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Living Donor Organ Transplantation
... (Bailey, 2001) "(…) selling an organ does not necessarily have to mean a commodification of the donor's body which leads to a depersonalized view of human beings and an offence against their dignity, because the question of self-degradation depends on whether the person who sells an organ evaluates his/her action as self-degradation or not." (Guttman & Land, 1999) O excesso de demanda de órgãos para transplantes é resolvida com incentivos de mercado ou com mais regulamentação governamental? E como desenvolvimentos biotecnológicos, como a possibilidade de transplantes interespécies (xenotransplantes) e/ou a utilização de órgãos artificiais influencia a resposta dessa pergunta? ...
Objetivo: A obtenção do número adequado de órgãos cadavéricos para transplantes é um item de política pública importante. Modelos econômicos tradicionais supõem que a solução pode ser obtida por incentivos financeiros. Críticos dessa abordagem insistem que o mercado não resolve o problema, mas a intervenção estatal sim. Métodos: Este artigo apresenta o modelo do homo economicus maturus de Frey (1997), cujo principal mérito é mostrar que ambas as críticas estão incorretamente colocadas, pois indivíduos respondem não apenas a incentivos monetários de forma positiva, como demonstram os modelos tradicionais, mas também podem apresentar reações psicológicas adversas. Esse modelo é aplicado ao dilema da doação de órgãos com a inclusão do fator tecnológico, por meio da substituição de órgãos humanos por órgãos não humanos (xenotransplantes). Resultados: O principal resultado do artigo é mostrar como um avanço tecnológico pode melhorar o bem-estar sem alterar o dilema moral dos indivíduos. Conclusões: A extensão do modelo econômico tradicional permite uma análise com novas possibilidades acerca de mudanças tecnológicas e dos dilemas morais que elas podem trazer.
... As T. M. Wilkinson observes, " It is sometimes thought that living donor transplantation involves a clash between the duty not to harm and the duty to respect autonomy. This is somewhat misleading, however, because of plausible developments of the underlying principles, doing no harm need not speak against live donation and respecting autonomy need not speak in its favour " [15]. In other words, the middle position need not be a compromise between avoiding harm and autonomy: the rule not to do harm does not automatically rule out living donor transplantation, nor does autonomy clearly justify it. ...
A sound evaluation of every bioethical problem should be predicated on a careful analysis of at least two basic elements: (i) reliable scientific information and (ii) the ethical principles and values at stake. A thorough evaluation of both elements also calls for a careful examination of statements by authoritative institutions.
Unfortunately, in the case of medically complex living donors neither element gives clear-cut answers to the ethical problems raised. Likewise, institutionary documents frequently offer only general criteria, which are not very helpful when making practical choices.
This paper first introduces a brief overview of scientific information, ethical values, and institutionary documents; the notions of “acceptable risk” and “minimal risk” are then briefly examined, with reference to the problem of medically complex living donors.
The so-called precautionary principle and the value of solidarity are then discussed as offering a possible approach to the ethical problem of medically complex living donors.
Social scientists have recently diverged from mainstream bioethical discussion on the topic of the medical use of human biological materials for therapeutic, reproductive and research purposes. Rather than justifying the donation and provision of biological materials solely in terms of alleviating physical, psychological and social suffering, saving or enhancing life, and advancing biomedical knowledge, this work looks beyond humanist bioethics to take a social justice approach to questions of the life sciences. In this article, I draw insight from these accounts to propose an approach to the sociology of live kidney and breastmilk donation that is situated at the interface of the new sociology of morality and affect studies. To do so, I examine the moral economy of tissue provision with respect to its organisation around the discourse of altruism and the gift. I then turn to recent work on tissue economies, which are in the business of creating and producing biovalue, to discuss the manipulation of affect and the entanglement of new forms of bio‐intimacy in the production and reproduction of somatic life. The aim of the article was to contribute to the study of the sociology of donation as a substantive field of specialisation within sociology.
In jurisdictions where the sale of body tissue and organs is illegal, organ transplantation is often spoken of as a gift of life. In the social sciences and bioethics this concept has been subject to critique over the course of the last two decades for failing to reflect the complexities of organ and tissue exchange. I suggest that a new ethical model of organ donation and transplantation is needed to capture the range of experiences in this domain. The proposed model is both analytical and empirically oriented, and draws on research findings linking a series of qualitative sociological studies undertaken in New Zealand between 2007 and 2013. The studies were based on document analysis, field notes and 127 semi-structured in-depth interviews with people from different cultural and constituent groups directly involved in organ transfer processes. The aim of the article is to contribute to sociological knowledge about organ exchange and to expand the conceptual toolkit of organ donation to include the unconditional gift, the gift relation, gift exchange, body project, and body work. The rationale for the proposed model is to provide an explanatory framework for organ donors and transplant recipients and to assist the development of ethical guidelines and health policy discourse.
© 2015 The Author. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.
Previously, recurrence of insulin-dependent diabetes mellitus after pancreas transplants was only sporadically reported. Newer data, however, indicate recurrence rates as high as 5%. After identical-twin pancreas transplants, diabetes recurs in the absence of immunosuppressive therapy - strong evidence that it is an autoimmune disease. After deceased donor pancreas transplants, immunologic markers (autoantibodies, autoreactive T cells) herald recurrence. Selective destruction of β cells, still relatively uncommon, is not restricted to MHC compatibility. The development of diabetes in living pancreas donors is rare; it can be largely avoided by meticulous metabolic evaluation before donation and prevention of obesity after donation.
The portal vein flow (PVF), portal vein pressure (PVP), and hepatic venous pressure gradient (HVPG) were prospectively assessed to explore their relationships and to better define hyperflow and portal hypertension (PHT) during liver transplantation (LT). Eighty-one LT procedures were analyzed. No correlation between PVF and PVP was observed. Increases in the central venous pressure (CVP) were transmitted to the PVP (58%, range = 25%-91%, P = 0.001). Severe PHT (HVPG ≥ 15 mm Hg) showed a significant reciprocal association with high PVF (P = 0.023) and lower graft survival (P = 0.04). According to this initial experience, an HVPG value ≥ 15 mm Hg is a promising tool for the evaluation of hemodynamic stress potentially influencing outcomes. An algorithm for graft inflow modulation based on flows, gradients, and systemic hemodynamics is provided. In conclusion, the evaluation of PHT severity with PVP could be delusive because of the influence of CVP. PVF and PVP do not correlate and should not be used individually to assess hyperflow and PHT during LT.
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