Developing a Living Donor Ethics Framework

2021 ◽  
pp. 53-80
Author(s):  
Lainie Friedman ◽  
J. Richard Thistlethwaite, Jr
Keyword(s):  
Living Donor ◽  
Human Subjects ◽  
Ethical Framework ◽  
Vulnerable Groups ◽  
Belmont Report ◽  
Ethics Framework ◽  
Special Obligations ◽  
Starting Point ◽  
Living Donor Transplantation ◽  
Special Relationships

This chapter advances an ethical framework for living donor transplantation. Given the analogies between living donor transplantation and human subjects research, the three principles enumerated in the National Commission’s Belmont Report are adopted as the starting point: respect for persons, beneficence, and justice. Two additional principles are also adopted: the principle of vulnerability and the principle that special relationships create special obligations. Whereas the Belmont Report discussed vulnerable groups, vulnerability is more aptly understood as an assortment of vulnerabilities that may apply to different people in different circumstances at different times of their lives. Eight distinct but overlapping vulnerabilities are described: capacitational, juridic, deferential, social, medical, situational, allocational, and infrastructural. The living donor advocate team (LDAT) stands in special relationship with the potential living donor and supports living organ donation provided that the living donor successfully addresses the challenges to autonomy and voluntariness that these vulnerabilities pose.

Developing an ethics framework for living donor transplantation

2018 ◽  
Vol 44 (12) ◽  
pp. 843-850 ◽  
Author(s):  
Lainie F Ross ◽  
J Richard Thistlethwaite
Keyword(s):  
Living Donor ◽  
Human Subjects ◽  
Well Being ◽  
Vulnerable Groups ◽  
Belmont Report ◽  
National Commission ◽  
Research Participants ◽  
Ethics Framework ◽  
Living Donor Transplantation ◽  
Clinical Benefits

Both living donor transplantation and human subjects research expose one set of individuals to clinical risks for the clinical benefits of others. In the Belmont Report, the National Commission for the Protection of Human Subjects of Biomedical and Behavior Research (National Commission) articulated three principles to serve as the basis for a research ethics framework: respect for persons, beneficence and justice. In contrast, living donor transplantation lacks a framework. In this manuscript, we adapt the three principles articulated in the Belmont Report to serve as the foundation for an ethics framework for living donor transplantation which we supplement with the principles of vulnerability and responsibility. The National Commission supported additional protections for vulnerable groups of potential research participants. In 2001, Kenneth Kipnis effectively argued that the concept of vulnerable groups failed to explore in what ways particular groups of people were vulnerable, thereby risking unnecessary protections for some and inadequate protections for others. He proposed a taxonomy that explored different types of vulnerabilities that all research participants may experience to provide a more robust framework for human subjects protections, which we adapt to living donors. Robert Goodin claims that health professionals, who stand in special relationship with patients, are responsible for promoting and protecting their well-being. In living donor transplantation, the donor transplant team is responsible for empowering prospective donors to address their vulnerabilities and/or for protecting those who cannot by disqualifying them from donation.

Vulnerability in Health Care: A Concept Analysis

2019 ◽  
Vol 25 (4) ◽  
pp. 284-291
Author(s):  
Erika Gathron
Keyword(s):  
Health Care ◽  
Health Disparities ◽  
Minority Groups ◽  
Code Of Ethics ◽  
Human Subjects ◽  
Research Participation ◽  
Vulnerable Groups ◽  
Belmont Report ◽  
National Commission ◽  
Human Research Ethics

This article introduces the concept of vulnerability in health care and explores the extant literature to determine its tenets. The debate over what constitutes ethical research is centered in part on the concept of vulnerability. The Belmont Report (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1978), the first human research ethics guideline to identify vulnerable groups, specified that those identified as vulnerable need extra protections during research participation. Identified limitations of the Belmont Report, especially with regard to racial minorities, led to the Heckler Report (Heckler, M. M., & U. S. Department of Health and Human Services, 1985), which laid the foundation for actionable steps to eliminate health disparities among racial and ethnic minority groups. The American Nurses Association's Code of Ethics for Nurses with Interpretive Statements (American Nurses Association, 2015), requires nurses to promote, advocate, and strive to protect the health, safety, and rights of all individuals and groups. A conceptual understanding of vulnerability allows nurses and researchers to advocate for and better serve individuals and groups deemed vulnerable. Nurse advocacy is paramount in reducing health disparities and improving health outcomes among vulnerable groups.

The Living Organ Donor as Patient

2021 ◽  
Author(s):  
Lainie Friedman Ross ◽  
J. Richard Thistlethwaite, Jr.
Keyword(s):  
Organ Donation ◽  
Organ Transplantation ◽  
Living Donor ◽  
Organ Procurement ◽  
Well Being ◽  
Living Donors ◽  
Solid Organ ◽  
Organ Donors ◽  
Ethics Framework ◽  
Special Obligations

This is a book about living solid organ donors as patients in their own right. This book is premised on the supposition that the field of living donor organ transplantation is ethical, even if some specific applications are not, eg, pre-mortem organ procurement of an imminently dying patient. When Joseph Murray performed the first successful living kidney donor transplant in 1954, he thought this would be a temporary stopgap. Today, however, the goal of adequate organ supply without living donors remains elusive. If anything, the supply:demand ratio is worse. In this book, a five-principle living donor ethics framework is developed and used to examine the ethical issues raised by living donor selection demographics, innovative attempts to increase living organ donation, and living donor decision-making and risk thresholds. This ethics framework uses the three principles of the Belmont Report modified to organ transplantation (respect for persons, beneficence, and justice) supplemented by the principles of vulnerability and of special relationships creating special obligations. The approach requires that the transplant community fully embraces living organ donors (and prospective living organ donors) as patients to whom special obligations are owed. Only when living organ donors are regarded as patients in their own right and have a living donor advocate team dedicated to their well-being can the moral boundaries of living solid organ donation be determined and realized. This book provides theoretical arguments and practice guidelines, complemented by case studies, to ensure that living donors are given the full respect and care they deserve.

Adult-to-Adult Living-Donor Liver Transplantation

Swiss Surgery ◽  
2003 ◽  
Vol 9 (5) ◽  
pp. 227-236 ◽  
Author(s):  
Majno ◽  
Mentha ◽  
Berney ◽  
Bühler ◽  
Giostra ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Therapeutic Option ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Multidisciplinary Program ◽  
First Case ◽  
Living Donor Transplantation ◽  
The Right

Living donor liver transplantation is a relatively new procedure in which the right side of the liver is harvested in a healthy donor and transplanted into a recipient. After the first case in 1994, over 3000 cases have been done worldwide. This review summarizes the reasons why the procedure is needed, describes its main technical aspects, highlights the boundaries in which it can be done safely, summarizes the current experience worldwide and describes the main points of the program in our unit. We argue that living-donor transplantation is a viable alternative to a long time on the waiting list for several patients, and it can be performed safely and successfully provided that all precautions are undertaken to minimize the risks in the donor and to increase the chances of a good outcome in the recipients. If these prerequisites are met, and within the framework of a structured multidisciplinary program, we believe that living-donor liver transplantation should be funded by health insurances as a recognized therapeutic option.

scholarly journals Improved zinc and iron absorption from breakfast meals containing malted oats with reduced phytate content

1996 ◽  
Vol 76 (5) ◽  
pp. 677-688 ◽  
Author(s):  
Marie Larsson ◽  
Lena Rossander-Hulthén ◽  
Brittmarie Sandström ◽  
Ann-Sofie Sandberg
Keyword(s):  
Iron Absorption ◽  
Human Subjects ◽  
Vulnerable Groups ◽  
Whole Body ◽  
Absolute Amount ◽  
Average Increase ◽  
Mineral Deficiency ◽  
Breakfast Meal ◽  
Body Retention ◽  
Phytate Content

The absorption of Zn or Fe from breakfast meals containing oat porridge prepared from malted and soaked oats and a control porridge made from untreated oats was measured in human subjects. The effect on Zn and Fe absorption of reducing the phytate content of oat-porridge meals was examined in each subject by extrinsic labelling of porridge with 65Zn and of bread rolls with 55Fe and 59Fe, and measuring whole-body retention and the erythrocyte uptake of isotopes. Each experiment comprised nine to ten subjects. The absorption of Zn from malted-oat porridge with a phytate (inositol hexaphosphate) content of 107 μmol was 18·3%, and significantly higher (P < 0·05) than from the control porridge containing 432 μmol phytate (11·8%). Fe absorption from the meal containing malted-oat porridge with 107 μmol phytate (Expt 2) was also significantly improved (P < 0·05) compared with that from the meal containing control porridge with 437 μmol phytate. The average increase in Fe absorption was 47%, or from 4·4 to 6·0%. In the breakfast meal containing malted porridge with 198 μmol phytate (Expt 3) the increase in Fe absorption was not significantly improved. Even though the phytate content was reduced to a greater extent in Expt 3 than Expt 2, the average increase in Fe absorption in Expt 3 was only 25% more than that from the meal containing control porridge (with 599 μmol phytate), depending on the higher absolute amount of phytate. In conclusion, an improvement in Zn and Fe absorption from oat products can be achieved by practising malting and soaking in the processing of oats. This may be of importance in the prevention of mineral deficiency in vulnerable groups.

scholarly journals Intersectoral approaches and integrated services in achieving the right to health for refugees upon resettlement: a scoping review protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016638 ◽  
Author(s):  
Dena Javadi ◽  
Etienne V Langlois ◽  
Shirley Ho ◽  
Peter Friberg ◽  
Göran Tomson
Keyword(s):  
Scoping Review ◽  
Human Subjects ◽  
Grey Literature ◽  
Open Science ◽  
Right To Health ◽  
Refugee Health ◽  
International Standards ◽  
Vulnerable Groups ◽  
Physical And Mental Health ◽  
The Right

IntroductionGlobal insecurity and climate change are exacerbating the need for improved management of refugee resettlement services. International standards hold states responsible for the protection of the right of non-citizens to an adequate standard of physical and mental health while recognising the importance of social determinants of health. However, programmes to protect refugees’ right to health often lack coordination and monitoring. This paper describes the protocol for a scoping review to explore barriers and facilitators to the integration of health services for refugees; the content, process and actors involved in protecting refugee health; and the extent to which intersectoral approaches are leveraged to protect refugees’ right to health on resettlement, especially for vulnerable groups such as women and children.Methods and analysisPeer-reviewed (through four databases including MEDLINE, Web of Science, Global Health and PsycINFO) and grey literature were searched to identify programmes and interventions designed to promote refugee health in receiving countries. Two reviewers will screen articles and abstract data. Two frameworks for integration and intersectoral action will be applied to understand how and why certain approaches work while others do not and to identify the actors involved in achieving success at different levels of integration as defined by these frameworks.Ethics and disseminationFindings from the scoping review will be shared in relevant conferences and meetings. A brief will be created with lessons learnt from successful programmes to inform decision making in design of refugee programmes and services. Ethical approval is not required as human subjects are not involved.Trial registration numberRegistered on Open Science Framework athttps://osf.io/gt9ck/.

scholarly journals Targeting and tailoring an intervention for adolescents who are overweight

2014 ◽  
Vol 22 (2) ◽  
pp. 237-247 ◽  
Author(s):  
Kirsti Riiser ◽  
Knut Løndal ◽  
Yngvar Ommundsen ◽  
Nina Misvær ◽  
Sølvi Helseth
Keyword(s):  
Health Behavior ◽  
Ethical Issues ◽  
Public Health Intervention ◽  
Well Being ◽  
Health Behavior Change ◽  
Overweight And Obesity ◽  
Ethical Framework ◽  
Vulnerable Groups ◽  
Attribution Of Responsibility ◽  
Ethical Aspects

There are important ethical issues to be examined before launching any public health intervention, particularly when targeting vulnerable groups. The aim of this article is to identify and discuss ethical concerns that may arise when intervening for health behavior change among adolescents identified as overweight. These concerns originate from an intervention designed to capacitate adolescents to increase self-determined physical activity. Utilizing an ethical framework for prevention of overweight and obesity, we identified three ethical aspects as particularly significant: the attribution of responsibility for health behavior, liberty to choose, and the effect on the participants’ psychosocial well-being. It is discussed whether and how measures can be taken to deal with these aspects. It seems evident that the ethical aspects are mainly concerned with the vulnerability of adolescents identified as overweight. However, we claim that when individual feedback and counseling is provided, tailored interventions have a unique potential to empower adolescents to make ethically anchored decisions about their own health behavior.

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