research would meet the ethical standards of research involving human participants, and would pro... more research would meet the ethical standards of research involving human participants, and would promote the safety and well-being of the seller; this clause helps to ensure that the sellers will receive adequate postnephrectomy surveillance and follow-up care, which would work to mitigate postsale backfire. Importantly, this prototype kidney market would make it mandatory for all participants to read and demonstrate understanding of relevant empirical findings (such as those of Koplin and those he cites), prior to their participation therein—something that is altogether absent in current black markets, and (presumably) the Iranian market as well. (“Many people who have sold one of their kidneys come to view their bodies as damaged or disordered, and routinely fear their imminent demise,” “There is a statistically significant number of those that sell their kidney who come to regret their decision to do so, and reversing the nephrectomy is likely practically impossible,” “If your current or foreseeable primary mode of employment depends on physical labor, then your risk of long-term postsale backfire increases significantly,” “If you do not have adequate health care coverage, and/or have reservations about seeking postsale medical care, then your risk of long-term postsale backfire increases significantly,” “For many people, the economic benefits of selling their kidney are temporary, and for others they are nonexistent,” etc.) This clause would serve to increase participant protection and awareness, enabling them to realistically weigh the prospect of postsale backfire with the alternative of leaving things as they are, for them. Ultimately, however, it would be up to them to decide whether to sell their kidney, in an attempt to improve their plight, with the knowledge that there is a fairly high probability that their doing so will turn out to be a mistake (for them to make). &
Compassion fatigue is the result of repeated vicarious trauma from caring for those who have suff... more Compassion fatigue is the result of repeated vicarious trauma from caring for those who have suffered. Although not well-researched in pediatric nephrology to date, there is reason to believe that it is a real and sustained threat to the pediatric nephrology workforce. Interventions aimed at individuals, the profession, and the organizations in which pediatric nephrologists work can create spaces to discuss and ameliorate compassion fatigue. This will result in better care for patients, more stable pediatric nephrology divisions and a stronger, more resilient pediatric nephrology workforce.
Canadian Journal of Kidney Health and Disease, 2021
While the deceased organ donor rate in Canada has increased by >50% since 2010, the supply con... more While the deceased organ donor rate in Canada has increased by >50% since 2010, the supply continues to lag behind demand, and 223 Canadians died while waiting for a kidney transplant in 2019.1 Presumed consent has been suggested as a strategy to reduce this gap. While Canadian provinces and the United States employ opt-in models, the presumed consent approach is the practice in many other countries, including Austria, Belgium, France, Wales, and Spain, (the last of which has the highest deceased donor rate in the world.)2 In April 2019, Nova Scotia passed legislation to become the first North American jurisdiction to adopt presumed consent legislation, and this legislation went into effect on January 18, 2021.3 In addition to the legislation, Nova Scotia simultaneously adopted other elements of health system transformation including mandatory notification for all patient deaths, approach of families for all medically suitable deceased donors, and center reporting of donor perfor...
This chapter will consider psychosocial aspects of pediatric organ transplantation for transplant... more This chapter will consider psychosocial aspects of pediatric organ transplantation for transplant candidates (those being considered for listing), organ recipients, and their families—including living related donors. We will outline an ethical approach to considering several questions: How ought mental health issues (for patient and caregiver), substance use, and assessment of available psychosocial support structures play into decisions about organ transplant candidacy in pediatrics? How should medical teams address problems with a parent’s psychological function or coping skills when the child’s transplant candidacy is threatened? What are the psychological sequelae of transplantation for children and adolescents and how do they affect medical decision-making?
Canadian Journal of Kidney Health and Disease, 2020
Purpose of program: To provide guidance on the management of patients with advanced chronic kidne... more Purpose of program: To provide guidance on the management of patients with advanced chronic kidney disease (CKD) not requiring kidney replacement therapy during the COVID-19 pandemic. Sources of information: Program-specific documents, pre-existing, and related to COVID-19; documents from national and international kidney agencies; national and international webinars, including webinars that we hosted for input and feedback; with additional information from formal and informal review of published academic literature. Methods: Challenges in the care of patients with advanced CKD during the COVID-19 pandemic were highlighted within the Canadian Senior Renal Leaders Forum discussion group. The Canadian Society of Nephrology (CSN) developed the COVID-19 rapid response team (RRT) to address these challenges. They identified a lead with expertise in advanced CKD who identified further nephrologists and administrators to form the workgroup. A nation-wide survey of advanced CKD clinics was ...
This chapter will explore the ethical issues that arise in the care of the adolescent transplant ... more This chapter will explore the ethical issues that arise in the care of the adolescent transplant recipient. We will explore the dilemmas that arise in four clinical situations: (1) the adolescent who refuses transplant, (2) the non-adherent teen who is being considered for transplant, (3) contraception for female transplant recipients and (4) transition from pediatric to adult care. Ethical issues will include (1) adolescent decision-making and developing capacity (2) measuring adherence and using it as a criterion for transplant eligibility (3) maternal-fetal conflict in the use of drugs with teratogenic potential and (4) ethical concerns that arise during transition from pediatric to adult care.
Alcohol and cannabis use as a contraindication to organ transplantation is a controversial issue.... more Alcohol and cannabis use as a contraindication to organ transplantation is a controversial issue. Until recently, patients in Canada with alcohol-associated liver disease were required to demonstrate abstinence for 6 mo to receive a liver transplant. There is no equivalent rule that is applied consistently for cannabis use. There is some evidence that alcohol and cannabis use disorder pretransplant could be associated with worse outcomes posttransplantation. However, early liver transplantation for patients with alcohol-associated liver disease in France and in the United States has led to challenges of the 6-mo abstinence rule in Canada in the media. It has also resulted in several legal challenges arguing that the rule violates human rights laws regarding discrimination in the provision of medical services and that the rule is also unconstitutional (this challenge is still before the court). Recent legalization of cannabis use for adults in Canada has led to questions about the ap...
research would meet the ethical standards of research involving human participants, and would pro... more research would meet the ethical standards of research involving human participants, and would promote the safety and well-being of the seller; this clause helps to ensure that the sellers will receive adequate postnephrectomy surveillance and follow-up care, which would work to mitigate postsale backfire. Importantly, this prototype kidney market would make it mandatory for all participants to read and demonstrate understanding of relevant empirical findings (such as those of Koplin and those he cites), prior to their participation therein—something that is altogether absent in current black markets, and (presumably) the Iranian market as well. (“Many people who have sold one of their kidneys come to view their bodies as damaged or disordered, and routinely fear their imminent demise,” “There is a statistically significant number of those that sell their kidney who come to regret their decision to do so, and reversing the nephrectomy is likely practically impossible,” “If your current or foreseeable primary mode of employment depends on physical labor, then your risk of long-term postsale backfire increases significantly,” “If you do not have adequate health care coverage, and/or have reservations about seeking postsale medical care, then your risk of long-term postsale backfire increases significantly,” “For many people, the economic benefits of selling their kidney are temporary, and for others they are nonexistent,” etc.) This clause would serve to increase participant protection and awareness, enabling them to realistically weigh the prospect of postsale backfire with the alternative of leaving things as they are, for them. Ultimately, however, it would be up to them to decide whether to sell their kidney, in an attempt to improve their plight, with the knowledge that there is a fairly high probability that their doing so will turn out to be a mistake (for them to make). &
Compassion fatigue is the result of repeated vicarious trauma from caring for those who have suff... more Compassion fatigue is the result of repeated vicarious trauma from caring for those who have suffered. Although not well-researched in pediatric nephrology to date, there is reason to believe that it is a real and sustained threat to the pediatric nephrology workforce. Interventions aimed at individuals, the profession, and the organizations in which pediatric nephrologists work can create spaces to discuss and ameliorate compassion fatigue. This will result in better care for patients, more stable pediatric nephrology divisions and a stronger, more resilient pediatric nephrology workforce.
Canadian Journal of Kidney Health and Disease, 2021
While the deceased organ donor rate in Canada has increased by >50% since 2010, the supply con... more While the deceased organ donor rate in Canada has increased by >50% since 2010, the supply continues to lag behind demand, and 223 Canadians died while waiting for a kidney transplant in 2019.1 Presumed consent has been suggested as a strategy to reduce this gap. While Canadian provinces and the United States employ opt-in models, the presumed consent approach is the practice in many other countries, including Austria, Belgium, France, Wales, and Spain, (the last of which has the highest deceased donor rate in the world.)2 In April 2019, Nova Scotia passed legislation to become the first North American jurisdiction to adopt presumed consent legislation, and this legislation went into effect on January 18, 2021.3 In addition to the legislation, Nova Scotia simultaneously adopted other elements of health system transformation including mandatory notification for all patient deaths, approach of families for all medically suitable deceased donors, and center reporting of donor perfor...
This chapter will consider psychosocial aspects of pediatric organ transplantation for transplant... more This chapter will consider psychosocial aspects of pediatric organ transplantation for transplant candidates (those being considered for listing), organ recipients, and their families—including living related donors. We will outline an ethical approach to considering several questions: How ought mental health issues (for patient and caregiver), substance use, and assessment of available psychosocial support structures play into decisions about organ transplant candidacy in pediatrics? How should medical teams address problems with a parent’s psychological function or coping skills when the child’s transplant candidacy is threatened? What are the psychological sequelae of transplantation for children and adolescents and how do they affect medical decision-making?
Canadian Journal of Kidney Health and Disease, 2020
Purpose of program: To provide guidance on the management of patients with advanced chronic kidne... more Purpose of program: To provide guidance on the management of patients with advanced chronic kidney disease (CKD) not requiring kidney replacement therapy during the COVID-19 pandemic. Sources of information: Program-specific documents, pre-existing, and related to COVID-19; documents from national and international kidney agencies; national and international webinars, including webinars that we hosted for input and feedback; with additional information from formal and informal review of published academic literature. Methods: Challenges in the care of patients with advanced CKD during the COVID-19 pandemic were highlighted within the Canadian Senior Renal Leaders Forum discussion group. The Canadian Society of Nephrology (CSN) developed the COVID-19 rapid response team (RRT) to address these challenges. They identified a lead with expertise in advanced CKD who identified further nephrologists and administrators to form the workgroup. A nation-wide survey of advanced CKD clinics was ...
This chapter will explore the ethical issues that arise in the care of the adolescent transplant ... more This chapter will explore the ethical issues that arise in the care of the adolescent transplant recipient. We will explore the dilemmas that arise in four clinical situations: (1) the adolescent who refuses transplant, (2) the non-adherent teen who is being considered for transplant, (3) contraception for female transplant recipients and (4) transition from pediatric to adult care. Ethical issues will include (1) adolescent decision-making and developing capacity (2) measuring adherence and using it as a criterion for transplant eligibility (3) maternal-fetal conflict in the use of drugs with teratogenic potential and (4) ethical concerns that arise during transition from pediatric to adult care.
Alcohol and cannabis use as a contraindication to organ transplantation is a controversial issue.... more Alcohol and cannabis use as a contraindication to organ transplantation is a controversial issue. Until recently, patients in Canada with alcohol-associated liver disease were required to demonstrate abstinence for 6 mo to receive a liver transplant. There is no equivalent rule that is applied consistently for cannabis use. There is some evidence that alcohol and cannabis use disorder pretransplant could be associated with worse outcomes posttransplantation. However, early liver transplantation for patients with alcohol-associated liver disease in France and in the United States has led to challenges of the 6-mo abstinence rule in Canada in the media. It has also resulted in several legal challenges arguing that the rule violates human rights laws regarding discrimination in the provision of medical services and that the rule is also unconstitutional (this challenge is still before the court). Recent legalization of cannabis use for adults in Canada has led to questions about the ap...
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