This article updates the qualitative research on Iran reported in the 2012 article by Tong et al.... more This article updates the qualitative research on Iran reported in the 2012 article by Tong et al. “The experiences of com- mercial kidney donors: thematic synthesis of qualitative research” (Tong et al. in Transpl Int 25:1138–1149, 2012). The basic approach used in the Tong et al. article is applied to a more recent and more comprehensive study of Iranian living organ donors, providing a clearer picture of what compensated organ donation is like in Iran since the national government began regulating compensated donation. Iran is the only country in the world where kidney selling is legal, regulated, and subsidized by the national government. This article focuses on three themes: (1) coercion and other pressures to donate, (2) donor satisfaction with their donation experience, and (3) whether donors fear social stigma. We found no evidence of coercion, but 68% of the paid living organ donors interviewed felt pressure to donate due to extreme poverty or other family pressures. Even though 27% of the living kidney donors interviewed said they were satisfied with their donation experience, 74% had complaints about the donation process or its results, including some of the donors who said they were satisfied. In addition, 84% of donors indicated they feared experiencing social stigma because of their kidney donation.
Letter to the Editor, American Journal of Transplantation, with table. Suggests ways of improving... more Letter to the Editor, American Journal of Transplantation, with table. Suggests ways of improving informed consent documents used in connection with living donor organ transplantation.
Nurses in a community hospital pediatric unit are struggling with the issue of how to care for a ... more Nurses in a community hospital pediatric unit are struggling with the issue of how to care for a severely handicapped newborn. The parents are confused and cannot decide whether to approve a series of operations that will extend the infant's life or to request only palliative care. Where can the nursing staff go for help with these issues? Does the hospital have a bioethics service? What should nurses expect if they avail themselves of this service? Would members of the bioethics service decide what should be done? How would the family be involved?
Ethical considerations in determining whether a human organ market could exist without causing ex... more Ethical considerations in determining whether a human organ market could exist without causing exploitation of vulnerable populations may depend on the size of the market. Some ethical and religious considerations are culture dependent; others require legal structures to protect fundamental human rights. Both these factors suggest that an ethical market in human organs may be feasible, but not necessarily in every country or across national boarders.
Kidney transplantation has become the treatment of choice for patients with end-stage renal disea... more Kidney transplantation has become the treatment of choice for patients with end-stage renal disease. Six decades of success in the field of transplantation have made it possible to save thousands of lives every year. Unfortunately, in recent years success has been overshadowed by an ever-growing shortage of organs. In the United States, there are currently more than 100 000 patients waiting for kidneys. However, the supply of kidneys (combined cadaveric and live donations) has stagnated around 17 000 per year. The ever-widening gap between demand and supply has resulted in an illegal black market and unethical transplant tourism of global proportions. While we believe there is much room to improve the Iranian model of regulated incentivized live kidney donation, with some significant revisions, the Iranian Model could serve as an example for how other countries could make significant strides to lessening their own organ shortage crises.
The laws governing bioethics issues are confusing and sometimes contradictory because of several ... more The laws governing bioethics issues are confusing and sometimes contradictory because of several types of tensions inherent in our legal system. The U.S. constitutional guarantees of separation of church and state and individual rights make bioethics issues involving personal, moral, or religious convictions particularly contentious. This Fall 2007 issue of Legal Trends in Bioethics includes legislative, judicial, and regulatory developments in bioethics on the state, federal, and in some cases even international level. This issue highlights troubling interventions into the patient/physician relationship, but also covers medical tourism, abortion, and mandatory child vaccinations.
Conclusion: Although Engelhardt's The Foundations of Bioethics is an impressive work, it is p... more Conclusion: Although Engelhardt's The Foundations of Bioethics is an impressive work, it is plagued by problems of justification, conceptual confusion, and inconsistencies....A libertarian theory can arrive at the same basic requirements of mutual respect, autonomy, nonuse of force, and tolerance for a wide range of diverse life styles without relying on a lowest-common-denominator principle and without depriving fetuses, infants, and the mentally retarded of their status as persons. This can be done by taking a deontological approach to libertarian theory that denies that all moral beliefs are worthy of respect. Some beliefs, such as Engelhardt's belief that fetuses, infants, and the mentally retarded are nonpersons, simply fall beneath the floor of acceptable moral alternatives, even in a libertarian society, because such beliefs are based on a misunderstanding of personhood and violate the principle of mutual respect.
International journal of organ transplantation medicine, 2010
The US Uniform Determination of Death Act provides two alternatives for determining death-the cir... more The US Uniform Determination of Death Act provides two alternatives for determining death-the circulatory criteria and the neurological criteria-yet history and the public's current understanding of death in the US may mean that only brain death criteria can be relied upon without raising public suspicion that the medical profession is sacrificing the well-being of one group of patients (i.e., those dying after traumatic injury) to save another group (i.e., those in need of organs). The problem is exacerbated by existing debate on the appropriate waiting time after which death is inevitable and when the brain should be actually considered dead through prolonged absence of autoresuscitation. Given the difficulty of definitive determination of the time when brain function has ceased, two solutions are proposed: abandon the Dead Donor Rule or redefine death. Implementing the former would mean convincing the public to accept organ harvesting before the dying patient is completely br...
Ethical considerations in determining whether a human organ market could exist without causing ex... more Ethical considerations in determining whether a human organ market could exist without causing exploitation of vulnerable populations may depend on the size of the market. Some ethical and religious considerations are culture dependent; others require legal structures to protect fundamental human rights. Both these factors suggest that an ethical market in human organs may be feasible, but not necessarily in every country or across national boarders.
This article updates the qualitative research on Iran reported in the 2012 article by Tong et al.... more This article updates the qualitative research on Iran reported in the 2012 article by Tong et al. “The experiences of com- mercial kidney donors: thematic synthesis of qualitative research” (Tong et al. in Transpl Int 25:1138–1149, 2012). The basic approach used in the Tong et al. article is applied to a more recent and more comprehensive study of Iranian living organ donors, providing a clearer picture of what compensated organ donation is like in Iran since the national government began regulating compensated donation. Iran is the only country in the world where kidney selling is legal, regulated, and subsidized by the national government. This article focuses on three themes: (1) coercion and other pressures to donate, (2) donor satisfaction with their donation experience, and (3) whether donors fear social stigma. We found no evidence of coercion, but 68% of the paid living organ donors interviewed felt pressure to donate due to extreme poverty or other family pressures. Even though 27% of the living kidney donors interviewed said they were satisfied with their donation experience, 74% had complaints about the donation process or its results, including some of the donors who said they were satisfied. In addition, 84% of donors indicated they feared experiencing social stigma because of their kidney donation.
Letter to the Editor, American Journal of Transplantation, with table. Suggests ways of improving... more Letter to the Editor, American Journal of Transplantation, with table. Suggests ways of improving informed consent documents used in connection with living donor organ transplantation.
Nurses in a community hospital pediatric unit are struggling with the issue of how to care for a ... more Nurses in a community hospital pediatric unit are struggling with the issue of how to care for a severely handicapped newborn. The parents are confused and cannot decide whether to approve a series of operations that will extend the infant's life or to request only palliative care. Where can the nursing staff go for help with these issues? Does the hospital have a bioethics service? What should nurses expect if they avail themselves of this service? Would members of the bioethics service decide what should be done? How would the family be involved?
Ethical considerations in determining whether a human organ market could exist without causing ex... more Ethical considerations in determining whether a human organ market could exist without causing exploitation of vulnerable populations may depend on the size of the market. Some ethical and religious considerations are culture dependent; others require legal structures to protect fundamental human rights. Both these factors suggest that an ethical market in human organs may be feasible, but not necessarily in every country or across national boarders.
Kidney transplantation has become the treatment of choice for patients with end-stage renal disea... more Kidney transplantation has become the treatment of choice for patients with end-stage renal disease. Six decades of success in the field of transplantation have made it possible to save thousands of lives every year. Unfortunately, in recent years success has been overshadowed by an ever-growing shortage of organs. In the United States, there are currently more than 100 000 patients waiting for kidneys. However, the supply of kidneys (combined cadaveric and live donations) has stagnated around 17 000 per year. The ever-widening gap between demand and supply has resulted in an illegal black market and unethical transplant tourism of global proportions. While we believe there is much room to improve the Iranian model of regulated incentivized live kidney donation, with some significant revisions, the Iranian Model could serve as an example for how other countries could make significant strides to lessening their own organ shortage crises.
The laws governing bioethics issues are confusing and sometimes contradictory because of several ... more The laws governing bioethics issues are confusing and sometimes contradictory because of several types of tensions inherent in our legal system. The U.S. constitutional guarantees of separation of church and state and individual rights make bioethics issues involving personal, moral, or religious convictions particularly contentious. This Fall 2007 issue of Legal Trends in Bioethics includes legislative, judicial, and regulatory developments in bioethics on the state, federal, and in some cases even international level. This issue highlights troubling interventions into the patient/physician relationship, but also covers medical tourism, abortion, and mandatory child vaccinations.
Conclusion: Although Engelhardt's The Foundations of Bioethics is an impressive work, it is p... more Conclusion: Although Engelhardt's The Foundations of Bioethics is an impressive work, it is plagued by problems of justification, conceptual confusion, and inconsistencies....A libertarian theory can arrive at the same basic requirements of mutual respect, autonomy, nonuse of force, and tolerance for a wide range of diverse life styles without relying on a lowest-common-denominator principle and without depriving fetuses, infants, and the mentally retarded of their status as persons. This can be done by taking a deontological approach to libertarian theory that denies that all moral beliefs are worthy of respect. Some beliefs, such as Engelhardt's belief that fetuses, infants, and the mentally retarded are nonpersons, simply fall beneath the floor of acceptable moral alternatives, even in a libertarian society, because such beliefs are based on a misunderstanding of personhood and violate the principle of mutual respect.
International journal of organ transplantation medicine, 2010
The US Uniform Determination of Death Act provides two alternatives for determining death-the cir... more The US Uniform Determination of Death Act provides two alternatives for determining death-the circulatory criteria and the neurological criteria-yet history and the public's current understanding of death in the US may mean that only brain death criteria can be relied upon without raising public suspicion that the medical profession is sacrificing the well-being of one group of patients (i.e., those dying after traumatic injury) to save another group (i.e., those in need of organs). The problem is exacerbated by existing debate on the appropriate waiting time after which death is inevitable and when the brain should be actually considered dead through prolonged absence of autoresuscitation. Given the difficulty of definitive determination of the time when brain function has ceased, two solutions are proposed: abandon the Dead Donor Rule or redefine death. Implementing the former would mean convincing the public to accept organ harvesting before the dying patient is completely br...
Ethical considerations in determining whether a human organ market could exist without causing ex... more Ethical considerations in determining whether a human organ market could exist without causing exploitation of vulnerable populations may depend on the size of the market. Some ethical and religious considerations are culture dependent; others require legal structures to protect fundamental human rights. Both these factors suggest that an ethical market in human organs may be feasible, but not necessarily in every country or across national boarders.
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