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Shaheen MF, Bukhari R, Almutairi TM, Altheaby A, Altamimi A, Bin Saad K. Enhancing Transplant Awareness and Acceptance Through Targeting Knowledge Gaps and Common Misconceptions. Cureus 2024; 16:e52303. [PMID: 38226316 PMCID: PMC10789223 DOI: 10.7759/cureus.52303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 01/17/2024] Open
Abstract
Introduction Organ transplantation is a critical intervention for patients with end-stage organ failure, but misconceptions and knowledge gaps often hinder organ donation. This study evaluates the acceptability and effectiveness of an organ donation campaign focusing on addressing knowledge gaps and misconceptions in Riyadh, Saudi Arabia. Methods A two-day awareness campaign was conducted in a shopping mall, featuring four stations providing information on various aspects of organ donation. Participants completed a self-administered, researcher-developed, questionnaire before and after the tour. Results Of the 201 participants, 167 completed the questionnaire (83% response rate). The majority (92.9%) reported learning new information and indicated that the knowledge improved their perspective on organ donation. A high percentage (93.5%) felt the campaign answered their questions, with 90.9% deciding to register as organ donors. Conclusion A knowledge-enhancing campaign can effectively improve public perception and promote awareness of organ donation and transplantation. However, the study is limited by its short timeframe, location, and subjective data. Future research should explore the impact of such campaigns on donor registrations and evaluate their effectiveness in different cultural contexts.
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Affiliation(s)
- Mohammed F Shaheen
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Rawan Bukhari
- College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Taif M Almutairi
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abdulrahman Altheaby
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abdulrahman Altamimi
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Khalid Bin Saad
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Iltis A. Heads, Bodies, Brains, and Selves: Personal Identity and the Ethics of Whole-Body Transplantation. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2022; 47:257-278. [PMID: 35543469 DOI: 10.1093/jmp/jhab049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Plans to attempt what has been called a head transplant, a body transplant, and a head-to-body transplant in human beings raise numerous ethical, social, and legal questions, including the circumstances, if any, under which it would be ethically permissible to attempt whole-body transplantation (WBT) in human beings, the possible effect of WBT on family relationships, and how families should shape WBT decisions. Our assessment of many of these questions depends partially on how we respond to sometimes centuries-old philosophical thought experiments about personal identity. As with so much in bioethics, it is impossible to escape, or at least inadvisable to try to bypass, the relevant foundational philosophical concerns.
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Affiliation(s)
- Ana Iltis
- Department of Philosophy and Center for Bioethics, Health and Society, Wake Forest University, Winston-Salem, North Carolina, USA
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Wall AE, Fiedler A, Karp S, Shah A, Testa G. Applying the ethical framework for donation after circulatory death to thoracic normothermic regional perfusion procedures. Am J Transplant 2022; 22:1311-1315. [PMID: 35040263 DOI: 10.1111/ajt.16959] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 01/25/2023]
Abstract
The novel approach of thoracic normothermic regional perfusion (TA-NRP) for in-situ preservation of organs prior to removal presents a new series of ethical questions about donation after circulatory determination of death (DCD) procedures. This manuscript describes the framework used for the analysis of ethical acceptability of DCD donation and analyzes the specific practice of TA-NRP DCD within that framework to demonstrate that TA-NRP DCD can be performed within the ethical boundaries of DCD donation. We argue that TA-NRP DCD organ procurements meet the ethical standards of informed consent, non-maleficence, adherence to the dead donor rule, and irreversibility, and as such, are ethically acceptable. We also describe the potential benefits of TA-NRP DCD procedures that result from higher organ yields and better recipient outcomes. Finally, we call for open and transparent support of TA-NRP DCD by professional organizations as a necessary cornerstone for the advancement of TA-NRP DCD procedures.
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Affiliation(s)
- Anji E Wall
- Baylor Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Amy Fiedler
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Seth Karp
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ashish Shah
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Giuliano Testa
- Baylor Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
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Wall AE, Shabbir R, Chebrolu S, Vines E, Trahan C, Niles P, Testa G. Variation in donation after circulatory death hospital policies in a single donor service area. Am J Surg 2022; 224:595-601. [DOI: 10.1016/j.amjsurg.2022.03.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 02/06/2023]
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Iltis AS. Organ Donation, Brain Death and the Family: Valid Informed Consent. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2015; 43:369-382. [PMID: 26242960 DOI: 10.1111/jlme.12254] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
I argue that valid informed consent is ethically required for organ donation from individuals declared dead using neurological criteria. Current policies in the U.S. do not require this and, not surprisingly, current practices inhibit the possibility of informed consent. Relevant information is withheld, opportunities to ensure understanding and appreciation are extremely limited, and the ability to make and communicate a free and voluntary decision is hindered by incomplete disclosure and other practices. Current practices should be revised to facilitate valid informed consent for organ donation.
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Affiliation(s)
- Ana S Iltis
- Director of the Center for Bioethics, Health and Society and a Professor of Philosophy at Wake Forest University. She holds a Ph.D. in Philosophy from Rice University
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6
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Bodí MA, Pont T, Sandiumenge A, Oliver E, Gener J, Badía M, Mestre J, Muñoz E, Esquirol X, Llauradó M, Twose J, Quintana S. Brain death organ donation potential and life support therapy limitation in neurocritical patients. Med Intensiva 2014; 39:337-44. [PMID: 25443330 DOI: 10.1016/j.medin.2014.07.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 06/26/2014] [Accepted: 07/29/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To analyze the profile, incidence of life support therapy limitation (LSTL) and donation potential in neurocritical patients. STUDY DESIGN A multicenter prospective study was carried out. SETTING Nine hospitals authorized for organ harvesting for transplantation. PATIENTS All patients consecutively admitted to the hospital with GCS < 8 during a 6-month period were followed-up until discharge or day 30 of hospital stay. STUDY VARIABLES Demographic data, cause of coma, clinical status upon admission and outcome were analyzed. LSTL, brain death (BD) and organ donation incidence were recorded. RESULTS A total of 549 patients were included, with a mean age of 59.0 ± 14.5 years. The cause of coma was cerebral hemorrhage in 27.0% of the cases.LSTL was applied in 176 patients (32.1%). In 78 cases LSTL consisted of avoiding ICU admission. Age, the presence of contraindications, and specific causes of coma were associated to LSTL. A total of 58.1% of the patients died (n=319). One-hundred and thirty-three developed BD (24.2%), and 56.4% of these became organ donors (n=75). The presence of edema and mid-line shift on the CT scan, and transplant coordinator evaluation were associated to BD. LSTL was associated to a no-BD outcome. Early LSTL (first 4 days) was applied in 9 patients under 80 years of age, with no medical contraindications for donation and a GCS ≤ 4 who finally died in asystole. CONCLUSIONS LSTL is a frequent practice in neurocritical patients. In almost one-half of the cases, LSTL consisted of avoiding admission to the ICU, and on several occasions the donation potential was not evaluated by the transplant coordinator.
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Affiliation(s)
- M A Bodí
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Universitat Rovira i Virgili, Institut Investigació Sanitària Pere Virgili, Tarragona, España.
| | - T Pont
- Coordinación de Trasplantes, Hospital Universitario Vall d'Hebrón, Barcelona, España
| | - A Sandiumenge
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Universitat Rovira i Virgili, Institut Investigació Sanitària Pere Virgili, Tarragona, España
| | - E Oliver
- Coordinación de Trasplantes, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - J Gener
- Servicio de Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España
| | - M Badía
- Servicio de Medicina Intensiva, Hospital Universitario Arnau de Vilanova de Lleida, Lérida, España
| | - J Mestre
- Servicio de Medicina Intensiva, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - E Muñoz
- Servicio de Medicina Intensiva, Hospital Sant Pau i Santa Tecla, Tarragona, España
| | - X Esquirol
- Servicio de Medicina Intensiva, Hospital de Granollers, Granollers, Barcelona, España
| | - M Llauradó
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Universitat Rovira i Virgili, Institut Investigació Sanitària Pere Virgili, Tarragona, España
| | - J Twose
- Organización Catalana de Trasplantes, Barcelona, España
| | - S Quintana
- Servicio de Medicina Intensiva, Hospital Mutua de Terrassa, Terrassa, Barcelona, España
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Abstract
Deciding to cease treatment in intensive care unit patients whose prognosis is hopeless allows programming the moment of death, and hence, post mortem transplantable organ donation. Such organ donations are more frequent in Anglo-Saxon countries. In the context of growing organ needs, they have significantly increased the number of organs that are available for transplant. Progressive experience has shown that crystal-clear procedures must be set up in order to avoid lack of understanding, opposition, or even conflict between involved medical teams and immediate relatives of potential donors. The decision of organ transplantation must totally be separated from the decision of treatment cessation. Supportive treatment cessation must be done according to previously established procedures. Medications that are compatible with organ transplantation must be listed. Finally, the needs of patient relatives must be met.
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Abstract
Circulatory-respiratory or brain tests are widely accepted for definition and determination of death, but have several controversial issues. Both determinations have been stimulated by organ donation, but must be valid independently of this process. Current controversies in brain death include whether the definition is conceptually coherent, whether the whole-brain or brainstem criterion is correct, whether one neurological examination or two should be required, and when to conduct the examination following therapeutic hypothermia. Controversies about the circulatory determination of death include the minimum duration of asystole that is sufficient for death to be declared, and whether the distinction between permanent and irreversible cessation of circulatory functioning is important. In addition, the goal of organ donation raises issues such as the optimal way to time and conduct the request conversation with family members of the patient, and whether the Dead Donor Rule should be abandoned.
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Affiliation(s)
- James L Bernat
- Neurology Department, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
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Atwood D, Uttley R, Ortega D. Organ donor considerations. Nurs Manag (Harrow) 2012; 43:22-28. [PMID: 22572728 DOI: 10.1097/01.numa.0000414863.69502.b7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Trompeta JA, Cooper BA, Ascher NL, Kools SM, Kennedy CM, Chen JL. Asian American Adolescents' Willingness to Donate Organs and Engage in Family Discussion about Organ Donation and Transplantation. Prog Transplant 2012; 22:33-40, 70. [PMID: 22489441 DOI: 10.7182/pit2012328] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Context— Despite the growing need for organ donation among Asian Americans, studies suggest that they are reluctant to donate. Objective— To examine the association of attitudes and knowledge about organ donation and transplantation with willingness to donate and willingness to engage in family discussion about organ donation among Asian American adolescents. Design— A cross-sectional study. Setting— The Big Island of Hawaii. Participants— Self-identified Asian American adolescents (Japanese, Chinese, Filipino, Korean), ages 16 to 17 years old, and each adolescent's parent or guardian. Main Outcome Measures— Asian American adolescents provided demographic information and completed the Modified Organ Donation Attitude Survey, the Organ Donation and Transplantation Knowledge Survey, and the Suinn-Lew Asian Self-Identity Acculturation Scale. A parent or guardian also provided demographic information. Linear regression analyses were used to examine the associations with willingness to donate and to engage in family discussion about organ discussion. Results— Willingness to donate was associated with positive knowledge related to general aspects about organ donation and cultural limitations in receiving an organ transplant, a high level of acculturation, and a low level of negative attitudes ( R2 = 0.402, F = 18.86, P = .005). Asian American adolescents with approving or positive attitudes were likely to engage in family discussion about organ donation ( R2 = 0.195, F =27.93, P = .005). To reinforce and maintain high levels of knowledge and positive attitudes, organ donation education is most likely needed in high schools.
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Abstract
The principles of gift law establish a consistent international legal understanding of consent to donation under a range of regulatory systems. Gift law as the primary legal principle is important to both the foundation of systems that prevent organ sales and the consideration of strategies to increase organ donation for transplantation.
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Affiliation(s)
- Alexandra K Glazier
- New England Organ Bank, Boston University School of Law, Waltham, MA 02451, USA.
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Rady MY, Verheijde JL. Patients'-best-interests standard trumps autonomous health-care decisions: paternalism vs self-determination. Chest 2010; 138:1021-2; author reply 1022-3. [PMID: 20923809 DOI: 10.1378/chest.10-0939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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13
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Pope TM. Legal Briefing: Organ Donation and Allocation. THE JOURNAL OF CLINICAL ETHICS 2010. [DOI: 10.1086/jce201021310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Iltis AS. Organ Donation and Global Bioethics. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2010; 35:213-9. [DOI: 10.1093/jmp/jhq011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Verheijde JL, Rady MY, McGregor J. Presumed consent for organ preservation in uncontrolled donation after cardiac death in the United States: a public policy with serious consequences. Philos Ethics Humanit Med 2009; 4:15. [PMID: 19772617 PMCID: PMC2757028 DOI: 10.1186/1747-5341-4-15] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 09/22/2009] [Indexed: 05/28/2023] Open
Abstract
Organ donation after cessation of circulation and respiration, both controlled and uncontrolled, has been proposed by the Institute of Medicine as a way to increase opportunities for organ procurement. Despite claims to the contrary, both forms of controlled and uncontrolled donation after cardiac death raise significant ethical and legal issues. Identified causes for concern include absence of agreement on criteria for the declaration of death, nonexistence of universal guidelines for duration before stopping resuscitation efforts and techniques, and assumption of presumed intent to donate for the purpose of initiating temporary organ-preservation interventions when no expressed consent to donate is present. From a legal point of view, not having scientifically valid criteria of cessation of circulation and respiration for declaring death could lead to a conclusion that organ procurement itself is the proximate cause of death. Although the revised Uniform Anatomical Gift Act of 2006 provides broad immunity to those involved in organ-procurement activities, courts have yet to provide an opinion on whether persons can be held liable for injuries arising from the determination of death itself. Preserving organs in uncontrolled donation after cardiac death requires the administration of life-support systems such as extracorporeal membrane oxygenation. These life-support systems can lead to return of signs of life that, in turn, have to be deliberately suppressed by the administration of pharmacological agents. Finally, allowing temporary organ-preservation interventions without expressed consent is inherently a violation of the principle of respect for a person's autonomy. Proponents of organ donation from uncontrolled donation after cardiac death, on the other hand, claim that these nonconsensual interventions enhance respect for autonomy by allowing people, through surrogate decision making, to execute their right to donate organs. However, the lack of transparency and the absence of protection of individual autonomy, for the sake of maximizing procurement opportunities, have placed the current organ-donation system of opting-in in great jeopardy. Equally as important, current policies enabling and enhancing organ procurement practices, pose challenges to the constitutional rights of individuals in a pluralistic society as these policies are founded on flawed medical standards for declaring death.
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Affiliation(s)
- Joseph L Verheijde
- Bioethics, Policy and Law Program, School of Life Sciences, Center for Biology and Society, Arizona State University, 300 East University Drive, Tempe, Arizona 85287, USA
- Department of Biomedical Ethics, College of Medicine, Mayo Clinic, 5777 East Mayo Boulevard Phoenix, AZ 85054, USA
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, Arizona, 85054, USA
| | - Mohamed Y Rady
- Bioethics, Policy and Law Program, School of Life Sciences, Center for Biology and Society, Arizona State University, 300 East University Drive, Tempe, Arizona 85287, USA
- Department of Critical Care Medicine, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, Arizona, 85054, USA
| | - Joan McGregor
- Department of Philosophy, Arizona State University, 300 East University Drive, Tempe, Arizona 85287, USA
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Respecting patients’ rights at the end of life: Problems with the 2006 Uniform Anatomical Gift Act*. Crit Care Med 2009; 37:372-3. [DOI: 10.1097/ccm.0b013e3181932d71] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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