scholarly journals Using Mentally Incompetent Adults as Living Organ Donors: Widely Diverging Regulations in Europe

2012 ◽  
Vol 19 (5) ◽  
pp. 441-466 ◽  
Author(s):  
Kristof Van Assche ◽  
Gilles Genicot ◽  
Sigrid Sterckx

Abstract With the current situation in Belgium as its initial focus, this article will examine the regulatory framework that governs the use of mentally incompetent adults as living organ donors in Europe. Our survey of the national regulation of 22 countries will reveal widely diverging viewpoints, ranging from an absolute prohibition on organ procurement to a barely restricted authorisation to retrieve even non-regenerable organs. We also have a look at the way in which American and English court decisions have applied the best interests standard in an attempt to define the contours of acceptable organ removal from mentally incompetent donors. Taking the best interests of the mentally incompetent person as a yardstick, we suggest that legally prohibiting organ removal from mentally incompetents may be problematic, even if it concerns only non-regenerable organs, and that regulations should be refined accordingly.

Author(s):  
Jessica Berg ◽  
Emma Cave

This chapter discusses patient autonomy, capacity, and consent involving children. It first provides a general overview of children’s rights with respect to making medical decisions in both the United States and Europe. The chapter then discusses the best interests standard (which is usually applied in cases of minors) and how to consider capacity in the context of children. In the discussions of European approaches, the chapter covers relevant international and regional human rights law. The jurisdiction of England and Wales are used as examples. The chapter also provides a general overview of US state approaches and federal law. The chapter concludes by noting some new areas of medical decision-making which challenge the traditional models.


2020 ◽  
Vol 28 (3) ◽  
pp. 613-631
Author(s):  
John Eekelaar

Abstract While Article 5 of the UN Convention on the Rights of the Child requires states to respect parents’ responsibilities to provide ‘appropriate’ direction and guidance to their children, Article 18 also proclaims that ‘the best interests of the child will be [the parents’] basic concern’. But how can this be done if, as is widely accepted, the “best interests” standard is too indeterminate safely to allow courts to substitute their assessment of children’s interests for those of a child’s parents? This reason for privatising such decisions has been reinforced by concerns over the extent of public expenditure on court involvement in and legal aid for such issues, with the possible result of withdrawal of the law from this process. This article argues that there are inherent risks in leaving the arrangements for children of separating parents entirely in the hands of the parents, and considers various ways in which such risks might be reduced.


1973 ◽  
Vol 43 (4) ◽  
pp. 487-514 ◽  
Author(s):  
Hillary Rodham

The author examines the changing status of children under the law. Traditionally,the law has reflected a social consensus that children's best interests are synonymous with those of their parents, except under the few circumstances where the state is authorized to intervene in family life under the. doctrine of parens patriae. Little consideration has been given to the substantive and procedural rights of children as a discrete interest group. At present, law reform is moving to change children's legal status in two ways: by extending more adult rights to children and by recognizing certain unique needs and interests of children as legally enforceable rights. Ms. Rodham summarizes recent Supreme Court decisions which will influence changes of both kinds, and suggests specific directions reform might take.


Author(s):  
Kelser De Souza Kock ◽  
Mariana Gabriela Santana ◽  
Silvia Catarine Da Silva ◽  
Samuel Brida Andrade ◽  
Edvan Nunes dos Santos

Objetivo: Analisar o perfil epidemiológico e as disfunções orgânicas e eletrolíticas em potenciais doadores de órgãos. Métodos: Estudo transversal, descritivo. Foram selecionados pacientes com morte encefálica, na Unidade de Terapia Intensiva de um hospital do sul do estado de Santa Catarina, no período de 2014 a 2016. Resultados: Foram avaliados 64 indivíduos, com prevalência do sexo masculino (56,3%), com mediana de 51,5 anos de idade. O Acidente Vascular Cerebral mostrou-se como a principal causa de diagnóstico de morte encefálica, em 42% dos casos. Houve doação em 45% dos pacientes, totalizando 120 órgãos ou tecidos doados, destacando-se o globo ocular, os rins e o fígado. Nos exames laboratoriais os pacientes apresentaram uma mediana de 147,0 mmol/L para o sódio, 4,2 mmol/L para o potássio e 246,0 mg/dL para a glicose. O escore de SOFA apresentou mediana geral 6, com maiores valores nos SOFA cardiovascular e respiratório (p<0,001) em relação aos SOFA renal, hematológico e hepático. Conclusão: O perfil epidemiológico dos potenciais doadores é similar a outros estudos. Quanto às disfunções orgânicas eletrolíticas e metabólicas, foram evidenciados distúrbios de hipernatremia e hiperglicemia. As disfunções orgânicas significativas identificadas pelo SOFA foram nos sistemas cardiovascular e respiratório. Neste sentido, especial atenção deve ser dada a estes sistemas para adequada manutenção do potencial doador.Descritores: Morte encefálica, Obtenção de tecidos e órgãos, Eletrólitos, Escores de disfunção orgânicaABSTRACT:Objective: To analyze the epidemiological profile and the organ and electrolytics dysfunctions in potential organ donors. Methods: Cross-sectional, descriptive study. We selected patients with brain death at the Intensive Care Unit of a hospital in the southern state of Santa Catarina, from 2014 to 2016. Results: We evaluated sixty-six individuals, with a prevalence of males (56.3%), with a median age of 51.5 years. The Cerebral Vascular Accident was the main cause of brain death’s diagnosis (42%). There was donation in 45% of the patients, totaling 120 organs and tissue donated, standing out the eyeball, kidneys and liver. In the laboratory tests the patients had a median of 147.0 mmol / L for sodium, 4.2 mmol / L for potassium and 246.0 mg / dL for glucose. The SOFA score presented general median 6, with higher values in cardiovascular and respiratory SOFA (p <0.001) in relation to renal, hematological and hepatic SOFA. Conclusion: The epidemiological profile of potential donors is similar to other studies. As for the organic and metabolic dysfunctions, disorders of hypernatremia and hyperglycemia were evidenced. The significant organic dysfunctions identified by SOFA were in the cardiovascular and respiratory systems. In this sense, special attention should be given to these systems for adequate maintenance of the potential donor.Keywords: Brain death, Tissue and organ procurement, Electrolytes, Organ dysfunction scores


CHEST Journal ◽  
2010 ◽  
Vol 138 (4) ◽  
pp. 1021-1022 ◽  
Author(s):  
Mohamed Y. Rady ◽  
Joseph L. Verheijde

BMJ ◽  
2008 ◽  
Vol 336 (7657) ◽  
pp. 1346-1347 ◽  
Author(s):  
John Coggon ◽  
Margaret Brazier ◽  
Paul Murphy ◽  
David Price ◽  
Muireann Quigley
Keyword(s):  

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