Der Mangel an Spenderorganen – Ursachen und Lösungsmöglichkeiten aus ökonomischer Sicht / The Shortage of Transplants – An Economic Analysis of Causes and Possible Solutions

2007 ◽  
Vol 227 (5-6) ◽  
Author(s):  
Friedrich Breyer ◽  
Hartmut Kliemt
Keyword(s):  
Intensive Care ◽  
Brain Death ◽  
Social Institutions ◽  
Organ Allocation ◽  
Organ Shortage ◽  
Organ Donors ◽  
Organ Transplants ◽  
Presumed Consent ◽  
Human Organ

SummaryThere is an increasing shortage of human organ transplants in Germany. This paper aims at understanding the reasons for that shortage and discusses various ways to alleviate it by changing the rules of donation and procurement. In particular we consider creating adequate incentives for hospitals and individual donors to participate in the process. In Section 2 we provide a stylized account of the nature and extent of organ shortage in Germany in terms of some key data. Then, in Section 3 we will turn to the incentives of hospitals and their employees, in particular those of intensive care units. When they intend to participate in the process of procuring cadaveric human organ transplants, they may face some rather severe obstacles. In Section 4 we turn to the role of potential organ donors and their families. We discuss different strategies to increase consent to a donation of organs after brain-death has been diagnosed. We particularly consider monetary and other incentives as well as the introduction of the presumedconsent rule. In Section 5 we conclude that organ shortage is due not to natural constraints but to inappropriate social institutions. Introducing a presumed consent rule, reciprocity in organ allocation, better payments for hospitals and for donors are proposed as potential remedies.

The Shortage of Human Organs: Causes, Consequences and Remedies

2007 ◽  
Vol 29 (2) ◽  
Author(s):  
Friedrich Breyer ◽  
Hartmut Kliemt
Keyword(s):  
Social Institutions ◽  
Organ Allocation ◽  
Organ Shortage ◽  
Organ Transplants ◽  
Presumed Consent ◽  
Human Organ ◽  
Human Organs ◽  
Donor Organs

AbstractThere is an ever increasing shortage of human organ transplants in Germany. This paper aims at understanding the reasons for that shortage better and then discusses various ways to overcome it. After estimating the potential supply of donor organs it is discussed why actual supply remains far below potential supply. Insufficient reimbursement for hospitals, a lack of incentives to donate, and mistaken donation rules are diagnosed to cause the shortage. Thus, organ shortage is due not to natural constraints but to inappropriate social institutions. Introducing a presumed consent rule, reciprocity in organ allocation, better payments for hospitals and for donors seem potential remedies.

scholarly journals Role of intensive care nurses on guiding patients’ families/relatives to organ donation

2019 ◽  
Vol 35 (4) ◽  
Author(s):  
Ahmet Karaman ◽  
Neriman Akyolcu
Keyword(s):  
Intensive Care ◽  
Brain Death ◽  
Organ Donation ◽  
Organ Transplant ◽  
University Hospitals ◽  
Intensive Care Nurses ◽  
Creative Commons ◽  
The Family ◽  
Using Data

Objective: The aim was to determine the role of intensive care nurses on guiding the families/relatives of brain-death patients to organ donation. Methods: This research is a descriptive study. While the population of the study consisted of 1710 nurses working in the intensive care units of public, private and university hospitals in the city of Istanbul, the sample consisted of 353 intensive care nurses selected with stratified random sampling method from the probability sampling methods from this population. The data were collected by using “Data Collection Form”. Results: It was determined that 74.5% of the intensive care nurses carefully listened the family/relatives of the patient with possible brain death or suffering from brain death and supported them to express their emotion and thoughts clearly; when the family/relatives of the patients hospitalised in the intensive care unit wanted to get information about organ donation, 20.7% of the nurses made the preliminary explanation themselves and then guided the patient to an organ transplant coordinator for detailed information and 3.1% of the nurses generally gave this information themselves. Conclusions: It was determined that the knowledge of the intensive care nurses about brain death and organ donation was partially adequate and the function of guiding the families/relatives of brain-death patients to organ donation was mostly done by the physician. doi: https://doi.org/10.12669/pjms.35.4.1285 How to cite this:Karaman A, Akyolcu N. Role of intensive care nurses on guiding patients’ families/relatives to organ donation. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.1285 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals P1841THE JOURNEY OF KIDNEY TRANSPLANTATION IN EGYPT: STILL EXTRA-MILES TO GO

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mohamed Elrggal ◽  
Mohamed Gendia ◽  
Rowan Saad Zyada ◽  
Ali Moustafa Shendi Mohamed
Keyword(s):  
Kidney Transplantation ◽  
Organ Transplantation ◽  
Organ Transplant ◽  
Legal Framework ◽  
Organ Shortage ◽  
Organ Transplants ◽  
Organ Trafficking ◽  
Human Organ ◽  
Transplant Tourism ◽  
Transplant Program

Abstract Background and Aims Kidney transplantation is the renal replacement therapy of choice for patients with end-stage kidney disease. Egypt is a developing country with social, religious and demographic characteristics having enormous impact on the development and progress of its own national transplant program. Method A web-based review of relevant bibliography: articles and textbooks, reporting the progress in the transplant practice in Egypt and its legislations was conducted. Results Kidney transplantation started in Egypt about 43 years ago when the first transplant was performed at Mansoura Urology and Nephrology Center (UNC) in March 1976. The practice of kidney transplantation in Egypt has then evolved over the years. While about ten thousand transplants were performed from 1976 to 2011, the annual mean number of kidney transplantation between 2011 and 2016 increased to 1100 cases/year. The number of transplant centers has also grown from 12 in 1997 to 35 currently licensed centers. However, Egypt is still lacking a national transplant registry data. The legal framework developed over the last decade towards establishing a national transplant program. Until 2010, organ transplantation was only regulated by the professional code of ethics and conduct of the Egyptian Medical Syndicate. Representatives of the Istanbul Declaration met with the Egyptian Minister of Health and Egyptian Society of Nephrology leaders in Cairo in October 2008; since then, Egypt has been working to terminate illegal practices associated with organ transplantation, organ trafficking and transplant tourism. The first legislation for a national organ transplant program “The executive list for law number 5 of the year 2010 regarding regulating human organ transplants” was then issued after approval by the parliament. The law established “The Higher Committee for Organ Transplants” which includes 7 - 11 experts and is responsible for regulating and supervising all organ and tissue transplant procedures in the country. The new law criminalizes organ trafficking and set strict penalties for physicians, hospitals and medical facilities performing illegal organ transplant procedures. In 2017, the legislation has been further modified to make the penalties even harsher “Law number 142 of the year 2017 modification of some articles in law number 5 of the year 2010 regarding regulating human organ transplants”. Transplantation practice is still limited to live transplants. The cadaveric transplant program has not yet been put into action despite the new 2010 legislation has set the legal framework, yet lacking a clear definition of the legal death. Cadaveric transplantation was performed twice in Egypt in 1992 at Cairo (kasr El Aini hospital) from 2 criminals after execution in Alexandria. This was faced with social anger and rejection which led to legal restrictions for non-living organ procurement at that time. Barriers to establishment of a national transplant program in Egypt include cultural and religious rejection of deceased donation, organ shortage, and long waiting time in national transplant centers. Conclusion Despite the recent ameliorations in the current Egyptian transplant practice, the overall progress has been slow. This can be attributed to a complex interaction between social, religious and financial factors. Further advances are vital to reduce the burden implied by the state-funded dialysis therapy and to demolish organ trafficking and transplant tourism. As such, state efforts would continue to further improve the living donor and to implement the deceased donor transplantation programs.

THE ROLE OF SELECTED BIOCHEMICAL VALUES IN GRAFT QUALITY ESTIMATION IN BRAIN DEATH ORGAN DONORS

1999 ◽  
Vol 27 (Supplement) ◽  
pp. 174A
Author(s):  
Vladimir Cerny ◽  
Renata Parizkova ◽  
Pavel Zivny ◽  
Helena Zivna
Keyword(s):  
Brain Death ◽  
Organ Donors ◽  
Quality Estimation ◽  
Graft Quality

scholarly journals Organų donoro priežiūra intensyviosios terapijos skyriuje

2010 ◽  
Vol 8 (1) ◽  
pp. 0-0
Author(s):  
Viktorija Černiauskienė ◽  
Monika Čiplytė ◽  
Saulius Vosylius
Keyword(s):  
Intensive Care ◽  
Brain Death ◽  
Intensive Care Units ◽  
Care Management ◽  
Organ Procurement ◽  
Organ Donor ◽  
Organ Donors ◽  
Organ Donations ◽  
Vilnius University ◽  
Organ Donor Management

Viktorija Černiauskienė, Monika Čiplytė, Saulius VosyliusVilniaus universiteto Anesteziologijos ir reanimatologijos klinika, Vilniaus greitosios pagalbos universitetinė ligoninė,Šiltnamių g. 29, LT-04130 VilniusEl paštas: [email protected] Įvadas / tikslasDonorinių organų poreikis gerokai viršija atliktų organų transplantacijų skaičių. Dažniausios priežastys, dėl kurių potencialūs donorai netampa efektyviais donorais, yra donoro artimųjų prieštaravimas donorystei, medicininės kontraindikacijos, logistikos problemos, neadekvatus potencialių donorų gydymas iki eksplantacijos operacijos. Šio straipsnio tikslas yra apžvelgti naujausius medicinos mokslo laimėjimus atliekant potencialių organų donorų priežiūrą reanimacijos ir intensyviosios terapijos skyriuose. Metodai ir rezultataiIšliekant žymiam atotrūkiui tarp organų pasiūlos ir poreikio, būtina kuo efektyviau panaudoti esamus resursus, daugiau dėmesio skiriant tinkamai potencialaus organų donoro intensyviajai terapijai. Dėl smegenų mirties įvyksta sunkūs daugelio organizmui svarbių funkcijų sutrikimai: kraujotakos ir kvėpavimo sistemų, endokrininiai, elektrolitų balanso sutrikimai, hipotermija, koagulopatija ir intensyvus sisteminis uždegimo atsakas. IšvadosPasirinkta tinkama intensyviosios terapijos taktika galėtų padidinti transplantacijai tinkamų organų skaičių, išlaikyti geresnę jų funkciją po transplantacijos. Reikšminiai žodžiai: smegenų mirtis, intensyviosios terapijos skyriai, audinių ir organų donorystė, gairės Organ donor management in the intensive care unit Viktorija Černiauskienė, Monika Čiplytė, Saulius VosyliusClinic of Anaesthesiology and Intensive Care, Vilnius University,Šiltnamių Str. 29, LT-04130 Vilnius, LithuaniaE-mail: [email protected] Background / objectiveThe demand for donor organs greatly exceeds the number of transplantations. Many reasons may determine this inadequacy, such as family refusal, medical contraindications, logistics problems and inadequate management of the organ donor. The aim of the study was to present the recent achievements of medical practice in the management of organ donors in intensive care units. Methods and resultsWhile the discrepancy between the number of organ donations and transplantations persists, it is essential to use available resources more effectively, paying more attention to the intensive care management of the organ donor. Many physiological changes follow after brain death, such as cardiovascular and pulmonary dysfunction, endocrine and homeostasis disturbances, hypothermia, coagulopathy and an enhanced inflammatory response. ConclusionsOptimal intensive care could increase the number of organs available for transplantation and improve their function after it. Keywords: brain death, intensive care units, tissue and organ procurement, guidelines as topic

Non-therapeutic intensive care for organ donation

2014 ◽  
Vol 23 (2) ◽  
pp. 191-202 ◽  
Author(s):  
Stéphanie Camut ◽  
Antoine Baumann ◽  
Véronique Dubois ◽  
Xavier Ducrocq ◽  
Gérard Audibert
Keyword(s):  
Intensive Care ◽  
Brain Death ◽  
Organ Donation ◽  
Healthcare Professionals ◽  
University Hospital ◽  
Individual Autonomy ◽  
Post Mortem ◽  
Multiple Choice Questions ◽  
Presumed Consent ◽  
Family Approach

Background and Purpose: Providing non-therapeutic intensive care for some patients in hopeless condition after cerebrovascular stroke in order to protect their organs for possible post-mortem organ donation after brain death is an effective but ethically tricky strategy to increase organ grafting. Finding out the feelings and opinion of the involved healthcare professionals and assessing the training needs before implementing such a strategy is critical to avoid backlash even in a presumed consent system. Participants and methods: A single-centre opinion survey of healthcare professionals was conducted in 2013 in the potentially involved wards of a French University Hospital: the Neurosurgical, Surgical and Medical Intensive Care Units, the Stroke Unit and the Emergency Department. A questionnaire with multiple-choice questions and one open-ended question was made available in the different wards between February and May 2013. Ethical considerations: The project was approved by the board of the Lorraine University Diploma in Medical Ethics. Results: Of a total of 340 healthcare professionals, 51% filled the form. Only 21.8% received a specific education on brain death, and only 18% on potential donor’s family approach and support. Most healthcare professionals (93%) think that non-therapeutic intensive care is the continuity of patient’s care. But more than 75% of respondents think that the advance patient’s consent and the consent of the family must be obtained despite the presumed consent rule regarding post-mortem organ donation in France. Conclusion: The acceptance by healthcare professionals of non-therapeutic intensive care for brain death organ donation seems fairly good, despite a suboptimal education regarding brain death, non-therapeutic intensive care and families’ support. But they ask to require previously expressed patient’s consent and family’s approval. So, it seems that non-therapeutic intensive care should only remain an ethically sound mean of empowerment of organ donors and their families to make post-mortem donation happen as a full respect of individual autonomy.

Beliefs and Brain Death

2013 ◽  
Author(s):  
Eelco F.M. Wijdicks
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Death ◽  
Organ Donation ◽  
Cultural Beliefs ◽  
General Overview

Chapter 3 presents a general overview of religious and cultural beliefs and how they may pertain to the acceptance of brain death and organ donation. It also touches on the role of the clergy in the intensive care unit.

scholarly journals Caring for a potential organ donor at an intensive care unit: the role of the nurse

2017 ◽  
Vol 11 (2) ◽  
pp. 35-39
Author(s):  
Sylwia Kosek ◽  
Anna Klimczyk
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Death ◽  
Organ Donor ◽  
Loss Of Function ◽  
Potential Organ Donor ◽  
Difficult Conversations ◽  
The Family ◽  
The Individual

Brain death causes irreparable loss of function of the brain as whole and is tantamount to the individual death. According to the governing laws in Poland, a committee composed of three consultants, including a specialist in anaesthesiology and intensive care and a specialist in neurosurgery or neurology, states the individual death. Stating brain death has occurred discharges doctors from their obligation to continue therapy. In the event the organs can be harvested for transplant, after ruling out the objection of the deceased and medical counter indications, medical staff continues to care for the donor during the period of preliminary observation, diagnostics and establishing brain death, and later for the deceased, until the organs are harvested. It includes all activities, from monitoring to therapy, diagnostic and nursing activities. Nurses play an important role in the team providing care to a donor. The nurse should have extensive knowledge about brain death, its course and results, as they play an important role in proper diagnostic procedure and providing proper care until the organs are harvested. Strict nursing supervision of the donor allows the staff to detect deviations in the functioning of the organism early. The aim of this paper was to present the procedures concerning declaring brain death and portraying the role of a nurse in caring for a potential organ donor at an intensive care unit. Conclusions. Proper procedure is paramount in harvesting good quality organs for transplantation and assuring their proper functioning later. It is worthwhile to note the role of the nurse in contacts with the family, as cooperation with the donor’s family is an important aspect of the process, especially the ability to conduct difficult conversations.

scholarly journals The role of selected biochemical values in graft quality prediction in brain death organ donors

Critical Care ◽  
10.1186/cc927 ◽  
2000 ◽  
Vol 4 (Suppl 1) ◽  
pp. P208
Author(s):  
V Cerny ◽  
P Zivny ◽  
R Parizkova ◽  
P Dostal
Keyword(s):  
Brain Death ◽  
Quality Prediction ◽  
Organ Donors ◽  
Graft Quality
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