Key to organ donation may be cultural awareness

Article Abstract:

Hispanic Americans, like blacks, need donated organs more than non-Hispanic whites, since their incidence of non-insulin-dependent diabetes mellitus is three times higher, and their overall incidence of end-stage renal disease (irreversible kidney failure) is also higher. Donated organs from other Hispanics are less likely to be rejected, for reasons of tissue compatibility. In spite of these facts, Hispanics have a low rate of organ donation. This cannot be directly traced to religious or cultural proscriptions; almost as many Mexican Americans as Anglo Americans stated they would be willing to donate organs, in one recent study. Better educational approaches and gearing explanations to cultural beliefs about death could improve donation rates, but ''marketing'' approaches should not ignore the importance of informed consent. Understanding Hispanic family structure is important if donations are to be secured; although a donor procurement coordinator may approach the father of a dead child, as head of the household, it is the grandmother (or mother) who decides health-related matters. She is the one to be approached. Blood relationships supersede legal ones in Hispanic culture: the parents, not the spouse, of a deceased person, would have the more salient opinion in such matters. Kathleen Rand Reed, president of Necronomics, a company that studies transcultural aspects of organ donation, emphasizes the importance of the curanderas (folk healers) for Hispanics. These healers stress the linkage between the mind and the body, and physicians' attitudes toward curanderas strongly can affect a family's willingness to donate organs. Simply asking whether a patient has visited a healer can help establish trust. Another reason Hispanics refuse permission for organ donation may be that they fear they would violate the wishes of the deceased. Many (71 percent, compared with 59 percent of Anglo-Americans) have not discussed the issue with family members, according to one study. Health care practitioners and the clergy could promote awareness of the importance of organ donation. Involving priests, though, raises the issue of informed consent in a culture where authority figures are perceived as very powerful. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Social policy, Demographic aspects, Public opinion, Hispanic Americans, Donation of organs, tissues, etc., Tissue donation

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Clinicians' forensic interpretations of fatal gunshot wounds often miss the mark

Article Abstract:

Emergency physicians and surgeons are increasingly called upon to interpret fatal gunshot wounds, yet many appear to lack the expertise to make forensic judgements. Trauma specialists incorrectly described the wounds in 24 of 46 cases involving single, exiting gunshot wounds or multiple gunshot wounds. There were 16 errors in distinguishing between entrance and exit wounds and 15 errors in determining the number of wounds. Seventy-four percent of the multiple gunshot wounds were misinterpreted. Although errors like these may have little impact on treatment, they have substantial medicolegal consequences. In Wyoming, an innocent man was convicted of homicide when a coroner incorrectly classified a gunshot wound. Assuming that the smaller hole is always the entrance wound, he declared the victim had been shot in the back when she had actually committed suicide. Trauma specialists can assist investigations by accurately describing the wounds, their size and location. They should keep all clothes and record any unusual findings.

Evaluation, Medical examination, Study and teaching, Gunshot wounds, Forensic pathology, Forensic ballistics, Emergency physicians

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