Diminished autonomy and justice in liver transplantation – The price of scarcity?

2021 ◽  
pp. 147775092110162
Author(s):  
Philip Berry ◽  
Sreelakshmi Kotha
Keyword(s):  
Patient Autonomy ◽  
Patient Involvement ◽  
Organ Allocation ◽  
Self Determination ◽  
Wait List ◽  
Medical Assessment ◽  
Patient Factors ◽  
Future Directions ◽  
Allocation Criteria ◽  
Qualitative Nature

Patient autonomy and distributive justice are fundamental ethical principles that may be at risk in liver transplant units where decisions are dictated by the need to maximise the utility of scarce donor organs. The processes of patient selection, organ allocation and prioritisation on the wait list have evolved in a constrained environment, leading to high levels of complexity and low transparency. Regarding paternalism, opaque listing and allocation criteria, patient factors such as passivity, guilt, chronic illness and sub-clinical encephalopathy are cited as factors that may inhibit patient engagement. Regarding justice, established regional, gender and race based inequities are described. The paradox whereby hepatologists both advocate for individual patients and discharge their duty of stewardship to apportion organs according to larger utilitarian principles is explored. Competing subjective factors such as physicians’ perception of moral responsibility, the qualitative nature of expert medical assessment and institutional or personal loyalty to re-transplantation candidates are described. Realistic limits of self-determination and justice are discussed, and possible future directions in terms of patient involvement proposed.

Abstract 13468: Effect of Listing Criteria on Transplant Rate and Early Outcomes in Adults With Congenital Heart Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Wagih m Zayed ◽  
Neha Bansal ◽  
Snehal R Patel ◽  
Jacqueline M Lamour ◽  
Daniel J GOLDSTEIN ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Primary Diagnosis ◽  
Organ Allocation ◽  
Transplant Recipients ◽  
Allocation Policy ◽  
Kaplan Meier ◽  
Allocation Criteria ◽  
History Of

Introduction: Heart failure (HF) is the leading cause of death in adults with congenital heart disease (ACHD). Heart transplant (HT) is one of the few options for the treatment of advanced HF in this growing population. In October 2018, the United Network for Organ Sharing (UNOS) implemented a change in organ allocation criteria. The effect of this change on outcomes in ACHD patients (pts) after listing and transplant has not been evaluated. Hypothesis: Change in organ allocation criteria negatively impacts outcomes in ACHD patients. Methods: Data from the Scientific Registry of Transplant Recipients in pts age > 18 years old listed for HT between Oct. 2016 and 0ct. 2019 and followed through March 2020 were analyzed. Pts were grouped by diagnosis (ACHD and non-ACHD) and by the time of listing (pre- and post-change in allocation criteria). Differences in comorbidities, outcomes while listed, and 1-year Kaplan Meier survival post-HT were compared among groups. For comparison, post-change criteria (status 1-6) were equated to pre-change criteria (status 1A, 1B, 2). Results: Over 3 years, 11,931 patients were listed for HT; 459 had a primary diagnosis of ACHD. ACHD was present in 279/7942 pts listed in the 2 years pre-change and 180/3989 pts in the year post-change. ACHD pts listed post-change were less likely to have a history of cardiac surgery (88% vs. 79%, p=0.01) and more likely to have an abnormal BMI (p=0.015) than ACHD pts pre-change. Post-change, ACHD pts were listed at a higher priority status compared to pre-change ACHD. (Figure). The proportion of pts transplanted with ACHD increased slightly pre- and post-change (3.7% vs. 4.1%). There was no difference in 1-year survival in ACHD pts transplanted pre- and post-change (Figure). Conclusions: Recent changes to the UNOS organ allocation policy increased the proportion of ACHD patients transplanted with no change in early post-HT survival.

Patient autonomy and participation in end-of-life decision-making: An interpretive-systemic focus group study on perspectives of Asian healthcare professionals

2019 ◽  
Vol 18 (4) ◽  
pp. 425-430 ◽  
Author(s):  
Oindrila Dutta ◽  
Priya Lall ◽  
Paul Victor Patinadan ◽  
Josip Car ◽  
Chan Kee Low ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Patient Autonomy ◽  
Healthcare Professionals ◽  
Program Effectiveness ◽  
Self Determination ◽  
Truth Telling ◽  
Focus Group Study ◽  
Eol Care ◽  
Care Decision

AbstractObjectivesAsia's first national advance care planning (ACP) program was established in Singapore in 2011 to enhance patient autonomy and self-determination in end-of-life (EoL) care decision-making. However, no known study has examined the extent to which ACP in Singapore successfully met its aims. The purpose of the current study was to examine the attitudes of local healthcare professionals on patients’ autonomy in decision-making at the EoL since they strongly influence the extent to which patient and family wishes are fulfilled.MethodsGuided by the Interpretive-Systemic Framework and Proctor's conceptual taxonomy of implementation research outcomes, an interview guide was developed. Inquiries focused on healthcare professionals’ attitudes towards ACP, their clinical experiences working with patients and families, and their views on program effectiveness. Sixty-three physicians, nurses, medical social workers, and designated ACP coordinators who were actively engaged in ACP facilitation were recruited from seven major hospitals and specialist centers in Singapore through purposive sampling. Twelve interpretive-systemic focus groups were conducted, recorded, transcribed, and analyzed using a thematic analysis.ResultsThe extent to which patients in Singapore can exert autonomy in EoL care decision-making is influenced by five themes: (i) collusion over truth-telling to patient, (ii) deferment of autonomy by patients, (iii) negotiating patient self-determination, (iv) relational autonomy as the gold standard and (v) barriers to realization of patient choices.Significance of resultsHealthcare practitioners in Asian communities must align themselves with the values and needs of patients and their family and jointly make decisions that are consistent and congruent with the values of patients and their families. Sensitivity towards such cross-cultural practices is key to enhancing ACP awareness, discourse, and acceptability in Asian communities.

Replacing warfarin for better or worse: identifying patient factors and future directions

2013 ◽  
Vol 199 (3) ◽  
pp. 156-158 ◽  
Author(s):  
Basia O Diug ◽  
Judy A Lowthian ◽  
Michael Dooley
Keyword(s):  
Patient Factors ◽  
Future Directions

Learning in Physical Education: A Self-Determination Theory Perspective

2017 ◽  
Vol 36 (3) ◽  
pp. 277-291 ◽  
Author(s):  
Haichun Sun ◽  
Weidong Li ◽  
Bo Shen
Keyword(s):  
Physical Education ◽  
Affective Learning ◽  
Self Determination Theory ◽  
Need Satisfaction ◽  
The Self ◽  
Self Determination ◽  
Future Directions ◽  
Learning Domains ◽  
Motivational Profiles ◽  
The Impact

The purpose of this study was to review the literature relevant to learning in physical education (PE) according to the self-determination theory (SDT). In this literature review, we first provide an overview of SDT. Second, we discuss students’ SDT-related motivational profiles in PE. Third, we illustrate the relationships among students’ perceptions of the nature of an autonomy-supportive or controlling learning environment, need satisfaction, and self-determined motivation. Fourth, we explore the impact of SDT on students’ learning in PE with respect to the cognitive, psychomotor, and affective learning domains. Finally, we articulate the pedagogical implications on the basis of the reviewed SDT research and future directions for SDT research in PE.

The Patient Self-Determination Act: A Legal Solution for a Moral Dilemma

1992 ◽  
Vol 1 (1) ◽  
pp. 75-79 ◽  
Author(s):  
Jos V. M. Welie
Keyword(s):  
Decision Making ◽  
Advance Directive ◽  
Patient Autonomy ◽  
Moral Dilemma ◽  
Work Load ◽  
Professional Autonomy ◽  
Self Determination ◽  
The Law ◽  
Patient Self Determination Act

The Patient Self-Determination Act is a fact. Finally, respect for patient autonomy has been guaranteed. At first sight, there seems little reason to object to any measure that intends to increase the autonomy of the patient. Too long, one may argue, physicians have behaved paternalistically; too often, they have been advised to change this habit. If the profession of medicine is unwilling or simply unable to grant the patient the decision-making power that is her due, the law has to step in. One may add, this law in no way hinders professional autonomy; by requiring a hospital official to provide the patient with information about advance directive, the law actually reduces the work load of the physician, who is already overburdened.

The Organ Transplantation Act and Recent Trends in Korea

2013 ◽  
Vol 25 (2) ◽  
pp. 209-213 ◽  
Author(s):  
Ho No Joo
Keyword(s):  
Organ Donation ◽  
Organ Transplantation ◽  
Organ Allocation ◽  
Incentive System ◽  
Ethical Problems ◽  
Transplantation Act ◽  
Allocation Criteria ◽  
Recent Trends ◽  
Brain Dead

The Organ Transplantation Act, including transplantation of organs from brain-dead donors, entered into force in Korea on February 9, 2000. This article introduces the Organ Transplantation Act, focusing on scope of the Act, determination of brain death, removal of organs from brain-dead or deceased donors, removal from living donors, organ allocation, and prohibition of trade in human organs. Especially, some primary ethical dilemmas surrounding organ allocation arise from the shortage of available organs. The primary ethical problems surrounding organ allocation are as follows. A key purpose of the organ donation incentive system is to increase the number of organ transplants from brain-dead donors. In particular, the priority for kidney patient was allowed in consideration of doctor’s strong desire to increase the brain-dead donors. Also, the organ allocation criteria based on the organ donation incentive system appear unfair, especially for the kidney patient, because the criteria do not fit the principles of distributive justice. In the future, the organ donation incentive system itself may need to be reexamined.

scholarly journals The Development of Quality Assurance Mechanism and Accreditation of Open and Distance Education in Pakistan

2018 ◽  
pp. 36-55
Author(s):  
Waqar Un Nisa Faizi Et al.,
Keyword(s):  
Educational Quality ◽  
Quality Education ◽  
Self Determination ◽  
Quality Enhancement ◽  
Knowledge Quality ◽  
Education Commission ◽  
Quality Assurance Mechanism ◽  
Effective System ◽  
Qualitative Nature ◽  
High Level

The research was conducted with the intent to analyze authorization and quality development procedure for the open Distant Education system that is adopted in Pakistan. The Higher Education Commission in Pakistan has implemented various strategies for assuring a high level of quality education is provided. One of the efforts includes reorganizing the infrastructure of the educational institutes for its proficient implementation. The research method adopted in it is of qualitative nature which constitutes of analyzing various literature and evaluating the responses of questions gathered from the 21 Heads of Department. The responses were also generated from the four public universities in which the randomly selected answers were of forty students. The responses were studied to evaluate their perception, prospection, and the difficulties they perceive are associated with the methods and services adopted for improving educational quality in Pakistan. The study suggests that the quality enhancement follows an outline which is based on the fundamentals of making students nurture on the international viewpoint, educational quality standards and ownership standards, self-determination and relations, improving the student's knowledge quality and integrating all the parties associated for the formation of an effective system.

scholarly journals Moving Beyond Initiative: The Reconceptualization and Measurement of Unethical Pro-organizational Behavior

2021 ◽  
Vol 12 ◽  
Author(s):  
Jing Wang ◽  
Wei Shi ◽  
Guoqin Liu ◽  
Li Zhou
Keyword(s):  
Organizational Behavior ◽  
Social Exchange ◽  
Self Determination Theory ◽  
Self Determination ◽  
Measurement Tool ◽  
Future Directions ◽  
Academic Field ◽  
The Past ◽  
Original Meaning ◽  
Voluntary Behavior

Despite the fact that unethical pro-organizational behavior (UPB) has become a theoretical topic in the academic field and the fruitful achievements have been explored in the past decade, organizational researches have largely assumed that UPB is an active and voluntary behavior from the perspective of organizational identity and social exchange. In this paper, the authors argue that previous researches have traditionally considered only a very narrow subset of UPB, focusing almost exclusively on extreme voluntary cases which are not reflective of typical UPB. Instead of being primarily voluntary, some typical UPB can be compulsory in nature. We suggest a different look at UPB by contrasting to the so-called “voluntary” activities via compulsory mechanisms in the workplace. Mostly, we are interested in exploring and validating a measurement tool for this behavior. Based on self-determination theory, we argue that such behaviors are a substantial deviation from the original meaning of UPB and thus should be recognized and studied separately. Using six samples, the authors demonstrate the construct validity, reliability, and acceptable psychometric properties of the compulsory UPB scales. Future directions in UPB research are discussed.

Sign in / Sign up

Export Citation Format

Share Document