ABSTRACT
Abstract: 15. The difference between supply and demand of transplantable organs is a global problem, and one of the most discussed measures aiming to solve it is the implementation of a presumed consent (opt-out) policy in cadaveric organ donation. This type of system is controversial when it comes to its direct effects on organ donation rates as well as its ethical base. We aim to present the latest perspectives concerning the ethical implications of the policy, especially regarding consent: its need, the coherence of presuming it and the policy's capacity to fulfill its requirements. From a community perspective, we advocate a default change in societies with an opt-out system, with a strong population education in that direction. The potential rights of family objection are also approached as well as the differences between theoretical discussion and concrete application of public policy.
Resumen: 19. El desfase entre la oferta y la demanda de órganos para trasplantes es un problema mundial, y una de las medidas más discutidas para solucionarlo es la aplicación de una política de consientimiento presumido (opt-out) de la donación de órganos de cadáveres. Este tipo de sistema es controvertido teniendo en cuenta sus efectos directos sobre las tasas de donación de órganos, así como su base ética. Nuestro objetivo es presentar las últimas perspectivas sobre las implicaciones éticas, especialmente en lo que respecta al consentimiento: su necesidad, la consistencia de su presunción y la capacidad de cumplir sus requisitos. Desde el punto de vista comunitario, abogamos por un cambio por defecto en las sociedades con un sistema de opt-out, con una fuerte educación de la población a tal efecto. También se abordan los posibles derechos de la objeción familiar, así como las diferencias entre el debate teórico y la aplicación concreta de las políticas públicas.
Resumo: 23. A diferença entre a oferta e a procura de órgãos para transplantação é um problema global, e uma das medidas mais discutidas com vista à sua resolução é a implementação de uma política de consentimento presumido (opt-out) na doação de órgãos de cadáver. Este tipo de sistema é controverso ponderando os seus efeitos diretos nas taxas de doação de órgãos, bem como da sua base ética. O nosso objetivo é apresentar as últimas perspetivas relativas às implicações éticas, especialmente no que diz respeito ao consentimento: a sua necessidade, a coerência da sua presunção e a capacidade em cumprir os seus requisitos. Numa perspetiva comunitária, defendemos uma mudança de default nas sociedades com um sistema opt-out, com uma forte educação da população nesse sentido. Os direitos potenciais da objeção familiar também são abordados, bem como as diferenças entre a discussão teórica e a aplicação concreta da política pública.
Subject(s)
Humans , Tissue and Organ Procurement/ethics , Presumed Consent/ethics , CadaverABSTRACT
Objective To assess the detection of HIV/AIDS cases in medical institutions in China from 2008 to 2013.Methods 'Provider-initiated Opt-out HIV testing and counseling' method was offered to patients who met the needs for preoperation,perinatal examination,at the sexually transmitted disease (STD) clinic or other types of testing services.Results From 2008 to 2013,the number of HIV screening tests offered in medical institutions increased by 206.8％,from 24.94 million to 76.54 million.The number of diagnosed HIV cases increased by 149.8％,from 18 241 to 45 560.HIV positive coarse rate showed a slight decrease,from 7.3 per ten thousand in 2008 dropped to 6.0 per ten thousand in 2013.The HIV positive rate detected at the STD clinics or from other attendants showed a gradual decrease in 2009 and remained relatively stable.HIV positive rotes showed at the programs as preoperative testing,regular screening programs on blood products,on pretreatmentregular-blood-testing or through perinatal examination,maintained at low levels.Proportions of case detection at medical institutions increased annually from 2008 to 2013 (32.4％,36.0％,40.2％,45.3％,47.9％ and 50.6％ respectively) in China.Among them,the proportion of case detection via other types of testing services appeared over 50％.Over 20％ of the HIV cases were identified via preoperative testing.Conclusion Significant effects were seen through programs as offering Provider-initiated HIV testing and counseling to patients that receiving testing at the STD clinics or through other types of testing services.Opt-out HIV testing and counseling should be routinized in all the HIV related divisions in medical institutions.
ABSTRACT
Objective: A preliminary opt-out screening study for HIV was conducted in a tertiary care hospital in India according to Center for Disease Control (CDC) guidelines. A total of 876 cases were screened for HIV during August 2007 to December 2007 using tests approved by the National AIDS Control Organization (NACO). Results: Data indicates that the prevalence of HIV in emergency and pre-surgical setting was 21 per thousand at the tertiary care center. Positivity rate in the pediatric population was 20.9 per thousand while in adults it was 21.4 per thousand. Most patients were totally unsuspected. Nearly 40000 patients seek admission annually to the emergency department alone. Thus nearly 700 to 800 patients may be missed every year if one does not resort to such a practice. Conclusion: Since India has the second largest number of HIV cases in the world, opt-out screening program and testing in an emergency setting, as recommended by CDC, is extremely relevant. Logistics of implementation of this policy need to be worked out at a national level.
ABSTRACT
As the impact of molecular and genomic data grows in epidemiology,numerous studies of genetic epidemiology and post-genomics research rely increasingly on the use of human biobanks.Biobanking ranges in scope from small collections of samples in academic or hospital settings to large-scale national repositories.In this context,the construction of biobank is confronting With numerows ethical challenges,informed consent in particular.The paper analyses several concent moder of participation in biobank and explores the optinal model of China——opt-out.