The view of the three monotheistic religions toward xenotransplantation

Xenotransplantation, transplanting animal organs into humans, may offer a solution to the shortage of organs for transplantation. This would increase the chances for scheduled, elective transplantation, even for patients currently ineligible for receiving a human organ. However, xenotransplantation raises specific ethical and philosophical issues, that is, a personal identification of the body parts with the soul and spirit, the relationships between humans and animals, and challenges related to issues of medical and social ethics. The three monotheistic religions have laws and perspectives pertaining to xenotransplantation. This scholarly review examines the theology and viewpoints of the three monotheistic religions and their concerns regarding xenotransplantation (interspecies) in terms of religious-legal rulings, the ethical considerations related to the procedure, through religious scriptures and rulings of scholars of the three faith communities. This review should be viewed as a continuation of an extensive investigation of these issues, as the field of transplantation advances toward clinical trials. It was found that there are no fundamental religious reasons presented by any of the three religions to prohibit the use of animal organs as a means of treating severe and life-threatening conditions. However, there are certain limitations prescribed by each religion relating to the treatment of the animals and the choice of organs to be transplanted.

Assessment of Differential Perceptions of Core Nursing Competencies between Nurse Managers and Nursing Graduates: A Cross-Sectional Study

BACKGROUND

The literature review on perceptions of nursing competencies shows a critical shortage of studies addressing this topic.

AIM

To examine and compare perceptions of important nursing competencies of nursing graduates, and nurse managers.

METHODS

A cross-sectional study was conducted among 148 students, who were recent graduates of the nursing school with RN degrees and had completed advanced training lasting 3 months at the Sheba Academic School of Nursing and the Academic School of Tel Aviv-Yafo, and 183 nurse managers with at least one year of seniority in the position in hospitals and community clinics in Israel. The recruitment and data collection of the nurse managers lasted 12 months, from July 2021 to July 2022, and for nursing graduates, two months, from June 2022 to July 2022. An online questionnaire was constructed and validated by five professional and experienced individuals in the research domains for adequate content validity. The questionnaire consisted of 47 items in total. Domains included: (1) professionalism in research; (2) skills for direct treatment; (3) support and communication; (4) professional knowledge; (5) personal abilities; and (6) critical thinking and innovation.

RESULTS

Overall, 331 valid questionnaires were collected (85% response rate). The difference in the nurse's research professionalism index was found to be statistically significant with a higher rating given by nurse managers, p = 0.003. However, the difference in the direct treatment index of nurses was found to be statistically not significant, p = 0.610, between newly graduated nurses and nurse managers. The independent sample t-test indicated a significant difference with a higher rating among nurse managers in the nurse's support and communication index, p = 0.020; professional knowledge index, p < 0.001; personal abilities index, p < 0.001; and critical thinking index, p = 0.006, between newly graduated nurses and nurse managers.

CONCLUSION

Nursing education programs aimed at training future nurses with core competences should include a curriculum designed to promote the acquisition of these six core competences leading to a congruence between the role expectations of nurse managers and those of newly graduated nurses.

The general public's attitude towards accepting payment for kidney donation

Introduction

Kidney transplantation has become the most cost-effective treatment for patients with end-stage kidney disease (ESKD) and offers them the highest quality of life. Yet, kidney donation is often inaccessible due to cultural and traditional beliefs about organ donation. The goal of our study is to assess the value of kidney donation using the Willingness to Accept (WTA) technique. We also aim to understand the factors influencing an individual's willingness to donate an organ.

Methods

A self-administered survey was completed by 985 participants from the general public. The quantitative method and survey design that were chosen used descriptive, correlational, nonparametric, and multivariate statistical tests.

Results

Most of the respondents, 895 (90.9%) are not willing to donate a kidney while alive. Four hundred and five (41.1%) of the respondents are not willing to donate a kidney after their death, while the rest are willing to donate their kidney after their death without financial compensation. The same attitude applies to the donation of a kidney from their relatives. Significant predictors from the results of the logistic regression model in predicting the lowest (minimal) amount that will encourage donation of one kidney after death were: Marital status; Nationality; Adi card holder; Knowing people who need a kidney donation; confidence in the medical staff; and consideration of the family's opinions regarding organ donation.

Discussion

Using cost benefit analysis (CBA), with the aim of evaluating the willingness of individuals to accept payment for innovative medical procedures, such as kidney donation, allows an assessment of the perceived value of the medical procedure and enables policymakers to decide whether to allocate funds or offer subsidies for kidney donation, given the limited healthcare resources available. During our research, we found that most participants did not support the commercialization of organs. Our recommendation for policymakers and health professionals is to continue providing adequate funding for kidney donations and to implement educational programs aimed at improving attitudes towards organ donation.

Associations of the COVID-19 burden and various comorbidities of different ethnic groups in Israel: a cross-sectional study

Coronavirus disease (COVID-19) is highly transmissible between human beings. We examined differences in the core families with COVID-19 severity and mortality and comorbidities between Arab and Jews and explored the factors associated with COVID-19 severity and mortality to find a genetic component. A cross-sectional study was conducted among 2240 COVID-19 patients (> 18 years of age) randomly selected by online panels and questionnaires in the native language (Hebrew or Arabic) during March 2021-June 2022. Multivariable linear regression models were used to assess correlations with COVID-19 disease severity and mortality. Overall, 1549 (69%) were Arabs and 691 (31%) were Jews. The proportion of participants who died from COVID-19 was higher among Arabs compared with Jews (66% vs. 59%), P < 0.001. The mean number of deaths from COVID-19 and patients with severe COVID-19 was higher in ultra-Orthodox Jewish, non-academic core families and those who lived in the city residence compared with secular, academic core families and who live in the village residence, P < 0.001. A multivariable linear regression model showed a significant association between metabolic, kidney, cardiovascular, and respiratory diseases with COVID-19 severity (B coefficient - 0.43, B coefficient - 0.53, B coefficient - 0.53, B coefficient - 0.42, respectively) and COVID-19 mortality (B coefficient - 0.51, B coefficient - 0.64, B coefficient - 0.67, B coefficient - 0.34, respectively), P < 0.001. COVID-19 severity and mortality were highly associated with comorbidities, ethnicity, social and environmental factors. Furthermore, we believe that genetic factors also contribute to the increase in COVID-19 severity and mortality and the differences rates of these between Arabs and Jews in Israel.

Deontological Guilt and Moral Distress as Diametrically Opposite Phenomena: A Case Study of Three Clinicians

Feelings of guilt are human emotions that may arise if a person committed an action that contradicts basic moral mores or failed to commit an action that is considered moral according to their ethical standards and values. Psychological scholarship distinguishes between altruistic guilt (AG) and deontological guilt (DG). AG results from having caused harm to an innocent victim, either by acting or failing to act, whereas DG is caused by violating a moral principle. Although physicians may be expected to experience frequent feelings of guilt in their demanding and intensive work, it is surprising to find that this issue has not been explored in the professional literature on medical ethics. To that end, we conducted a qualitative study that included personal in-depth interviews with Sunni Muslim gynaecologists. These doctors provide underground infertility care and perform religiously forbidden treatments involving sex selection and gamete donation. They opened their hearts and spoke about the emotionally taxing pangs of conscience they suffer. Analysing their narratives led us to characterize their feelings of guilt as DG. We discuss the causes for their plight and the way they cope with it, compare DG to the concept of moral distress, and call for future research on clinicians' feelings of guilt and pangs of conscience.

The muslim patient and medical treatments based on porcine ingredients

Porcine-derived products serve as an effective solution for a wide range of human ailments; however, there may be objections to their use due to Islamic religious prohibitions on consuming products derived from pigs. In order to enhance the cultural competence of medical practitioners who treat Muslim individuals, which constitute about one fifth of the world population, this study aimed at evaluating the knowledge and positions of Muslim patients on this subject. A questionnaire presenting 15 uses of porcine-derived materials was filled out by 809 Muslims. The level of knowledge about the permissibility of these uses and participants' position on whether it should be approved was assessed. Findings show that Muslims are not familiar with Islamic religious jurisprudence that permits the use of porcine products to save lives after it has undergone an essential transformation known as Istihala. The respondents expressed a negative attitude towards the medical use of porcine-derived substances based on imprecise knowledge about the permissibility of use of porcine-derived materials, devices and treatments. We offer recommendations for improving the informed consent obtained from Muslim patients prior to conducting porcine-based treatments.

Prenatal Testing and Pregnancy Termination Among Muslim Women Living in Israel Who Have Given Birth to a Child with a Genetic Disease

The aim of the study was to investigate whether a Muslim woman with a child afflicted with a genetic disease who is living at home would perform more prenatal tests and pregnancy terminations as opposed to a woman with a normal child living at home, and what demographic characteristics, if any, influenced this decision. The study included 771 Muslim women; 37.1% lived with a child afflicted with a genetic disease; and 62.9% did not. Muslim women with a child affected with a genetic disease living at home will undergo more prenatal testing and more pregnancy terminations. Village dwellers were more religious and consulted further with a religious authority. More city dwellers underwent prenatal tests and pregnancy terminations and received more health care and genetic counseling. In the villages populated by Muslims, more genetic counselling must be given, accompanied by guidance from religious Muslim authorities.

Prenatal Tests Undertaken by Muslim Women Who Underwent IVF Treatment, Secular Versus Religious: An Israeli Study

Our goal was to determine if differences exist in the attitudes of religious Muslim women living in Israel toward prenatal testing and pregnancy termination after undergoing in vitro fertilization (IVF) compared to the secular Muslim women who had undergone IVF. Six hundred and ninety-nine Muslim women from cities and villages participated, 47% city-dwellers; 53% village-dwellers; 50%-secular; 50%-religious. Secular women who had undergone IVF performed more invasive tests and terminated more pregnancies due to an abnormal fetus than religious women. More genetic counseling must be provided explaining the different prenatal tests and the problems in raising an abnormal child.

'I Prefer To Die at Home With Dignity': Perceptions of Death Rituals Among Religious Muslim Kidney and Liver Transplant Patients With COVID-19

BACKGROUND

Kidney and liver transplant recipients may be at a high risk of contracting acute COVID-19 due to chronic immunosuppression and comorbidities. These patients receive combinations of immunosuppressive drugs, altering their innate and adaptive immunity, thus, rendering them more susceptible to bacterial and viral infections and higher mortality. Kidney and liver transplant recipients frequently exhibit one or several risk factors, increasing the risk for unfavorable outcomes.

METHODS

This qualitative study explores perceptions of religious rituals and practices relating to COVID-19 deaths among Muslim kidney and liver transplant recipients during the first, second, third, and fourth waves, focusing on their tendency to unlawfully refuse to be hospitalized due to their objection to certain guidelines that prevent or restrict religious practices and traditions. A qualitative study based on interviews with 35 older, religious Muslim liver and kidney transplant recipients was conducted face-to-face and on Zoom.

RESULTS

Our findings indicated the absence of acceptable and respectful death rites for the deceased in the event of death from COVID-19, spurring the refusal of older, religious Muslim transplant recipients in Israel to be hospitalized after contracting COVID-19.

CONCLUSIONS

To address these concerns, health authorities and religious leaders must collaborate to find solutions that satisfy the requirements of both the health system and the religious Muslim community.

Prenatal Diagnosis and Pregnancy Termination in Jewish and Muslim Women with a Deaf Child in Israel

Deafness is the most common sensory disability in humans, influencing all aspects of life, However, early diagnosis of hearing impairment and initiating the rehabilitation process are of great importance to enable the development of language and communication as soon as possible. We examined the differences in attitudes towards performing prenatal invasive tests and pregnancy terminations in Jewish and Muslim women in Israel due to deafness. Overall, 953 Israeli women, aged 18-46 years with a mean age of 32.0 (SD = 7.12), were enrolled. Of those, 68.7% were city dwellers and 31.3% were village dwellers, and 60.2% were Muslim women and 39.8% were Jewish women. All participants had a child with a hearing impairment or deafness. The group with no genetic hearing loss performed more prenatal invasive tests and pregnancy terminations than those with genetic hearing loss in both ethnic groups. Jewish women performed more invasive prenatal tests and, consequently, a pregnancy termination. Secular Jewish women more frequently underwent pregnancy terminations due to fetal deafness. Further genetic counseling and information concerning IVF and PGD procedures should be provided to the Muslim population.

Posthumous Organ Donation in Islam, Christianity, and Judaism: How Religious Beliefs Shape the Decision to Donate

Evidence indicates that the religious beliefs of patients, potential donors, family members, and healthcare professionals play an important role in deciding to donate an organ. We aim to summarize the religious views of Christians, Muslims, and Jews on organ donation contributing to the decision-making process. Different approaches to this topic worldwide are presented, providing helpful information for medical professionals. A literature review was conducted regarding the view of Israel's leadership of the three largest religions on organ transplantation. This review revealed that all Israeli central religious leaders have a positive view on organ donation. However, various aspects of the transplantation process (such as consent, brain death, and respect for the dead body) must be carried out as each religion prescribes. Thus, understanding the different religious views and regulations on organ donations may help reduce religious concerns about transplantation and narrow the gap between the need and the availability of organ donations.

Increasing Overnight Fluid Intake and Kidney Function During Ramadan Fasting: A Randomized Controlled Trial

BACKGROUND

All healthy Arab individuals are obligated to abstain from eating, drinking, and sexual relations from dawn to sunset during Ramadan, which is one of the 5 pillars of Islam. Fasting effects various body systems, apart from the renal system. Fasting can also increase serum creatinine levels because of dehydration. Our aim was to examine the effects of increased fluid intake during the night on serum creatinine and urea levels.

METHODS

This randomized controlled trial included 58 healthy subjects who were randomly divided into 2 groups of 29. The hydrated group drank 2 to 3 L of fluid from sunset to the dawn of the next day. Kidney function was measured before, during, and 1 month after Ramadan.

RESULTS

After adjustment for sociodemographic variables, the control group exhibited higher means of serum concentrations of creatinine and urea and lower estimated glomerular filtration rate than the hydrated group. The Ramadan group exhibited highest means of serum levels of creatinine and urea and the lowest estimated glomerular filtration rate compared with the pre- and post-Ramadan periods. All results were statistically significant at P <.05.

CONCLUSIONS

We found that Ramadan fasting was not associated with a permanent increase in serum creatinine or urea. For those groups with a high fluid intake, serum creatinine and urea were significantly lower than the controls suggesting a favorable effect of hydration during the nonfasting hours. This compensated with the dehydration occurring during daylight, as dehydration is responsible for increased concentrations of urea and creatinine. This study adds further evidence that Ramadan fasting does not affect the renal system of healthy subjects; however, fluids should be increased at night, during nonfasting hours.

The Use of Porcine-Derived Materials for Medical Purposes: What do Muslim and Jewish Individuals Know and Opine About It?

Porcine-derived medical products represent an effective solution for a wide range of human suffering, yet this may contradict Muslim and Jewish religious prohibitions against consuming pig. The present study evaluated the level to which Muslim and Jewish participants are knowledgeable about the conditions permitting porcine-based treatments and explored their attitudes toward the permissibility of these treatments. A questionnaire that presented fifteen medical uses of porcine-derived products was completed by 809 Muslims and 714 Jews. Neither Muslim nor Jewish participants are knowledgeable about the religious rulings of their religions which permit the use of pig for life saving. Participants of both groups objected to the view that porcine-derived materials should be permitted. The findings imply that the attitude toward porcine-derived materials for medical use is contingent upon the knowledge or lack thereof that individuals have regarding the permissibility of such use. We offer useful recommendations to improve the informed consent process before conducting porcine-based treatments.

Invalidating the Leadership of Muslim Spiritual Leaders in Death From COVID-And Shaping the Grief Journey - A Narrative Inquiry

This narrative study voices the perspectives of a hidden population, spiritual leaders of the Muslim minority in Israel whose leadership in attending to deaths throughout COVID-19 was invalidated. Findings elucidate their dilemmas as being responsible for protecting the community from infection on one hand, and for guiding religious death rituals and preventing disenfranchised grief of families and the community on the other hand. Denying religious minorities their right to conduct traditions in a safe manner and leaving spiritual leaders outside of decision making on shaping COVID-19 guidelines creates distrust and deepens aggravation of enfranchised grief. As the global society is becoming religiously fragmented, distrust of religious minorities in health authorities due to denial of burial of death rituals, funerals, and burials, may have societal consequences and must be considered. Recommendations of this study may assist authorities in creating guidelines that accord with the laws, traditions, and values of religions minorities, empowering their spiritual leaders.

The Ethical Standards of Sunni Muslim Physicians Regarding Fertility Technologies that are Religiously Forbidden

This research project is pioneering in that it is the first to provide empirical data regarding the ethical standards of Sunni Muslim physicians toward religiously prohibited reproductive technologies, a topic which is considered taboo in Muslim society. A total of 689 Sunni Muslim physicians rated their acceptance of 14 fertility treatments. They expressed objections to assisted reproductive technologies entailing gender selection, egg, sperm and embryo donation, and surrogacy. The findings show that the Sunni Muslim medical establishment avoids fertility options that are considered in violation of Islamic law, and Sunni Muslim physicians tend to obey religious law.

Underground Gamete Donation in Sunni Muslim Patients

This qualitative study focuses on the "underground" practices of Sunni Muslim physicians and patients who are performing and undergoing religiously prohibited third-party gamete donation. It is based on face-to-face interviews with two Sunni Muslim gynecologists and 25 Sunni Muslim women who underwent third-party gamete donation treatments and gave birth to a baby. The analysis of the interviews sheds light on patients' experiences regarding donation and explores the experiences of the gynecologists. The patients shared with us their inner conflict regarding childbearing using either donated sperm or a donated egg. They expressed a subversive attitude toward the religious authorities and the Islamic fatwa (religious ruling) that prohibits third-party gamete donation. The gynecologists provide fertility care involving third-party gamete donation despite Islamic religious prohibitions; in consequence, they suffer feelings of guilt for their actions. The study participants challenge accepted binary conceptions regarding the boundaries between religious laws and the desire to produce offspring, between what is allowed and what is forbidden, between guilt and happiness, and between the desire to maintain a marital relationship and the desire to comply with cultural-religious rules. Based on Gloria Anzaldua's theory of the borderlands, and the context-informed approach, this study underscores the importance of giving voice to Sunni Muslim patients who underwent third-party gamete donation treatments and contributes to a deeper understanding of their dilemma of finding a reproductive solution that does not run counter to religious values.

Standing on Both Sides: Analysis of a Transplant Coordinator's Ethical Position Between the Recipient and the Donor's Family

BACKGROUND

When an organ is harvested from a deceased donor, how should transplant coordinators handle the issue of contact between the donor's family and the organ recipient?

METHODS

The authors-qualified both by their own considerable practical experience and theoretical investigation-discussed various aspects of the problem, relating to the bioethical issues as well as the practical dilemmas that must be clarified and decided.

RESULTS

They proposed a strategy whereby transplant coordinators can analyze their own philosophical attitude toward the issue and respond accordingly in their work to the needs and preferences of both parties.

CONCLUSIONS

The professionals handling the transplant process need training tailored to the bioethical issues relevant to the challenges they are likely to confront. This training must consist not only of theoretical and ethical guidance but also simulations designed to clarify the clinician's own personal belief system and raise awareness and self-reflection of their own biases.

The View of the Three Monotheistic Religions Toward Cadaveric Organ Donation

Religious concerns regarding the legitimacy of cadaveric organ donation have been found to be major inhibiting factors for people to consent to donate organs post-mortem for transplantation; this constitutes a major cause for the grave shortfall of available organs for transplantation. The purpose of this review is to explore the view of the three monotheistic religions, namely Christianity, Islam, and Judaism, toward cadaveric organ donation. The literature review reveals that all three monotheistic religions support cadaveric organ donation but within certain restrictions. We provide a detailed description of the approach of each religion and the inhibiting considerations as interpreted by religious authorities. Health professionals need to collaborate with faith leaders in order to optimize the education of the public of believers with regard to the benefits stemming from organ donation. Developing transplantation medicine does not depend solely on technical capabilities and expertise; rather, this development should go hand in hand with religious, traditional and cultural beliefs and rituals. Providing a believer with a religious authority about cadaveric organ donation is very effective in helping families and individuals cope with difficult and critical decisions.

Death From COVID-19, Muslim Death Rituals and Disenfranchised Grief - A Patient-Centered Care Perspective

In Islam, religious directives regarding death are derived from the Quran and Islamic tradition, but there is a variety of death rituals and practices, lived by Muslims across contexts and geographies. This narrative study explored the dynamics of death and bereavement resulting from COVID-19 death among religious Muslims in Israel. Narrative interviews were conducted with 32 religious Muslims ages 73-85. Findings suggest several absent death rituals in COVID-19 deaths (i.e., the physical and spiritual purification of the body, the shrouding of the body, the funeral, and the will). Theoretically, this study linked death from COVID-19 with patient-centered care, highlighting disenfranchised grief due to the clash of health authority guidelines with religious death practices. Methodologically, this narrative study voices the perspectives of elder religious Muslims in Israel. Practically, this study suggests ways to implement the cultural perspective in COVID-19 deaths and enable a healthy bereavement process.

Differential Willingness to Pay for Kidney Transplantation From Living and Deceased Donors: Empirical Study Among End-Stage Kidney Disease (ESKD) Patients

Kidney transplantation has developed to the stage where it is currently the most cost-effective treatment for patients suffering from end-stage kidney disease (ESKD) and, when available, offers them the highest quality of life. Yet, kidney transplantation is challenged by cultural and traditional beliefs; thus, this study sought to evaluate the willingness to pay for a kidney transplant in a culturally sensitive population. A self-administered survey was completed by 734 end-stage kidney disease (ESKD) patients. A quantitative method and survey design were chosen and employed descriptive, correlational, nonparametric, and multivariate statistical tests. Participants were willing to pay a mean amount of $40 751.36 for a living donor kidney transplant, whereas the mean is considerably lower, $18 350.51, for a deceased donor kidney. Significant predictors of the willingness to pay (WTP) for a kidney transplant from a living donor and a deceased donor were found, among them: religiosity and ethnicity. The participants' willingness to pay for a kidney transplant could attest to significant benefits in enhancing patient well-being. The willingness to pay differentially for a donation from a deceased or a living donor stems from the higher chances of success with a living-donor organ as well as from moral and religious motives. In Israel kidney transplantation is not tradable in the free market and is fully funded by the state. The average cost of kidney transplantation in Israel is $61 714.50. Since the cost exceeds the utility and since the economic literature suggests that the funding of healthcare interventions should be provided up to the point where the costs of that funding equal the benefits that society derives from it, crucial revisions in public health policy should be made. Education may have a significant impact on the approach to kidney donation and organ donation in general.

Christianity, Islam, Judaism, and unwillingness to donate organs post-mortem

Willingness to donate organs is contingent upon knowledge about and attitude toward organ donation. In order to explore differences between members of the three monotheistic religions: Christianity, Islam, and Judaism, a nation-wide survey was conducted in Israel. Members of all three religions expressed a very low willingness to donate organs postmortem. They had similar levels of knowledge regarding organ donation and similar negative attitudes toward organ donation. The public feels negative regarding the issue, therefore education campaigns should be designed and implemented in order to refute potential misconceptions and hence increase the number of people who sign donor cards.

Underground COVID-19 Home Hospitals for Haredim: Non-Compliance or a Culturally Adapted Alternative to Public Hospitalization?

This thematic study analyzed the experiences of Jewish Haredi (Lithuanian) patients in underground home hospitals during the second wave of COVID-19 in Israel. This minority comprises 12.6% of the Israeli population. Participants were 30 members of this hidden population, ages 59-78. Haredi complied with community directives rather than with the national directive of hospitalizing COVID-19 patient only at public hospitals. Compliance with community directives was driven by a distrust in health authorities and clinicians at public hospitals; by the preference of patient-centered care, a desired approach of care that public hospitals fail to implement; by the need to sustain beliefs, values, and traditions; by community leadership; and by the need to conserve political power. While health authorities view underground home hospitals as demonstrating non-compliance with the national directive, Haredi leaders view underground home hospitals as demonstrating a self-sufficient, patient-centered care alternative to public hospitalizations. Considering the benefits of patient-centered care and the growth of the multi-cultural global landscape, we call upon health authorities to explore the accommodation of patient-centered care for COVID-19 patients and the designing of an adaptive multi-cultural policy that address multi-cultural aspects of religious minorities as key to health promotion. We propose ways to implement multi-cultural policies.

Clinician Stress and Adolescent Patient Anxiety: Understanding an Unfamiliar Case of a Dark Green-Effusion Peritoneal Dialysis Fluid

A 17-year-old Palestinian patient has been undergoing peritoneal dialysis for the past 4 years owing to reflux nephropathy. The patient was recently diagnosed positive for coronavirus disease 2019. Seven days after the diagnosis she complained of loss of vision in the right eye. The patient was referred for an angiography test for suspected right eye infarct. Fluorescein sodium was given by intravenous injection to examine the ophthalmic vasculature by retinal angiography. There was an indication of an eye infract. She was discharged and on returning home started her peritoneal dialysis. She began to drain the DIANEAL fluid and noticed a dark green fluid instead of the transparent fluid that comes out in every dialysis. After much inquiry the nephrologist decided to perform 6 short cycles of 1 hour each lasting for 7 hours altogether. The shade of the fluid began to change but the change was insufficient. The nephrologist decided to continue with the procedure. It was only on the sixth day that the color reverted to the familiar transparent shade. Over 6 days, the patient felt good, had no further complaints, except for the original complaint of loss of vision in the right eye. Her anxiety, however, was rising owing to the lack of familiarity with the DIANEL green fluid in her body draining. As for the nephrologist, it was only on the third day, when the fluid began to clear, that he could relax.

The Gendered Body Work of Muslim Arab Mothers Who Donate a Kidney to Their Children

PURPOSE

Previous studies showed that among the pediatric ESRD patients who receive a kidney donation from a parent, in most cases the mother is the one that agrees to donate her kidney to the sick child, whereas fathers are less willing to donate. The present study sought to explore decision making regarding which parent would donate a kidney to their child among Muslim Arab parents of pediatric ESRD patients.

DESIGN AND METHODS

The study design is a cross sectional qualitative study. We conducted semi-structured interviews with thirty-one parents: twenty-five mothers and six fathers, who donated a kidney to their child.

RESULTS

Parents tended to refrain from donating a kidney to a sick daughter; mothers were more willing to donate than fathers. Our findings imply that culturally constructed notions of gender and motherhood are mobilized to the realm of health and illness, and mothers' body work is an influential factor in determining survival chances of pediatric ESRD patients and their quality of life.

CONCLUSIONS

Our study shows that kidney donation made by mothers to their children represents a gendered body work and powerfully demonstrate gender relations in Arab society. Cultural artefacts shape parents' differential propensity to donate organs for a female or a male offspring.

PRACTICE IMPLICATIONS

It is recommended that the nursing staff enlist the help of Muslim clerics to increase the willingness of fathers to donate a kidney for their offspring, and also to encourage both parents to donate a kidney to a sick daughter. Education campaigns are needed to raise awareness and encourage changes in the attitudes of the Muslim families of pediatric ESRD patients toward parental kidney donation.

Evaluating health-related quality of life and emotions in Muslim and Jewish kidney transplant patients

BACKGROUND

The scholarship on the impact of the source of the donated kidney (living donor (LD) or deceased donor) and the ethnoreligious background on the quality of life post-transplantation have received little scientific attention. The purpose of the present research is to evaluate health-related quality of life and psychological feelings among kidney transplant (KT) recipients.

OBJECTIVE

To compare the health related quality of life and psychological feelings between kidney transplant (KT) recipients who received a graft from a living versus a deceased donor, and between Muslim and Jewish patients.

METHODS

Two hundred and sixty-two renal recipients completed the health-related quality of life (HRQOL; World Health Organization Quality of Life Brief Version (WHOQOL-BREF)) questionnaire and answered the Transplant Effects Questionnaire assessing their post-transplantation emotional and psychological responses.

RESULTS

KT recipients reported medium levels of physical, psychological, social and environmental dimensions of HRQOL. Muslim recipients reported significantly higher levels of physical, psychological and social dimensions of HRQOL than Jews. Recipients of kidneys from LD reported higher levels of HRQOL and reported significantly higher levels of guilt and responsibility to be healthy.

CONCLUSIONS

Our findings indicate that receiving a graft from an LD contributes to the HRQOL in the physical, psychological and environmental dimensions. Hence, donations from LD should be encouraged, by investing efforts in promoting public awareness of the importance of donating kidneys by LDs. Muslim KT recipients enjoy better physical, social and psychological HRQOL; this difference can be explained by the supportive and embracing familial and social networks characterizing traditional Arab communities. Post-transplantation support programs should be designed in order to provide further support and improve emotional and psychological responses to postoperative reality.

The Emotional Labor of the Transplant Coordinator: An Inherent Predicament

Although extensive scholarship has been dedicated to the emotional experiences of transplant patients, little is known about the emotional experiences of transplant coordinators. The present article aims to illuminate the phenomenon of emotional labor invested by transplant coordinators. The transplant coordinator is a key person in the process of obtaining consent for organs for transplantation from deceased or living donors. One of the most taxing phenomena among nurses is emotional labor. Emotional labor is a term that denotes the investment of emotional effort to reach a consonance between one's inner authentic feelings and outward expression of one's emotions. Thirteen experienced transplant coordinators were interviewed for the purpose of unveiling their work-related feelings and emotions. Analysis of their narratives revealed 3 types of emotional labor based on the taxonomy proposed by Theodosius: therapeutic, instrumental, and collegial. Findings show that much emotional labor is invested by these nurses. Emotional labor is usually stressful and has an adverse effect on nurses' psychological well-being and health, especially when emotions that are not genuinely felt have to be conveyed. Transplant coordinators must fake their emotional expressions to excel in their job. Their job is psychologically taxing, leading in most cases to regret over choosing this job. Implications for research, policy, and practice include a recommendation that transplant unit managers act to help transplant coordinators avoid the painful emotions that accompany the experience of emotional labor. We provide several useful recommendations about how to alleviate and prevent these negative emotions.

What do Sunni Muslims think about religiously forbidden reproductive options?

This study explored the attitudes of Sunni Muslims towards religiously forbidden reproductive options: gamete donation, sex selection, surrogacy, and adoption. A total of 824 married Sunni Muslim people read 12 hypothetical vignettes depicting five types of assisted reproductive technologies: (i) sperm donation; (ii) egg donation, (iii) surrogacy; (iv) sex selection of a male foetus; and (v) and sex selection of a female foetus. They also related to the option of adopting a baby. Each vignette was presented twice: once depicting a relatively younger couple and once again describing a relatively older couple. The respondents were asked to state the level of their objection or acceptance for each of the twelve vignettes. In accord with the Islamic ruling, respondents reported objections to sex selection, egg and sperm donation, and surrogacy. However, they expressed a moderate level of acceptance of adoption of a baby. The greatest objection was directed at sperm donation, followed by objection to egg donation. Our study shows that the Sunni Muslims do not support the provision of fertility care for reproductive options that clearly contravene Islamic religious ruling. The findings may help fertility experts understand the cultural and religious complexities in treating Sunni Muslim couples.

The double gender bias in parental kidney donation among Muslim Arab patients

Previous studies showed that it is usually the mother who agrees to donate her kidney to a child with an end-stage renal disease, while the fathers tend much less to donate. The present study sought to explore decision-making regarding which parent would donate a kidney to their child. Interviews were conducted with twenty-five mothers and six fathers who donated a kidney to their child. Analysis of the narratives reveals unwillingness to donate a kidney to a sick daughter and five reasons why mothers are more willing to donate than fathers. Our study shows that parents' patterns of kidney donation to their children powerfully demonstrate gender relations in Arab society and that culturally related matters have a significant impact on human organ transplantation, hence on quality of life and the chances of survival of nephrological pediatric patients. We recommend that the nursing staff enlist the help of Muslim clerics to increase the willingness of fathers to donate a kidney, for sons as well as for daughters. We call for designing education campaigns aimed at raising awareness and encouraging changes in the attitudes of the families of pediatric ESRD patients as well as of physicians.

Moral distress and moral residue experienced by transplant coordinators

Transplant coordinators play a pivotal role in the process of obtaining consent for live or dead donation of organs. The objective of the project is to unveil emotional experiences and ethical conduct of transplant coordinators using a qualitative research methodology. Ten transplant coordinators who have worked for more than 20 years in this job were recruited by using a purposive sampling technique. The transplant coordinators spoke of negative feelings and moral distress with regard to futile care of family members of deceased donors as well as of living donors. Transplant coordinators experience moral distress on a daily basis; being compelled to compromise their integrity causes moral distress and moral residue, hence, training and support should be offered to them.

"A Bridge Over Troubled Water": Nurses' Leadership in Establishing Young Adults' Trust Upon the Transition to Adult Renal-Care - A Dual-Perspective Qualitative Study

PURPOSE

Patient trust is strongly related to adherence, but has not been tested in transitional care. Low adherence post-transitions of young adults from pediatrics to adult renal care jeopardizes transplanted kidneys and quality of life. We aimed at identifying barriers to trust of young adults in nurses and trust-building elements upon and post transition.

DESIGN AND METHODS

Following IRB approval, we recruited 21 young adults who underwent kidney transplants before the transition to adult renal care and eleven nurses from adult care in two Israeli tertiary hospitals that perform kidney transplants. We conducted 42 in-depth narrative interviews with young adults and one interview with each nurse. We used thematic analysis guided by Meleis's framework of effective transitions.

RESULTS

Most young adults' attributed negative meanings to the transition to adult care which did not enhance their well-being. Young adults were not provided with resources to promote their autonomy and role-sufficiency; despite preparation processes pre-transition, they were not aware of expectations from them. Their own unmet expectations of clinicians made them feel unsafe, objectified, and helpless and resulted in distrust in professionals, low adherence, and in some cases, dropping out of care and lower quality of life.

CONCLUSIONS

Nurses who focused on building a relationship with young adults rather than on operational tasks established trust and led young adults towards role-sufficiency, satisfaction with care, adherence, and optimized quality of life.

PRACTICE IMPLICATIONS

The proposed recommendations for nurses and clinicians structure the trust-building process using elements to improve transitional care.

Peritoneal Dialysis in Extremely Obese Patient From Palestine, A Case Report

INTRODUCTION

The incidence of ESRD is increasing dramatically and the majority of patients are commenced to hemodialysis (HD) or peritoneal dialysis (PD) due to the long waiting time for renal transplantation. PD has comparable outcomes with HD but many barriers limit its utilization. Obesity is considered among the barriers and this was attributed to its related complications.

CASE REPORT

A 50-year-old male patient with ESRD presented to our hospital for PD. He was extremely obese (BMI = 44.2 kg/m2). The case was discussed between the nephrology, surgical and nursing team, and the decision was made to proceed towards PD.

CONCLUSION

Obesity should not impede the beneficial effects of PD. The obstacles of obesity, which we faced; could be overcome with the collaboration between a highly qualified multidisciplinary team.

Grave new world: The conspiracy of silence surrounding non-voluntary euthanasia

The scholarship of euthanasia indicates that in most cases, to date, non-voluntary euthanasia has been studied where euthanasia is legalized. Findings of these studies demonstrate the 'slippery slope' and reveal that non-voluntary euthanasia is pervasive in these countries. The research is aimed at answering two questions: (1) What are the common death hastening methods? (2) Is the acceptance of active non-voluntary euthanasia related to the legal status of euthanasia? A qualitative study was conducted in ICUs with 15 nurses. All of the interviewees refused to take part in the death hastening cases and did not obey any doctor's instruction that could hasten or cause death. Therefore, doctors who conducted NVE did it by themselves. The present study provides evidence of the phenomenon of illegal non-voluntary euthanasia as a routine practice by physicians in palliative care units in Israel. Interviews with 15 nurses employed in these units shed light on the means and methods used by these doctors to hasten terminal patients' death. We conclude that Nurses in various end-of-life care units persist in preserving their professional integrity and refuse to obey doctors' instructions for non-voluntary euthanasia. The slippery slope argument has been refuted in this context.

Religious observance and perceptions of end-of-life care

This study examines the impact of the level of religious observance on the attitudes toward end-of-life (EOL) decisions and euthanasia of Jews in Israel-where euthanasia is illegal-as compared to Jews living in the USA, in the states where euthanasia is legal. A self-reporting questionnaire on religiosity and personal beliefs and attitudes regarding EOL care and euthanasia was distributed, using a convenience sample of 271 participants from Israel and the USA. Findings show that significant differences were found in attitudes between Jews of different levels of religious observance with respect to patient autonomy, right to die with dignity, and dying in familiar and supportive surroundings. The USA and Israeli Jews have similar knowledge regarding EOL care and expressed similar attitudes and perceptions toward the issues of authority of medical staff and religious figures and patient's autonomy. Findings indicate that the level of religious observance has more potency in shaping their attitudes and perceptions of EOL decisions than the state law. We conclude by discussing the implications of our findings with regard to multicultural health systems and providing practical recommendations.

Long-term hemodialysis therapy in neonates and infants with end-stage renal disease: a 16-year experience and outcome

BACKGROUND

Peritoneal dialysis is the preferred mode of renal replacement therapy in infants with end-stage renal disease (ESRD). Hemodialysis (HD) is seldom used in neonates and infants due to the risk of major complications in the very young.

METHODS

Demographic, clinical, laboratory, and imaging data on all infants younger than 12 months with ESRD who received HD in our Pediatric Dialysis Unit between January 1997 and June 2013 were analyzed.

RESULTS

Eighteen infants (n = 6 male) with ESRD (median age 3 months; median weight 4.06 kg) received HD through a central venous catheter (CVC) for a total of 543 months (median duration per infant 16 months). Seven of the infants (39%) were neonates, and five (28%) had serious comorbidities. There were five episodes of CVC infection, which is a rate of 0.3/1000 CVC days. Median catheter survival time was 320 days. Most infants had good oral intake, and only four (22%) required a gastric tube; 14 (78%) infants displayed normal growth. Fourteen (78%) infants had hypertension, of whom four (22%) had severe cardiac complications; eight (44%) showed delayed psychomotor development. Eleven (61%) of the infants, including six (86%) of the neonates, survived. Five (28%) infants underwent renal transplantation; 10-year graft survival was 80%.

CONCLUSIONS

Based on these results, long-term HD in neonates and infants with ESRD is technically feasible, can be implemented without major complications, carries a very low rate of CVC infection and malfunction, and results in adequate nutrition, good growth, as well as good kidney graft and patient survivals. Future efforts should aim to prevent hypertension and its cardiac sequelae, improve neurodevelopmental outcome, and lower mortality rate in these infants.

Low infection rates and prolonged survival times of hemodialysis catheters in infants and children

BACKGROUND AND OBJECTIVES

Hemodialysis (HD) catheter-related complications are regarded as the main cause of HD failure in infants and children with ESRD. In this study, we determined HD catheter infection rates and survival times in children.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We analyzed demographic, clinical, laboratory, and microbiologic data on all infants and children with ESRD who received HD therapy through a tunneled central venous catheter (CVC) in our Pediatric Dialysis Unit between January 2001 and December 2009. Our strict care of HD-CVCs makes no use of any kind of prophylactic antibiotic therapy.

RESULTS

Twenty-nine children with ESRD (median age, 10 years) received HD through a CVC, for a total of 22,892 days during the study period. Eleven (38%) children were infants (<1 year of age) who received HD for a cumulative 3779 days (16% of total). Fifty-nine CVCs were inserted, of which 13 (22%) were in infants. There were 12 episodes of CVC infection-a rate of 0.52/1000 CVC days. Four (33%) episodes occurred in infants-a rate of 1.06/1000 CVC days. Only three (5%) of the CVCs were removed because of infection. Median catheter survival time for all children was 310 days and for infants was 211 days.

CONCLUSIONS

Very low CVC infection rates (one infection per 5 CVC years) and prolonged CVC survival times (around 1 year) are achievable in infants and children with ESRD receiving HD therapy by adhering to a strict catheter management protocol and without using prophylactic antibiotic therapy.