Physicians' attitudes and approaches are pivotal in procuring organs for transplantation

Article Abstract:

Several kinds of attempts to increase organ donation for transplantation are reviewed; all such efforts are fueled by the current desperate shortage of donated organs. The United Network for Organ Sharing collaborates with the American Association of Neurological Surgeons and the Congress of Neurological Surgeons to improve the donation rate. Of particular concern is the way requests for donations are made. Families who experienced good rapport with their loved one's medical staff prior to the death are more likely to agree to donation than families who felt ignored. Research has also shown that families are more likely to donate if they understand their relative is dead, something that may be difficult if brain death has occurred but heart activity and respiration continue. Organs can only be donated from patients in this condition. Requests for organ donations are best made by health care workers other than the physician, whose involvement may give the family hope that the patient will recover. Recommendations from a recent conference sponsored by the Partnership for Organ Donation include: to focus on hospitals with the greatest potential for organ donation, rather than big-city trauma centers; use of appropriate terminology by the person requesting donation; and inclusion of topics relevant to organ donation in medical and nursing school curricula, which generally neglect the topic at this time. A pilot project of the Partnership for Organ Donation is now underway in four regions to increase the supply of donated organs. Part of the project attempts to make neurosurgeons more aware of the need for organs by introducing them to organ recipients. A suggested Mexican program to grant organ donors hero status equivalent to that of war veterans' provides a reward for the ''gift of life''. Such an approach is preferable to offering money to donors' families, because it does not raise the same ethical issues. Additional articles on organ donation appear in the March 13, 1991 issue of The Journal of the American Medical Association. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Physicians, Medical professions, Recruiting, Beliefs, opinions and attitudes, Donation of organs, tissues, etc., Tissue donation, Organ donors, Tissue donors

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Ethical considerations in listing fetuses as candidates for neonatal heart transplantation

Article Abstract:

Technological innovations in prenatal diagnostic accuracy raise a host of complex and ethical questions. In 1989, a fetus diagnosed with hypoplastic left heart syndrome (HLHS) became the first to undergo deliberate preterm delivery for heart transplantation. This case and ones similar to it highlight a critical issue: should newborns and fetuses be competing for already scarce human hearts? Prior to Jun 1992, length of time on the organ waiting list was the only basis for distinguishing among all heart transplant candidates under six months of age. Because in most cases a fetus with HLHS still thrives in the uterus while live-born infants struggle on intensive care units, the United Network for Organ Sharing (UNOS) recommended infants be offered a donor organ before fetuses. Furthermore, UNOS stated a fetus should not be placed on the waiting list to accrue time before it can actually undergo transplantation. Some form of counseling and information on the risks to personal safety should be available to the pregnant women involved.

Social policy, Surgery, Ethical aspects, Infants (Newborn), Newborn infants, Heart, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation, Heart transplantation, United Network for Organ Sharing, Hypoplastic left heart syndrome

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