for donors are prohibited. The author has completed extensive research via the Internet (PubMed) of worldwide scientific literature on paid organ donation, also researching studies concerning public opinion on organ commercialism and "regulated markets". Italian transplant laws also have been reported and analyzed.
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Affiliation(s)
- P Bruzzone
- Department of General Surgery, Surgical Sciences and Transplantation "Paride Stefanini", Università di Roma "La Sapienza", Rome, Italy.
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31
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Ambagtsheer F, Van Balen LJ, Duijst-Heesters WLJM, Massey EK, Weimar W. Reporting Organ Trafficking Networks: A Survey-Based Plea to Breach the Secrecy Oath. Am J Transplant 2015; 15:1759-67. [PMID: 25873198 DOI: 10.1111/ajt.13245] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 01/23/2015] [Accepted: 01/29/2015] [Indexed: 01/25/2023]
Abstract
Patients travel worldwide to purchase kidneys. Transplant professionals can play a role in identifying kidney purchase. However, due to the tension between their rights and obligations, a lack of understanding and knowledge exists on how to prevent and report purchase. We present the results of a national survey that describes transplant professionals' experiences, attitudes, behaviors, conflicts of duties, legal knowledge and needs for guidelines toward patients who purchase kidneys abroad. Second, we clarify professionals' rights and obligations regarding organ purchase and propose actions that they can take to report purchase. Of the 100/241 (42%) professionals who treated patients who traveled to a country outside the European Union for a kidney transplant, 31 (31%) were certain that patients purchased kidneys. Sixty-five (65%) had suspicions that patients had bought kidneys. The majority reported a conflict of duties. Eighty percent reported a need for guidelines. Professionals can help prevent organ purchase by disclosing information about organ trafficking networks to law enforcement. Such disclosure can support the investigation and prosecution of networks. We offer key components for guidelines on disclosure of these networks.
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Affiliation(s)
- F Ambagtsheer
- Department of Internal Medicine, Section Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L J Van Balen
- Department of Internal Medicine, Section Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - E K Massey
- Department of Internal Medicine, Section Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - W Weimar
- Department of Internal Medicine, Section Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Hippen B. Debating Organ Procurement Policy Without Illusions. Am J Kidney Dis 2015; 66:577-82. [PMID: 26094999 DOI: 10.1053/j.ajkd.2015.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 05/01/2015] [Indexed: 11/11/2022]
Abstract
In this perspective, I review and critique claims that the transplant waiting list overstates the demand for kidneys and correct a few mischaracterizations of some structural barriers to increasing rates of transplantation. The solutions to the shortage of organs proffered by opponents of financial incentives fail to account for a panoply of clinical, regulatory, and financial realities of transplantation centers in the United States in ways that undermine the thesis that a trial of financial incentives for organ procurement is not warranted at this time. I conclude with some personal pessimistic reflections on the progress of this debate.
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Affiliation(s)
- Benjamin Hippen
- Metrolina Nephrology Associates, PA, and The Carolinas Medical Center, Charlotte, NC.
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Koplin JJ. From blood donation to kidney sales: the gift relationship and transplant commercialism. Monash Bioeth Rev 2015; 33:102-122. [PMID: 26458365 DOI: 10.1007/s40592-015-0035-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In The Gift Relationship, Richard Titmuss argued that the practice of altruistic blood donation fosters social solidarity while markets in blood erode it. This paper considers the implications of this line of argument for the organ market debate. I defend Titmuss' arguments against a number of criticisms and respond to claims that Titmuss' work is not relevant to the context of live donor organ transplantation. I conclude that Titmuss' arguments are more resilient than many advocates of organ markets suggest, and more relevant to the debate than is commonly appreciated.
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Affiliation(s)
- Julian J Koplin
- Centre for Human Bioethics, School of Philosophical, Historical and International Studies, Monash University, Menzies Building, 20 Chancellors Walk, Melbourne, VIC, 3800, Australia.
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Koplin JJ. The ambiguous lessons of the Iranian model of paid living kidney donation : Fry-Revere, S. (2014). The kidney sellers: a journey of discovery in Iran. (Durham: Carolina Academic Press). Monash Bioeth Rev 2015; 32:284-90. [PMID: 25743055 DOI: 10.1007/s40592-015-0023-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Julian J Koplin
- Centre for Human Bioethics, Monash University, Ringwood, VIC, Australia,
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35
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Quality and Quantity of Health Evaluation and the Follow-up of Iranian Living Donors. Transplant Proc 2015; 47:1092-5. [DOI: 10.1016/j.transproceed.2014.11.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/19/2014] [Indexed: 01/13/2023]
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EXP CLIN TRANSPLANTExp Clin Transplant 2015; 13. [DOI: 10.6002/ect.mesot2014.o30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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37
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Survey of the Knowledge, Perception, and Attitude of Medical Students at the University of Leeds Toward Organ Donation and Transplantation. Transplant Proc 2015; 47:247-60. [DOI: 10.1016/j.transproceed.2014.11.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 11/25/2014] [Indexed: 11/21/2022]
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Abstract
Establishing a programme for the prevention and treatment of acute kidney injury, chronic kidney disease and end-stage renal disease in a developing country involves unique challenges. We became involved in a collaborative effort to improve nephrology care in Haiti after participating in the emergency response to the 2010 earthquake. The focus of this ongoing project is overcoming barriers to implementation with the goal of improving training and resources for Haitian health-care workers and developing programmes for renal disease prevention and treatment in a setting of limited resources. Here, we offer practical advice for nephrologists who would like to help to advance medical care in developing countries. Rather than technical issues related to the prevention and treatment of renal disease, we focus on collaboration, education and the building of partnerships.
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Eslami AA, Rabiei L, Khayri F, Rashidi Nooshabadi MR, Masoudi R. Sleep quality and spiritual well-being in hemodialysis patients. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e17155. [PMID: 25237580 PMCID: PMC4166099 DOI: 10.5812/ircmj.17155] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 02/13/2014] [Accepted: 03/29/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sleep disorders are considered as one of the most important problems in hemodialysis patients, making their everyday life a serious hazard. Sleep quality of hemodialysis patients and consequences of sleep disorders on other aspects of health such as spiritual well-being are important issues. OBJECTIVES This study examined the relationship between spiritual well-being and quality of sleep in hemodialysis patients in Isfahan, Iran. PATIENTS AND METHODS This study was a correlation research, carried out on 190 hemodialysis patients. Data collection Questionnaires included demographic forms, Pittsburgh sleep quality index (PSQI), and Ellison and Paloutzian spiritual well-being scale. Data were analyzed using descriptive and inferential statistics (Pearson correlation and linear regression analysis) at P < 0.05 significance level, by SPSS software version 18. RESULTS Of 190 study participants, 163 (85.78%) with scores more than five index had sleep disturbances and 27 (14.12%) had no sleep disturbance; 3 (1.52%) had mild, 163 (85.78%) moderate, and 24 (12.30%) good spiritual health conditions. Pearson correlation test showed significant relationship between the sleep quality items of Pittsburg and spiritual well-being (P < 0.04, r = 0.149). Through the regression analyses of spiritual health, family, education, financial status, marital status, occupation, and use of sleep medication, the predictive power of these variables was found 0.417% and prediction of spiritual well-being was more than others (ß = 0.209). CONCLUSIONS Considering bed as one of the most vital physical, mental, and emotional needs, it is very important in mental and spiritual well-being of hemodialysis patients as an influencing factor in mental relaxation and reducing disease tensions. Paying attention to sleep quality and spiritual well-being components of hemodialysis patients in formulating and promoting healthcare programs is recommended.
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Affiliation(s)
- Ahmad Ali Eslami
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Leili Rabiei
- School of Health, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Freidoon Khayri
- Nursing and Midwifery School, Iran University of Medical Sciences, Tehran, IR Iran
| | | | - Reza Masoudi
- Nursing and Midwifery School, Shahrekord University of Medical Sciences, Shahrekord, IR Iran
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41
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Khatami SM, Mahdavi-Mazdeh M. Perfect is the enemy of good: the Iranian system of paid donation. Am J Transplant 2014; 14:1222-3. [PMID: 24618409 DOI: 10.1111/ajt.12675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- S M Khatami
- Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
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42
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Kidney international web focus on transplantation. Kidney Int 2014; 85:227-9. [PMID: 24487359 DOI: 10.1038/ki.2013.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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43
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Aramesh K. A closer look at the Iranian model of kidney transplantation. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2014; 14:35-37. [PMID: 25229581 DOI: 10.1080/15265161.2014.947044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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44
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Fallahzadeh MK, Jafari L, Roozbeh J, Singh N, Shokouh-Amiri H, Behzadi S, Rais-Jalali GA, Salehipour M, Malekhosseini SA, Sagheb MM. Comparison of health status and quality of life of related versus paid unrelated living kidney donors. Am J Transplant 2013; 13:3210-4. [PMID: 24266971 DOI: 10.1111/ajt.12488] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 07/16/2013] [Accepted: 07/21/2013] [Indexed: 01/25/2023]
Abstract
The aim of this cross-sectional study was to assess the health status and quality of life (QOL) of paid unrelated versus related living kidney donors postdonation at Shiraz Transplant Center in Iran. We invited all donors (n = 580, 347 paid unrelated, 233 related) who underwent donor nephrectomy at our center from 2004 to 2010 to participate in a health survey and physical examination. Of 580 donors, 144 consented to participate; participation of paid unrelated donors was significantly lower than related (52/347 vs. 92/233; p < 0.001). Participants underwent a complete physical examination, QOL assessment (using a 36-item short form health survey [SF-36] questionnaire) and laboratory work-up. The paid unrelated donors compared with related donors were younger (34.2 ± 7.2 vs. 40.7 ± 9.7 years, p < 0.001), had shorter time since donation (2.9 ± 1.6 vs. 3.8 ± 2 years, p = 0.004), had higher estimated GFR (72.6 ± 22 vs. 63.8 ± 15.3 mL/min/1.73 m(2), p = 0.006) and had a higher percentage of patients with microalbuminuria (35% vs. 0%, p < 0.001). Additionally, general health and social functioning scores among paid unrelated donors were significantly lower (p < 0.001 and p = 0.02, respectively) than related donors. Other SF-36 scores, although lower in paid unrelated donors, did not reach statistical significance. Iranian paid unrelated donors have lower QOL and higher incidence of microalbuminuria compared with related donors.
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Affiliation(s)
- M K Fallahzadeh
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; John C. McDonald Regional Transplant Center, Willis-Knighton Health System, Shreveport, LA; Division of Nephrology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA
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46
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Dave R, James C, Ahmad N. Expanding organ donation in the UK: ethical, moral and logistical dilemmas. Br J Hosp Med (Lond) 2013; 74:512-7. [DOI: 10.12968/hmed.2013.74.9.512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rajiv Dave
- General Surgery in the Division of Surgery, Department of Transplantation, St James's University Hospital, Leeds
| | | | - Niaz Ahmad
- Division of Surgery, Department of Transplantation, St James's University Hospital, Leeds LS9 7TF
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47
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Caskey FJ, Ravanan R. Access to kidney transplantation in Australia: does equal mean equitable? Kidney Int 2013; 83:18-20. [PMID: 23271486 DOI: 10.1038/ki.2012.372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Sociodemographic gradients have been widely reported in end-stage renal disease treatment, as in the general population. So should we be relieved by the report from Grace et al. of no such gradient in access to deceased donor kidney transplantation in Australia? Although the authors have adjusted for the 'competing risk' of living kidney donor transplantation, which is higher in higher socioeconomic groups, it feels a little early to be reassured.
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Najafi I, Alatab S, Atabak S, Majelan NN, Sanadgol H, Makhdoomi K, Ardalan MR, Azmandian J, Shojaee A, Keshvari A, Hosseini M. Seventeen years' experience of peritoneal dialysis in Iran: first official report of the Iranian peritoneal dialysis registry. Perit Dial Int 2013; 34:636-42. [PMID: 23733658 DOI: 10.3747/pdi.2012.00054] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To facilitate planning, national renal registries provide reliable and up-to-date information on numbers of patients with end-stage renal disease (ESRD), developing trends, treatment modalities, and outcomes. To that end, the present publication represents the first official report from Iranian Peritoneal Dialysis Registry. METHODS The prevalence, demographics, and clinical characteristics of patients on peritoneal dialysis (PD) were collected from all PD centers throughout the country. RESULTS By the end of 2009, the prevalence of ESRD was 507 per million population in Iran. The most common renal replacement modality was hemodialysis (51.2%), followed by kidney transplantation (44.7%), and then PD (4.1%). The mean age of PD patients was 46 years, and the most common causes of ESRD were diabetes (33.5%), hypertension (24.4%), and glomerulonephritis (8.2%). Overall patient mortality was 25%, with cardiac events (46%), cerebral stroke (10%), and infection (8%) being the main causes of death. The 1-, 3-, and 5-year survivals were 89%, 64%, and 49% respectively. The most common cause of dropout was peritonitis (17.6%). Staphylococcus (coagulase-negative and S. aureus) was the most prevalent causative organism in peritonitis episodes; however, in more than 50% of episodes, a sterile culture was reported. Mean baseline serum hemoglobin and albumin were 10.7 g/dL and 3.6 g/dL respectively. CONCLUSIONS Our registry results, representing the second largest report of PD in the Middle East, is almost comparable to available regional data. We hope that, in future, we can improve our shortcomings and lessen the gap with developed countries.
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Affiliation(s)
- Iraj Najafi
- Division of Nephrology, Shariati Hospital, and Nephrology Research Center, Tehran University of Medical Sciences, Tehran; Division of Nephrology, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran; Division of Nephrology, Sadoughi Hospital, Yazd University of Medical Sciences, Yazd; Division of Nephrology, Ali-ebn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan; Division of Nephrology, Imam Khomeini Hospital, Urmiah University of Medical Sciences, Urmiah; Division of Nephrology, Imam Hospital, Tabriz University of Medical Sciences, Tabriz; Division of Nephrology, Shafa Hospital, Kerman University of Medical Sciences, Kerman; Pegahsoft, Khorasan Science and Technology Park, Mashad; Division of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran; and Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sudabeh Alatab
- Division of Nephrology, Shariati Hospital, and Nephrology Research Center, Tehran University of Medical Sciences, Tehran; Division of Nephrology, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran; Division of Nephrology, Sadoughi Hospital, Yazd University of Medical Sciences, Yazd; Division of Nephrology, Ali-ebn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan; Division of Nephrology, Imam Khomeini Hospital, Urmiah University of Medical Sciences, Urmiah; Division of Nephrology, Imam Hospital, Tabriz University of Medical Sciences, Tabriz; Division of Nephrology, Shafa Hospital, Kerman University of Medical Sciences, Kerman; Pegahsoft, Khorasan Science and Technology Park, Mashad; Division of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran; and Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahnaz Atabak
- Division of Nephrology, Shariati Hospital, and Nephrology Research Center, Tehran University of Medical Sciences, Tehran; Division of Nephrology, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran; Division of Nephrology, Sadoughi Hospital, Yazd University of Medical Sciences, Yazd; Division of Nephrology, Ali-ebn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan; Division of Nephrology, Imam Khomeini Hospital, Urmiah University of Medical Sciences, Urmiah; Division of Nephrology, Imam Hospital, Tabriz University of Medical Sciences, Tabriz; Division of Nephrology, Shafa Hospital, Kerman University of Medical Sciences, Kerman; Pegahsoft, Khorasan Science and Technology Park, Mashad; Division of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran; and Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Nouri Majelan
- Division of Nephrology, Shariati Hospital, and Nephrology Research Center, Tehran University of Medical Sciences, Tehran; Division of Nephrology, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran; Division of Nephrology, Sadoughi Hospital, Yazd University of Medical Sciences, Yazd; Division of Nephrology, Ali-ebn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan; Division of Nephrology, Imam Khomeini Hospital, Urmiah University of Medical Sciences, Urmiah; Division of Nephrology, Imam Hospital, Tabriz University of Medical Sciences, Tabriz; Division of Nephrology, Shafa Hospital, Kerman University of Medical Sciences, Kerman; Pegahsoft, Khorasan Science and Technology Park, Mashad; Division of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran; and Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Houshang Sanadgol
- Division of Nephrology, Shariati Hospital, and Nephrology Research Center, Tehran University of Medical Sciences, Tehran; Division of Nephrology, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran; Division of Nephrology, Sadoughi Hospital, Yazd University of Medical Sciences, Yazd; Division of Nephrology, Ali-ebn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan; Division of Nephrology, Imam Khomeini Hospital, Urmiah University of Medical Sciences, Urmiah; Division of Nephrology, Imam Hospital, Tabriz University of Medical Sciences, Tabriz; Division of Nephrology, Shafa Hospital, Kerman University of Medical Sciences, Kerman; Pegahsoft, Khorasan Science and Technology Park, Mashad; Division of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran; and Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Khadijeh Makhdoomi
- Division of Nephrology, Shariati Hospital, and Nephrology Research Center, Tehran University of Medical Sciences, Tehran; Division of Nephrology, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran; Division of Nephrology, Sadoughi Hospital, Yazd University of Medical Sciences, Yazd; Division of Nephrology, Ali-ebn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan; Division of Nephrology, Imam Khomeini Hospital, Urmiah University of Medical Sciences, Urmiah; Division of Nephrology, Imam Hospital, Tabriz University of Medical Sciences, Tabriz; Division of Nephrology, Shafa Hospital, Kerman University of Medical Sciences, Kerman; Pegahsoft, Khorasan Science and Technology Park, Mashad; Division of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran; and Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Ardalan
- Division of Nephrology, Shariati Hospital, and Nephrology Research Center, Tehran University of Medical Sciences, Tehran; Division of Nephrology, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran; Division of Nephrology, Sadoughi Hospital, Yazd University of Medical Sciences, Yazd; Division of Nephrology, Ali-ebn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan; Division of Nephrology, Imam Khomeini Hospital, Urmiah University of Medical Sciences, Urmiah; Division of Nephrology, Imam Hospital, Tabriz University of Medical Sciences, Tabriz; Division of Nephrology, Shafa Hospital, Kerman University of Medical Sciences, Kerman; Pegahsoft, Khorasan Science and Technology Park, Mashad; Division of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran; and Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Jalal Azmandian
- Division of Nephrology, Shariati Hospital, and Nephrology Research Center, Tehran University of Medical Sciences, Tehran; Division of Nephrology, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran; Division of Nephrology, Sadoughi Hospital, Yazd University of Medical Sciences, Yazd; Division of Nephrology, Ali-ebn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan; Division of Nephrology, Imam Khomeini Hospital, Urmiah University of Medical Sciences, Urmiah; Division of Nephrology, Imam Hospital, Tabriz University of Medical Sciences, Tabriz; Division of Nephrology, Shafa Hospital, Kerman University of Medical Sciences, Kerman; Pegahsoft, Khorasan Science and Technology Park, Mashad; Division of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran; and Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Shojaee
- Division of Nephrology, Shariati Hospital, and Nephrology Research Center, Tehran University of Medical Sciences, Tehran; Division of Nephrology, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran; Division of Nephrology, Sadoughi Hospital, Yazd University of Medical Sciences, Yazd; Division of Nephrology, Ali-ebn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan; Division of Nephrology, Imam Khomeini Hospital, Urmiah University of Medical Sciences, Urmiah; Division of Nephrology, Imam Hospital, Tabriz University of Medical Sciences, Tabriz; Division of Nephrology, Shafa Hospital, Kerman University of Medical Sciences, Kerman; Pegahsoft, Khorasan Science and Technology Park, Mashad; Division of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran; and Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Keshvari
- Division of Nephrology, Shariati Hospital, and Nephrology Research Center, Tehran University of Medical Sciences, Tehran; Division of Nephrology, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran; Division of Nephrology, Sadoughi Hospital, Yazd University of Medical Sciences, Yazd; Division of Nephrology, Ali-ebn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan; Division of Nephrology, Imam Khomeini Hospital, Urmiah University of Medical Sciences, Urmiah; Division of Nephrology, Imam Hospital, Tabriz University of Medical Sciences, Tabriz; Division of Nephrology, Shafa Hospital, Kerman University of Medical Sciences, Kerman; Pegahsoft, Khorasan Science and Technology Park, Mashad; Division of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran; and Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Hosseini
- Division of Nephrology, Shariati Hospital, and Nephrology Research Center, Tehran University of Medical Sciences, Tehran; Division of Nephrology, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran; Division of Nephrology, Sadoughi Hospital, Yazd University of Medical Sciences, Yazd; Division of Nephrology, Ali-ebn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan; Division of Nephrology, Imam Khomeini Hospital, Urmiah University of Medical Sciences, Urmiah; Division of Nephrology, Imam Hospital, Tabriz University of Medical Sciences, Tabriz; Division of Nephrology, Shafa Hospital, Kerman University of Medical Sciences, Kerman; Pegahsoft, Khorasan Science and Technology Park, Mashad; Division of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran; and Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Current world literature. Curr Opin Organ Transplant 2013; 18:241-50. [PMID: 23486386 DOI: 10.1097/mot.0b013e32835f5709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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