Why We Must Leave Our Organs to Others

Organ procurement presents several ethical concerns (from what constitutes acceptable criteria for death to issues involved in specifically designating to whom an organ can be given), but none is more central than the concern for what are appropriate means for acquiring organs. The following discussion attempts a different perspective on the issue of organ procurement by arguing that, rather than appealing to our charitable consciences or our pocketbooks, relinquishing our organs after death in this day and age is, in fact, obligatory for most people. Each of us is pressed by the growing demand for our organs should we die “rightly,” and that desperate need has risen to such a level that not to release our organs for transplantation would constitute a serious moral wrong.     

移植免疫中微嵌合现象给我们的思考

随着移植免疫学研究的不断深入发展,诱导免疫耐受克服移植排斥反应已成为器官移植的主要研究目标。Starzl提出“双向移植排斥理论”并阐述临床使用免疫抑制药物下移植排斥反应的特点,突破了原有单向移植排斥理论的框架。“双向移植排斥理论”及理论内存在的问题给予我们众多有益的思考,在移植免疫学研究中,只有坚持用系统原则动态的看待事物间的联系与矛盾,进行科学实践,才能获得正确的理论,从而进一步推动移植免疫学的发展。     

Perceptions of Liver Transplant Candidates with or Without an Alcohol Use History

Cirrhosis secondary to alcohol use is a primary cause of liver disease and a medical condition for which liver transplantation is a viable treatment option. However, there remains considerable debate within both the lay and the medical communities regarding the distribution of a scarce medical resource to adults with alcoholism. This study examined college students' perceptions toward an adult, presented in a written vignette, for whom liver transplantation was medically indicated. The influence of gender (female and male) and alcohol use history (no alcohol history, alcoholism history with long-term abstinence, alcoholism history with current use) on these ratings was examined. Subjects rated the adult presented with no alcohol history more positively than they did the adults presented with a history of alcoholism. Also, the adult with no alcohol history was more likely to be offered transplantation and was given higher priority ratings for transplantation by subjects. While subjects' own alcohol use history and organ donor registration status were not associated with ratings, having a family member with an alcohol problem and personally knowing a transplant recipient were related to more favorable ratings toward the adult presented in the vignette. Implications of these findings as well as limitations of the study are discussed.     

‘If I leave home,who will take care of mum?’ Intergenerational transmission of parental trauma through projective identification

Using the construct of projective identification and integrating it with the body of literature on intergenerational transmission of unsymbolized parental trauma, I describe the case of an adult daughter that illustrates intergenerational transmission of unsymbolized parental trauma. It is suggested that the daughter has unconsciously identified with the disavowed feelings of anxiety projected into her by her mother. The daughter’s projective identification of her mother’s unresolved past traumas prevent her from leaving the parental home for the first time, despite being 35 years old. In turn, it is thought that the mother’s unconscious grasping onto her daughter is an attempt to avoid the confrontation of her own unprocessed fears implanted into her by her own mother, thus linking three generations of disavowal. As a way of extending the exiting theory, it is proposed that when there are long-term and inexplicable experiences of anxiety that coalesces around the intergenerational transmission of parental trauma, the term ‘intergenerational transmission of traumatic anxiety’ can be used to describe it.     

Psychological Distress in Caregivers of Liver and Lung Transplant Candidates

Although organ transplantation represents a stressful experience for the entire family, surprisingly little research has focused on the adjustment of caregivers. The purpose of this study was to examine what caregivers report to be the greatest benefits and stressors pretransplant, the prevalence of psychological distress and caregiver strain in pretransplant caregivers as compared to normative populations, and the physical, psychological, and demographic variables that predict distress. Fifty-two caregivers of transplant candidates (28 liver and 24 lung) completed a series of questionnaires, including the Psychosocial Adjustment to Illness Scale (PAIS-SR), SF-36 Health Survey, Caregiver Strain Index (CSI), and qualitative questions about benefits and stressors. The most commonly reported benefit of being a caregiver could be categorized as Helping the Patient, and the most common stressors were associated with Uncertainty/Waiting/Fears. Compared to normative samples of caregivers of patients with Alzheimer's disease, caregivers of liver transplant candidates reported more caregiver strain; there were no differences for lung transplant caregivers. Caregiver social functioning was found to be the only significant predictor of caregiver distress, with those caregivers who report greater distress also reporting extreme and frequent interference with normal social activities. Implications of these findings for psychological interventions are discussed.     

The interface between physical and mental disorders: The need to dismantle the biopsychosocialneuroimmunological model of disease

This article argues for the necessity of cognitive-behavioral assessment for a thorough understanding of how psychological factors mediate disease process across a wide range of diseases including coronary artery disease, breast cancer, and human immunodeficiency disease. Based on empirical data presented as part of the APA Presidential miniconvention, “To Your Health: Psychology through the Life Span,” the conclusion is that psychological treatment can help extend life. Stress management programs can positively influence adherence to treatment regimens and positively influence the human immune system response during the course of treatment and recovery from illness. Even in the face of life-threatening circumstances such as liver transplantation, Stage II and III breast cancer, and after HIV infection has been diagnosed, the quality of life can be remarkably improved. Physicians and psychologists must work together to produce the beneficial effects of the synergy between mind-body processes.     

Cultural Diversity and Patients with Reduced Capacity: The Use of Ethics Consultation to Advocate for Mentally Handicapped Persons in Living Organ Donation

Theoretical Medicine and Bioethics - Living organ donation will soon become the source of the majority of organs donations for transplant. Should mentally handicapped people be allowed to donate,...     

公众对活体大器官移植的认知态度与对策

对河南地区公众关于活体大器官移植态度进行的抽样调查结果显示：（1）公众赞成开展活体大器官移植;（2）多数公众反对器官买卖,但赞成器官买卖的也有相当大的比例;（3）亲情是亲属活体器官捐献者愿意捐献的主要原因。针对调查结果,我们在比较分析的基础上,提出了相关对策,促使活体大器官移植技术更好地造福于人类。     

Parent Stress and Coping: Waiting for a Child to Receive a Kidney Transplant

The current study examined the degree of parent stress and depression among mothers and fathers of children with end-stage renal disease (ESRD) listed for a kidney transplant, to determine whether demographic factors, stress, and coping would predict parent depression. Eighty-six mothers and 58 fathers of children with ESRD preparing for a kidney transplant completed standardized measures of parent stress related to the child’s chronic illness (PIP), coping style (Brief Cope), and depression (BDI-II). Information about the disease was obtained from the medical record. Maternal depression was predicted by having a lower family income, higher degree of parent stress associated with the child’s illness, and the use of avoidant coping strategies. Paternal depression was only predicted by higher parent stress. Illness related variables did not contribute significantly to the understanding of parent outcomes. Pre-transplant evaluations should screen for elevated levels of stress and depression, and develop interventions to help parents cope with their child’s renal disease.