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Rapid Responses: Rapid Responses published:
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Emphasis on factors
- Dr Rajasree Pai (22 April 2009)
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Many solutions are needed
- Luis V Limchiu (23 April 2009)
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A delicate theme
- Aikaterini Patrona, 44892 Bochum- Langendreer, Germany (23 April 2009)
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Looking for donors
- Manuel Romero-Gómez (23 April 2009)
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Engagement with the bereaved family
- Augustine Bonsu (23 April 2009)
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Organ donation opt-out
- George J Kiricenkov (23 April 2009)
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Target medical students
- Eilidh J O'Loughlin (23 April 2009)
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Modifiable factors
- Alexandros G. Metallinos (24 April 2009)
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Relatives consent for organ donation: some cultural issues
- Amal C Paul (24 April 2009)
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Payment for organ donation
- Subhash J. Sukhtankar (24 April 2009)
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I refuse the organ sale
- Silvana Di Gregorio (25 April 2009)
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Ethics
- William J DeMedio (25 April 2009)
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organ donation
- ruben toledo (25 April 2009)
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organ donation for payment
- kala.b mohan (26 April 2009)
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Live Organ Doantion
- Madhav Gajanan Raje (26 April 2009)
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Re: Ethics
- L Sam Lewis (26 April 2009)
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is this really a family affair?
- colin ferguson (1 May 2009)
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Say Yes!
- Maqsood Anwar Noorani (1 May 2009)
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enhancing organ donation
- Pushpa Varma (1 May 2009)
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Improvement in infrastructure required
- Jacquelyn K Lewin (1 May 2009)
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Informed consent requires public education about brain stem death
- Sue R Roff (5 May 2009)
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Dr Rajasree Pai, Resident University of Connecticut
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The factors (modifiable) need to be evaluated further and the reasons behind them need to be uncovered. The authors should recommend what steps would be beneficial in such a situation to boost organ donation by dispelling the so-called modifiable factors. Competing interests: None declared |
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Luis V Limchiu, Training Officer for Renal Fellows National Kidney and Transplant Institute, Quezon City, Philippines, 1116
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While I do agree that the experience, and skill of the requesting person as well as the timing of the request for deceased organ donation from the relatives are important in the success of getting the organ. It's impact will not be enough considering the huge gap between the demand and the available supply for organs. In the meantime, while we debate on our high chairs about the ethics and morality of paid organ donation, our patients are dying on dialysis who could have been saved by transplantation (considering the growing evidence of better survival on transplantation). I think we should listen more closely to our patients opinion as they are the real stakeholders on this debate. Recognition also that true and real good intention to help people on the side of the donor should not be considered incompatible with some financial gain for their effort. I think strict regulation of paid organ donation ferreting out abuses and clearly pure financial motivations should be given more study until better ways are found to save our patients on ESRD. Competing interests: none |
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Aikaterini Patrona, Resident in the last year of training Department of Neurosurgery, Ruhr University of Bochum, 44892 Bochum- Langendreer, Germany
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Communicating the brain death of a patient to the relatives is a very delicate situation.For the physician in the ICU the question that comes up is how and when do I bring up organ donation without giving the impression I have ceased to care about the dying patient and his organs are the only thing I am interested in.
The results of the study are not surprising. Fortunately they support what good medical practice is all about.
The setting,the timing and the skills of the staff involved do affect the outcome of an organ donation request. Basic ethical principles,knowledge and training are essential in dealing with this high demanding situation.
Competing interests: None declared |
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Manuel Romero-Gómez, head of Department 41003 Seville Spain
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Spain showed one of the highest rates of organ donation per population. Payment is forbidden and it's a key point. Two main actions are required to increase donation: a) selecting trained and skilled key people able to ask for organ donation in this very difficult scenario; and b) general population must be confident in the overall process of transplant from methods to increase donation to selection of candidates and final results. Competing interests: None declared |
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Augustine Bonsu, Consultant Anaesthetist SY23 1ER
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In addition to good communication skills in soliciting for donors, I believe some sort of reward, financial if desired or support/assistance with bereavement rituals, cremation, funeral or religious service would make relatives feel the 'gift' from their beloved is well appreciated. Furthermore the demonstration of empathy/interest in the bereaved family's other concerns should convince them that the system is not simply after body parts. Competing interests: None declared |
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George J Kiricenkov, md 36116
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The law should be that all organs are available for donation. People should have to opt-out instead of opt-in. A change as easy to implement as legalizing marijuana. Competing interests: None declared |
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Eilidh J O'Loughlin, GPSTR ST2 St Lukes Psychiatric Hosptial, Middlesborough
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It seems sensible to suppose someone skilled and confident in a task will acheive a better outcome. How about targeting this area in communication skills at medical school along with the usual chestnuts such as Breaking Bad News? It could also be introduced as a common station to cover in postgrad exams. It should be covered as early as possible so doctors feel confident to rasie the issue. By the time the students graduate or complete post grad exams they will have covered it in theory many times so will feel more confident in practice. Competing interests: None declared |
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Alexandros G. Metallinos, Consultant Neurologist 6 Methodiou Av. Corfu Greece 49100
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I strongly agree that modifiable factors play an important role and should obviously be targeted. Even this option though, would be no less money dependent than paying for the organs, since the personnel required for success of such an approach must be well trained and generally the whole setting maybe quite expensive. Competing interests: None declared |
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Amal C Paul, G.P. The Gables Surgery, 231 Swinnow Road, Leeds LS16 8LG
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Organ donation is a very sensitive personal, family, society and cultural issue. It carries a great sense of fear and anxiety as well as a fullflment. Relatives of a dying person are already stressed, anxious and confused. Asking for a organ donation consent may only add another agony confirming that their loved one is dying. On the other hand the request may be an eye opening for the relatives to address the last wishes of the dying member of the family. They may make further inquiry to confirm or refute the last wishes. Certainly a professional approach may increase the success to obtain a consent, and the rate may further be increased with an assurance that there will not be a disfigurement and financially not penalising. I rather want to highlight some cultural issues. In Asian culture organ donation is poorly understood and perceived as an unwelcoming move by the relatives. Removal of an organ from the body is seen as act of violation of cultural norm. These views are greatly emphasied by the religious priests. Their advice and directives are very much valued, respected and obeyed by the asian families. Providing information, education, and training to the relagious leaders in the ethos of organ donation and the procedures involved in donation will be highly effective in increasing the rate of consent. The families are part of the society and the society should be involved as a whole rather than the families in isolation. Competing interests: None declared |
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Subhash J. Sukhtankar, Retired Surgeon N/A
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Medical profession has changed into a business and even NHS is managed like a business with more nonmedical personnel in this well known institution. So, I believe there is no moral issues if the person who is willing to donate gets renumeration for the service to NHS. Such practices go on any way in the poor countries, where it appears to be a agency business with middle man taking the big cut- so it is better to give money directly to the person who donates the organ and saves somebody's life !! With the recession, I would not be surprised if such practices become more frequent. S Sukhtankar Competing interests: None declared |
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Silvana Di Gregorio, staff 08029
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I refuse the posibility that organ donation could be change to Organ Sale. This could increase the organ's "mafia". Is not aceptable. Competing interests: None declared |
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William J DeMedio, MD 17602
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Your body is not your own property. You did not buy it nor create it. Your organs likewise are the property of their Creator. Therefore you cannot ethically sell them. You can only give them of your own free will. Free will is the only thing which you truly possess. Competing interests: None declared |
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ruben toledo, family physcician mexico imss 37208
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Hi, interesting topic in bioetics. what i think, is that must be create a culture of life and death, like it is , something natural, and give to relatives options and complet freedom to choose. the complete knowledge of the human been it is not easy, the people who accepted is probably cause experimented a situation that take it to the edge, and easily can understand it. I think about me ................if i decide for cremation, everithig is loose, the 70% of my body is water, and if i slect the different elements like calcium (the most of all) pb, au, cd, p, etc, how much it costs? 2 pounds probably in a good price?...............we need a most humanist culture, where the people decides with no asking for it, probably the answer in the metaphisycs.............. warm regards dr. ruben toledo Competing interests: None declared |
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kala.b mohan, anesthesiologist chennai , India
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Organ donation should be by whole hearted voluntary consent from relatives. this can be achieved by proper advertisement in visual media like newspapers or in telivision. At school level we can encourage students, by saying that "when your grandparents will leave this earth to heaven, why dont you help to donate his/her organ to a needy person". for those who are in low socio economic status, instead of giving payment , they can be considered for job oppertunities by reserving 2% or 3% of jobs for the children of those who donated organs. Competing interests: None declared |
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Madhav Gajanan Raje, Consultant - Psychiatrist Nagpur,India, 440022.
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Live Organ Donation is not morally & ethically acceptable to all,in all countries. So Organ donation after death should be promoted instead. Competing interests: None declared |
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L Sam Lewis, GP Surgery, Newport, Pembrokeshire, SA42 0TJ
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And there's the rub ! Maybe my will is not nearly so free as you believe, and hence my 'ethical choices' are severely constrained, or indeed largely predicted and pre-determined.. ? Certainly, and paradoxically, it seems to me that if you are correct in stating that I cannot sell any part of 'my' body, then my will cannot be 'free'. I am therefore, I think Yours truly. Competing interests: Free Will or Determinism ? |
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colin ferguson, consultant in intensive care plymouth,pl68dh
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I don't understand why I am able to give all my goods to whoever I specify after my death and there is no involvement of my family or anyone else whilst when I try to make a gift of organs my family have an entitlement to deny my wishes.This makes no sense at all. Efforts to increase the availability of organs should concentrate on changing the law to make it clear that the wishes of the donor,expressed in advance ,are sufficient to proceed.We can discuss how to ensure that everyone is guided into expressing their wishes. Competing interests: None declared |
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Maqsood Anwar Noorani, Medical Director Karachi National Hospital Clarence Gate Gardens NW1 6AL London
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Almost a year ago, I wrote an article in the BMJ with two objectives: to stop transplant tourism in Pakistan and to increase the number of organ donations in the UK. Since the introduction of the organ donation Ordinance in Pakistan, transplant tourism has greatly been curtailed but the enigma of the shortage of the organs in the UK continues to haunt us despite of extraordinary hard work by various members of the transplant team and UK Transplant. As a matter of fact the ratio of the patients waiting for transplant to the organs available has increased, perhaps due to a reduction in transplant tourism. During this period there have been several positive steps recommended by the government such as 4.5 million pound funding for publicity campaign for donation, establishment of dedicated organ retrieval teams and increasing the number of coordinators. This has already started showing positive results by an increase in the number of registered donors. However I doubt very much that this shall have the desired outcome as a lot more remains to be done. I personally think unless the idea of presumed consent (opt out) is not implemented, one can not achieve the required results. However in order to maximise the benefits in the present setup, I would recommend the following suggestions. 1) The Donor registration form should be modified to make it a proper irrevocable legal document. It should include the names and signatures of two close relatives as witnesses and this document should become a legal binding document to the relatives. This should make the patients wishes clear to the relatives and avoid the relatives refusing to donate organs despite the patient’s wishes. 2) The students in universities are the most motivated people for any good cause. Lectures and discussions should be held by senior transplant officials in colleges and universities to motivate these young people to get involved in debate and to make up their own mind regarding getting registered on the donor register. 3) The job of co-ordinators is very challenging and traumatizing. They get sandwiched between the grief of the relatives of the deceased and the anxiety of the patients waiting for the transplant. They should be well paid, and above all appreciated and valued as they are in the front line in the whole process. 4) As regards the ethnic minority, in whom the donation rate is minimal, more and more efforts should be made through local councillors, religious scholars, ethnic transplant community, and media to motivate them. Discussions should also be arranged within their community. Their own leaders should explain to them the philosophy of donation. The ethnic minorities settled in the UK are all highly educated, considerate and kind hearted people and if explained the facts and figures properly, I am sure we shall start to see a rise in donations from these communities. However, if this does not work despite prolonged efforts and time, then the idea of organ for organ and no organ for no organ should be considered in order to increase the number of donation in these communities for their own benefit. 5) Most importantly we must not forget the importance of the live donation program. Every effort should be made to meet the relatives of CRI and CRF patients and discuss openly and repeatedly with them the advantages of live and pre-emptive donations. The patient should also be explained very clearly about the advantages of live transplant and the disadvantage of waiting for an organ which they may never get. 6) I have always believed that there is always a donor available in every family and circle of close friends if we seriously look for it. For this we only have to change of our mind set. Are we ready for it? Say Yes! Prof. M A Noorani Competing interests: organ donation urinary fistulae in women |
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Pushpa Varma, prof. and head of ophthalmology dept . m.G.M. medical college and M.Y. hospital indore MP India 452001
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to enhance organ donation we should concentrate on various areas like hospital retrival programmes, publicity by celebrities, real stories and regular articles in various media, families of the donors should be falicitated in group on some good platform. if a skilfull person dose counselling it definitely has as positive effect. we are trying all the above measures in eye donation. it started working but often the organ is not of good quality, but still it can be utilised
for alternative use.
Competing interests: None declared |
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Jacquelyn K Lewin, SpR Anaesthesia University Hospital of North Staffordshire, Stoke-on-Trent, ST4 7LN
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I am sure that we would all agree that addressing the gap between individuals awaiting transplants and the number of organ donors is of high priority in the UK. But there are significant differences between the UK infrastructure for organ donation compared to in the USA, where the majority of the studies looked at in this systematic review were performed. In the USA it is a legal requirement to have a protocol for identifying potential organ donors, and to have a procedure whereby trained personnel request organ donation when a patient meets the criteria for organ donation (death or brain death). Thus, the organ procurement organisation (OPO) determine donor suitability for organ or tissue donation, and the request for organ donation is made by the OPO staff in cooperation with hospital staff. This system is therefore well established, well recognised and well funded, as it is the law. One conclusion of the review is that the consent rates were higher when the request was made by the OPO/TC with hospital staff(1). In the UK, there has been a definite move towards this by having 'in-house' transplant co-ordinators, who have the expertise in gaining consent, embedded in ICUs to try to improve consent rates. However, most requests for organ donation are still performed by time poor hospital staff with little formal training in this area. Until this can be addressed on a national scale, by increasing the training and support for hospital staff, it seems unlikely that there will be much impact on organ donation rates. 1.Simpkin A, Robertson L, Barber V, Young J. Modifiable factors influencing relatives' decision to offer organ donation: systematic review BMJ 2009;339:b991 Competing interests: None declared |
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Sue R Roff, Senior Research Fellow Centre for Medical Education, Dundee Medical School DD21LR
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If there was a responsible, comprehensive public education programme about the nature of brain stem death, we could all make up our minds before faced with the challenging decisions that are required for organ donation for ourselves and our loved ones. We should look at the acceptance of DNR as a guide to the public's ability to understand and accept the implications, which are complex - for the potential donor and his or her carers and loved ones. Competing interests: None declared |
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