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Grossi AA, Potena L, Rossano JW, Breathett K. Socioeconomic deprivation and heart transplantation: A call for progress in the United States and EUROPE. J Heart Lung Transplant 2024; 43:334-336. [PMID: 37884164 DOI: 10.1016/j.healun.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Affiliation(s)
- Alessandra Agnese Grossi
- Department of Human Sciences, Innovation and Territory, University of Insubria, Varese-Como, Italy; Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
| | - Luciano Potena
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.
| | - Joseph W Rossano
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Krannert Cardiovascular Center, Indiana University, Indianapolis, Indiana
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2
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Grossi AA, Puoti F, Maggiore U, Cardillo M. Refusal Rates to Organ Donation in Intensive Care Units Among Immigrant Populations in Italy. Transpl Int 2023; 36:11674. [PMID: 37745641 PMCID: PMC10513101 DOI: 10.3389/ti.2023.11674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Alessandra Agnese Grossi
- Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
- Department of Human Sciences, Innovation and Territory, University of Insubria, Como, Italy
| | - Francesca Puoti
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Umberto Maggiore
- Nephrology Unit, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Massimo Cardillo
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
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3
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Grossi AA, Puoti F, Masiero L, Troni A, Cianchi T, Maggiore U, Cardillo M. Inequities in Organ Donation and Transplantation Among Immigrant Populations in Italy: A Narrative Review of Evidence, Gaps in Research and Potential Areas for Intervention. Transpl Int 2023; 36:11216. [PMID: 37636900 PMCID: PMC10450150 DOI: 10.3389/ti.2023.11216] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/19/2023] [Indexed: 08/29/2023]
Abstract
Immigrants from outside Europe have increased over the past two decades, especially in Southern European countries including Italy. This influx coincided with an increased number of immigrants with end-stage organ diseases. In this narrative review, we reviewed evidence of the gaps between native-born and immigrant populations in the Organ Donation and Transplantation (ODT) process in Italy. Consistent with prior studies, despite the availability of a publicly funded health system with universal healthcare coverage, non-European-born individuals living in Italy are less likely to receive living donor kidney transplantation and more likely to have inferior long-term kidney graft function compared with EU-born and Eastern European-born individuals. While these patients are increasingly represented among transplant recipients (especially kidney and liver transplants), refusal rates for organ donation are higher in some ethnic groups compared with native-born and other foreign-born referents, with the potential downstream effects of prolonged waiting times and inferior transplant outcomes. In the process, we identified gaps in relevant research and biases in existing studies. Given the Italian National Transplant Center's (CNT) commitment to fighting inequities in ODT, we illustrated actions taken by CNT to tackle inequities in ODT among immigrant communities in Italy.
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Affiliation(s)
- Alessandra Agnese Grossi
- Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
- Department of Human Sciences, Innovation and Territory, University of Insubria, Como, Italy
| | - Francesca Puoti
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Lucia Masiero
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Alessia Troni
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Tiziana Cianchi
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Umberto Maggiore
- Nephrology Unit, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Massimo Cardillo
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
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Grossi AA, Randhawa G, Jansen NE, Paredes-Zapata D. Taking a "Care Pathway/Whole Systems" Approach to Equality Diversity Inclusion (EDI) in Organ Donation and Transplantation in Relation to the Needs of "Ethnic/Racial/Migrant" Minority Communities: A Statement and a Call for Action. Transpl Int 2023; 36:11310. [PMID: 37600748 PMCID: PMC10437067 DOI: 10.3389/ti.2023.11310] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023]
Abstract
International evidence shows variation in organ donation and transplantation (ODT) based upon a range of patient characteristics. What is less well understood is the impact of patient "ethnicity/race/immigration background," as these terms are defined and intended differently across countries. We also know that these characteristics do not operate in isolation but intersect with a range of factors. In this paper, we propose a framework that seeks to clarify the definition of the key terms "ethnicity/race/migrant" and to review how these communities are operationalized across European studies about inequities in ODT. Further, patients and the public wish to see Equality Diversity Inclusion (EDI) approaches in their everyday lives, not just in relation to ODT. We propose a 'care pathway/whole-systems' approach to ODT encompassing culturally competent public health interventions for a) the prevention and management of chronic diseases, b) improvements in public engagement for the promotion of the culture of ODT and enhancements in end-of-life care, through to c) enhanced likelihood of successful transplant among migrant/ethnic minority communities. Our framework recognizes that if we truly wish to take an EDI approach to ODT, we need to adopt a more social, human and holistic approach to examining questions around patient ethnicity.
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Affiliation(s)
- Alessandra Agnese Grossi
- Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
- Department of Human Sciences, Innovation and Territory, University of Insubria, Como, Italy
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, United Kingdom
| | | | - David Paredes-Zapata
- Donation and Transplant Coordination Section, Hospital Clínic, Barcelona, Spain
- Surgical Department, University of Barcelona, Barcelona, Spain
- Donation and Transplantation Institute Foundation, Barcelona, Spain
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5
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Grossi AA, Sever MS, Hellemans R, Mariat C, Crespo M, Watschinger B, Peruzzi L, Demir E, Velioglu A, Gandolfini I, Oniscu GC, Hilbrands L, Mjoen G. The 3-Step Model of informed consent for living kidney donation: a proposal on behalf of the DESCaRTES Working Group of the European Renal Association. Nephrol Dial Transplant 2023:7005240. [PMID: 36702535 DOI: 10.1093/ndt/gfad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Living donation challenges the ethical principle of non-maleficence in that it exposes healthy persons to risks for the benefit of someone else. This makes safety, informed consent (IC) and education a priority. Living kidney donation has multiple benefits for the potential donor, but there are also several known short- and long-term risks. Although complete standardization of IC is likely to be unattainable, studies have emphasized the need for a standardized IC process to enable equitable educational and decision-making prospects for the prevention of inequities across transplant centers. Based on the Three-Talk Model of shared decision making by Elwyn et al., we propose a model, named 3-Step (S) Model, where each step coincides with the three ideal timings of the process leading the living donor to the decision to pursue living donation: prior to the need for kidney replacement therapy (team talk); at the local nephrology unit or transplant center, with transplant clinicians and surgeons prior to evaluations start (option talk); and throughout evaluation, after having learned about the different aspects of donation, especially if there are second thoughts or doubts (decision talk). Based on the 3-S Model, to deliver conceptual and practical guidance to nephrologists and transplant clinicians, we provide recommendations for standardization of the timing, content, modalities for communicating risks, and assessment of understanding prior to donation. The 3-S Model successfully allows an integration between standardization and individualization of IC, enabling a person-centered approach to potential donors. Studies will assess the effectiveness of the 3-S Model in kidney transplant clinical practice.
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Affiliation(s)
- Alessandra Agnese Grossi
- Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy.,Department of Human Sciences, Innovation, and Territory, University of Insubria, Como, Italy
| | | | - Rachel Hellemans
- Department of Nephrology-Hypertension, University Hospital, Edegem, Belgium.,Faculty of Medicine & Health Sciences, Laboratory of Experimental Medicine and Paediatrics (LEMP), University of Antwerp,Wilrijk, Belgium
| | - Christophe Mariat
- Nephrology Dialysis and Renal Transplantation Dpt, Chu de Saint-Etienne, Université Jean Monnet, Saint-Etienne, France
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar Medical Research Institute (IMIM), Hospital del Mar, Barcelona, Spain. Partially supported by INT21/00003 (Spanish Ministry of Health ISCIII FIS-FEDER)
| | - Bruno Watschinger
- Medical University of Vienna, Department of Medicine III, Division of Nephrology and Dialysis, Vienna, Austria
| | - Licia Peruzzi
- Pediatric Nephrology Dialysis and Transplantation Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Erol Demir
- Transplant Immunology Research Centre of Excellence, Koç University Hospital, Istanbul, Turkey
| | - Arzu Velioglu
- Marmara University, School of Medicine, Department of Nephrology, Istanbul, Turkey
| | | | - Gabriel C Oniscu
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, United Kingdom
| | - Luuk Hilbrands
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - Geir Mjoen
- Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway
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6
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Nicoli F, Grossi AA, Testa J, Picozzi M. The Circle Method: A Novel Approach to Clinical Ethics Consultation. J Clin Ethics 2023; 34:79-91. [PMID: 36940352 DOI: 10.1086/723428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
AbstractDifferent methods are available in clinical ethics consultation. In our experience as ethics consultants, certain individual methods have proven insufficient, and so we use a combination of methods. Based on these considerations, we first critically analyze the pros and cons of two well-known methods in the working field of clinical ethics, namely Beauchamp and Childress's four-principle approach and Jonsen, Siegler, and Winslade's four-box method. We then present the circle method, which we have used and refined during several clinical ethics consultations in the hospital setting.
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Grossi AA, Puoti F, Fiaschetti P, Di Ciaccio P, Maggiore U, Cardillo M. Kidney transplantation and withdrawal rates among wait-listed first-generation immigrants in Italy. Eur J Public Health 2022; 32:372-378. [PMID: 35381065 PMCID: PMC9159323 DOI: 10.1093/eurpub/ckac027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Multiple barriers diminish access to kidney transplantation (KT) in immigrant compared to non-immigrant populations. It is unknown whether immigration status reduces the likelihood of KT after wait-listing despite universal healthcare coverage with uniform access to transplantation. Methods We retrospectively collected data of all adult waiting list (WL) registrants in Italy (2010–20) followed for 5 years until death, KT in a foreign center, deceased-donor kidney transplant (DDKT), living-donor kidney transplant (LDKT) or permanent withdrawal from the WL. We calculated adjusted relative probability of DDKT, LDKT and permanent WL withdrawal in different immigrant categories using competing-risks multiple regression models. Results Patients were European Union (EU)-born (n = 21 624), Eastern European-born (n = 606) and non-European-born (n = 1944). After controlling for age, sex, blood type, dialysis vintage, case-mix and sensitization status, non-European-born patients had lower LDKT rates compared to other immigrant categories: LDKT adjusted relative probability of non-European-born vs. Eastern European-born 0.51 (95% CI: 0.33–0.79; P = 0.002); of non-European-born vs. EU-Born: 0.65 (95% CI: 0.47–0.82; P = 0.001). Immigration status did not affect the rate of DDKT or permanent WL withdrawal. Conclusions Among EU WL registrants, non-European immigration background is associated with reduced likelihood of LDKT but similar likelihood of DDKT and permanent WL withdrawal. Wherever not available, new national policies should enable coverage of travel and medical fees for living-donor surgery and follow-up for non-resident donors to improve uptake of LDKT in immigrant patients, and provide KT education that is culturally competent, individually tailored and easily understandable for patients and their potential living donors.
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Affiliation(s)
- Alessandra Agnese Grossi
- Department of Human Sciences, Innovation and Territory, University of Insubria, Como, Italy.,Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
| | - Francesca Puoti
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Pamela Fiaschetti
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Paola Di Ciaccio
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Umberto Maggiore
- Nephrology Unit, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Massimo Cardillo
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
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Grossi AA, De Feo TM, Ambrosini A, Picozzi M. Shared decision-making and disclosure of adverse events: critical aspects for the quality and safety of kidney transplant practice. J Nephrol 2021; 35:1305-1307. [PMID: 34787797 DOI: 10.1007/s40620-021-01202-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/05/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Alessandra Agnese Grossi
- Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy.
- Department of Human Sciences, Innovation and Territory, University of Insubria, Contrada S. Abbondio 12, 21122, Como, Italy.
- Bioethics Work-Group, Northern Italy Transplant Program (CRR NITp), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
| | - Tullia Maria De Feo
- Bioethics Work-Group, Northern Italy Transplant Program (CRR NITp), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- Transplant Coordination Reference Center-Northern Italy Transplant Program (CRR NITp), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Andrea Ambrosini
- Renal Transplant Unit, Azienda Ospedaliera Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Mario Picozzi
- Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
- Bioethics Work-Group, Northern Italy Transplant Program (CRR NITp), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
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9
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Grossi AA, Maggiore U, Puoti F, Grossi PA, Picozzi M, Cardillo M. Association of immigration background with kidney graft function in a publicly funded health system: a nationwide retrospective cohort study in Italy. Transpl Int 2020; 33:1405-1416. [PMID: 32621764 DOI: 10.1111/tri.13688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/26/2020] [Accepted: 06/29/2020] [Indexed: 11/29/2022]
Abstract
The impact of immigration background on kidney graft function (eGFR) is unknown. Italy has a publicly funded health system with universal coverage. Since immigration from non-European Union (EU) countries beyond Eastern Europe is a recent and extensive phenomenon, Italy is a rather unique setting for studying the effect of immigration status as a socioeconomic and cultural condition. We retrospectively identified all adult deceased donor kidney transplant recipients (KTRs) in Italy (2010-2015) and followed them until death, dialysis or 5-years post-transplantation; 6346 were EU-born, 161 Eastern European-born, and 490 non-European-born. We examined changes in eGFR after 1-year post-transplant using multivariable-adjusted joint longitudinal survival random-intercept Cox regression. Compared to EU-born KTRs, in non-European-born KTRs the adjusted average yearly eGFR decline was -0.96 ml/min/year (95% confidence interval: -1.48 to -0.45; P < 0.001), whereas it was similar in Eastern European-born KTRs [+0.02 ml/min/year (-0.77 to +0.81; P = 0.96)]. Adjusted 5-year transplant survival did not statistically differ between non-European-born, Eastern European-born, and EU-born. In those surviving beyond 1-year, it was 91.8% in EU-born (87.1-96.8), 92.5% in Eastern European-born (86.1-99.4), and 89.3% in non-European-born KTRs (83.0-96.0). This study provides evidence that among EU KTRs, non-European immigration background is associated with eGFR decline.
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Affiliation(s)
- Alessandra Agnese Grossi
- Department of Biotechnologies and Life Sciences, Center for Clinical Ethics, University of Insubria, Varese, Italy
| | - Umberto Maggiore
- Nephrology Unit, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Francesca Puoti
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Paolo Antonio Grossi
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy.,Infectious Diseases Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Mario Picozzi
- Department of Biotechnologies and Life Sciences, Center for Clinical Ethics, University of Insubria, Varese, Italy
| | - Massimo Cardillo
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
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10
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Van Hemelrijck WMJ, Suggs LS, Grossi AA, Schröder-Bäck P, Czabanowska K. Breast cancer screening and migrants: exploring targeted messages for Moroccan migrant women in Brussels. Ethn Health 2019; 24:927-944. [PMID: 29039216 DOI: 10.1080/13557858.2017.1390550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 09/19/2017] [Indexed: 06/07/2023]
Abstract
Objectives: This study explored views of Moroccan migrant women on barriers and facilitators to the organized breast cancer screening program in Brussels (Belgium), and the potential of targeted printed invitations to increase this population's attendance to the program. Methods: We conducted one expert interview with the breast cancer screening program coordinator on current practices and challenges with regards to inviting Moroccan migrant women in Brussels for screening. Secondly, we held focus groups with Moroccan women aged 26-66. Sessions focused on perspectives on breast cancer screening and the existing generic program invitations. Directed content analysis of transcripts was based on the Health Belief Model. Alternative communication packages were developed based on barriers and suggestions from the focus groups. A second round of focus groups looked at the alternative communication packages and their potential to encourage Moroccan migrant women in Brussels to participate in the organized breast cancer screening program. Results: Alternative packages were appreciated by some, but a number of adjustments did not catch participants' attention. Printed communication delivered by post does not appear to be the preferred means of communication to encourage breast cancer screening for Moroccan migrant women in Brussels, nor does it seem appropriate to address the barriers to screening found in this study. Conclusions: The benefit of targeted postal invitation packages for Moroccan migrant women in Brussels seems limited for a variety of reasons. For future research, a large-scale study analyzing the topic in a cross-cultural perspective is warranted.
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Affiliation(s)
- Wanda Monika Johanna Van Hemelrijck
- Department of International Health, CAPHRI-Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht , The Netherlands
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel , Brussels , Belgium
| | - L Suzanne Suggs
- Institute for Public Communication, University of Lugano , Lugano , Switzerland
- Institute of Global Health Innovation, Imperial College London , London , UK
| | | | - Peter Schröder-Bäck
- Department of International Health, CAPHRI-Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht , The Netherlands
- Faculty for Human and Health Sciences, University of Bremen , Bremen , Germany
| | - Katarzyna Czabanowska
- Department of International Health, CAPHRI-Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht , The Netherlands
- Institute of Public Health, Jagiellonian University , Krakow , Poland
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11
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Picozzi M, Grossi AA, Ferioli E, Nicoli F, Gasparetto A. Donation After Circulatory Death: When Withdrawing Life-Sustaining Treatments Is Ethically Acceptable. Transplant Proc 2019; 51:117-119. [PMID: 30655134 DOI: 10.1016/j.transproceed.2018.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/04/2018] [Accepted: 05/21/2018] [Indexed: 11/15/2022]
Abstract
The possibility to determine death based on cardiocirculatory criteria in controlled cases, namely when there is a request to withhold treatment-or, more frequently, withdraw it-specifically recalls the recent Italian law on advance treatment directives and leaves the following question unanswered: Under what conditions is the patient's request legally and ethically acceptable? We present three ethical proportionality criteria for supporting physicians' decision-making facing patients' requests of treatment withdrawal, namely: 1. irreversible pathology with an ominous and worsening prognosis; 2. within an evaluation considering both clinical data and the patient's history; and 3. facing burdens that are no longer bearable. We finally argue that reflection over controlled donor may be a model for giving medicine the chance to responsibly deal with broader end-of-life issues.
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Affiliation(s)
- M Picozzi
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy; Center for Clinical Ethics, University of Insubria, Varese, Italy
| | - A A Grossi
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy; Center for Clinical Ethics, University of Insubria, Varese, Italy.
| | - E Ferioli
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy; Center for Clinical Ethics, University of Insubria, Varese, Italy
| | - F Nicoli
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy; Center for Clinical Ethics, University of Insubria, Varese, Italy; Clinical Ethics Service, Domus Salutis Clinic, Teresa Camplani Foundation, Brescia, Italy
| | - A Gasparetto
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
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12
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Gulino M, Patuzzo S, Baldelli I, Gazzaniga V, Merlo DF, Maiorana L, Murialdo G, Picozzi M, Armocida G, Cattorini P, Montaguti E, Bonometti S, Grossi AA, De Stefano F, Ciliberti R. Bioethics in Italian Medical and Healthcare Education. A Pilot Study. Acta Biomed 2019; 89:519-531. [PMID: 30657121 PMCID: PMC6502089 DOI: 10.23750/abm.v89i4.7238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/24/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Bioethics is relevant in healthcare and medical schools. However, unlike other foreign countries, its teaching in Italy has only been recently introduced, it is less extensively offered and no academic standards for bioethics education have been established. This research aims at understanding whether university bioethics courses attendees appreciate and consider teaching strategies to be effective with the objective of validating a coherent didactic approach to the discipline and stimulate further discussion on ways to improve it. METHODS A standardized survey was administered to 1590 students attending undergraduate degree programs in medicine and healthcare at four Italian universities. RESULTS The majority of interviewees (92.5%) had an interest in bioethics, considered it to be important for any life-sciences-related program (73.5%) and most healthcare (77.2%) and medical students (69.2%) suggested its teaching should be included in their curricula and made mandatory (66.3%) and continuous (57.7%), given its usefulness in clinical practice. Students consider bioethics as a care-integrated practice and appreciate teaching methods where it is integrated into clinical cases. Conceptual specificity and interdisciplinarity may affect the learning process and contribute to enhance students' analytical skills. CONCLUSIONS Italian bioethics education should be revised to meet students' expectations and preferences. Its complex, multi-disciplinary and transversal nature suggests bioethical education to be flexible and integrated among different disciplines, thus stimulating a broader critical capacity through cases studies and other interactive teaching methods for helping students better deal with bioethics-inherent difficulties and improve the learning process.
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