The role of affect in attitudes toward organ donation and donor-relevant decisions

We argue that affect plays a vital role in attitudes toward organ donation and that reluctance to become an organ donor is likely to be related to the experience of affective ambivalence. Assessing the affect associated with organ donation could help to predict donor-relevant decisions. Results of a confirmatory factor analysis on 464 students showed that affective evaluations can be distinguished both from cognitive evaluations and from overall evaluations. As expected, affective evaluations revealed ambivalence (using the ‘Griffin’ measure of ambivalence) toward organ donation, whereas the two other types of evaluations did not. Results of a follow-up study using logistic regression (n?=?85), showed that affective evaluations predicted donor-relevant decisions six months later. The present findings support the proposal to include separate affective evaluations in measures of attitudes to organ donation. More general implications for the measurement and structure of attitudes in health related domains are discussed.     

On the Ethics of Facial Transplantation Research

Transplantation continues to push the frontiers of medicine into domains that summon forth troublesome ethical questions. Looming on the frontier today is human facial transplantation. We develop criteria that, we maintain, must be satisfied in order to ethically undertake this as-yet-untried transplant procedure. We draw on the criteria advanced by Dr. Francis Moore in the late 1980s for introducing innovative procedures in transplant surgery. In addition to these we also insist that human face transplantation must meet all the ethical requirements usually applied to health care research. We summarize the achievements of transplant surgery to date, focusing in particular on the safety and efficacy of immunosuppressive medications. We also emphasize the importance of risk/benefit assessments that take into account the physical, aesthetic, psychological, and social dimensions of facial disfiguration, reconstruction, and transplantation. Finally, we maintain that the time has come to move facial transplantation research into the clinical phase.     

An “Opting In” Paradigm for Kidney Transplantation

Almost 60,000 people in the United States with end stage renal disease are waiting for a kidney transplant. Because of the scarcity of organs from deceased donors live kidney donors have become a critical source of organs; in 2001, for the first time in recent decades, the number of live kidney donors exceeded the number of deceased donors. The paradigm used to justify putting live kidney donors at risk includes the low risk to the donor, the favorable risk-benefit ratio, the psychological benefits to the donor, altruism, and autonomy coupled with informed consent; because each of these arguments is flawed we need to lessen our dependence on live kidney donors and increase the number of organs retrieved from deceased donors.

An “opting in” paradigm would reward people who agree to donate their kidneys after they die with allocation preference should they need a kidney while they are alive. An “opting in” program should increase the number of kidneys available for transplantation and eliminate the morally troubling problem of “organ takers” who would accept a kidney if they needed one but have made no provision to be an organ donor themselves. People who “opt in” would preferentially get an organ should they need one at the minimal cost of donating their kidneys when they have no use for them; it is a form of organ insurance a rational person should find extremely attractive.

An “opting in” paradigm would simulate the reciprocal altruism observed in nature that sociobiologists believe enhances group survival. Although the allocation of organs based on factors other than need might be morally troubling, an “opting in” paradigm compares favorably with other methods of obtaining more organs and accepting the status quo of extreme organ scarcity. Although an “opting in” policy would be based on enlightened self-interest, by demonstrating the utilitarian value of mutual assistance, it would promote the attitude that self-interest sometimes requires the perception that we are all part of a common humanity.     

器官移植准入制度迫在眉睫

器官移植在我国正在迅速、蓬勃发展。但是在各种利益的驱使下,我国的器官移植出现严重偏差。一些不具备技术实力的医院违反原则地盲目上马该项目。使国内器官移植生存率与国际相比有相当大差距,并在经济上及器官来源等各方面都造成了巨大浪费。因此,我国亟需配套与器官移植有关的各种法律、法规出台,以规范目前的混乱状况,提高我国器官移植质量。     

血液净化防治多器官功能障碍综合征的思考

血液净化防治多器官功能障碍综合征已在临床医疗中广泛应用。简要介绍血液净化及多器官功能障碍综合征的相关知识。重点运用科学思维分别从系统论方法、控制论方法、信息方法三方面阐述两者间的内在联系,为临床工作提供新的指导。     

浅谈《人体器官移植技术临床应用管理暂行规定》的九点不足

就新施行的《人体器官移植技术临床应用管理暂行规定》,提出其立法目的表述不妥;缺乏与其他法律法规之间的平衡和协调;未能明确提出按照公平效率原则分配器官;缺乏对未成年人的特殊保护;过分强调捐赠者对器官捐赠协议的任意撤消权;书面同意形式的局限性;未就禁止买卖原则的情形具体化;未能就建立具有中立性特点的器官调控中心作出规定;未能就脑死亡留下一个开放性的口子等九点不足,并提出了建议。     

SACRED LAW RECONSIDERED

People everywhere search for answers by using the resources of their traditions. They wish to do so in a legitimate way, and so they consult official institutions, specialists, and skilled individuals for their opinions; regardless of religious or cultural contexts, the common aim of these experts is to produce security, unity, and trust. Therefore, the norm‐finding processes in Islamic and Western contexts share fundamental similarities: the problem of finding a final ground for judgment, the strategies of constructing coherence and of organizing consensus, and the difficulties of obtaining legitimacy. What makes one debate “Islamic” and the other one “Western” is the different semantic materials, the different authorities, the different languages, and the different juridical frameworks. In my comparison of Muslim and Western discourses and practices, I conclude that Muslim and non‐Muslim scholars tend to overemphasize the uniqueness of Muslim legal and practical responses to bioethical challenges, because they restrict their purview to legal opinions, ignoring larger dynamics of legitimization.     

我国器官移植中供体不足的原因分析及对策

器官移植对于挽救晚期脏器功能衰竭病人的生命具有极其重要的意义,我国器官移植起步较晚,多种因素限制器官移植的发展,其中供体不足是关键因素之一.分析器官移植中供体不足的原因,认为冲破传统观念的束缚,加大宣传力度,加快立法步伐是我国器官移植中供体不足亟待解决的问题.     

Psychological experiences of renal transplant patients: A qualitative analysis

Introduction: Organ‐sourcing developments now permit increasing numbers of renal transplants. Recipients commonly experience negative affect pre‐ and/or post‐transplant yet research on patient experience is lacking. Aims: This study aims to develop theory based on the lived experience of recipients, and to guide psychological and support interventions by counsellors and professional carers for the benefit of patients. Methods: A sample of eight participants was interviewed about their transplant experiences. The interview data were analysed using grounded theory methodology. Uniquely the research was conducted by a renal transplant patient, which potentially adds interpretive insight. Results: The central finding is that the issues facing transplant patients before and after transplant may be summarised as living with paradox and conflict. Thus, recipients may need to juxtapose anger/sadness about losses with an adaptive attitude to making the most of a second chance at life, and negotiate a positive relationship with an ‘alien’ organ. Conclusions/implications: The study offers evidence‐based guidance to counsellors supporting recipients to adjust to a changing sense of self, and to form adaptive relationships with self, others and the new kidney. Finally the research recommends action on improving awareness of and access to counselling and other supports for renal transplantees, and the need for in‐depth experiential research in this expanding area.