Presumed consent for transplantation: a dead issue after Alder Hey?

In the wake of scandals about the unauthorised retention of organs following postmortem examination, the issue of valid consent (or the lack of it) has returned to the forefront. Emphasis is put on obtaining explicit authorisation from the patient or family prior to any medical intervention, including those involving the dead. Although the controversies in the UK arose from the retention of human material for education or research rather than therapy, concern has been expressed that public mistrust could also adversely affect organ donation for transplantation. At the same time, however, the British Medical Association (BMA) continues to call for a shift to a system of presumed consent for organ transplantation. This apparent inconsistency can be justified because valid distinctions exist between the reasons requiring explicit consent for retention and the acceptability of presumed consent for transplantation. This paper argues for introducing a system of presumed consent for organ donation, given the overwhelming expressions of public support for transplantation. Ongoing legislative review in the UK provides an ideal chance to alter the default position to one where potential donors can simply acquiesce or opt out of donation. Combined with consultation with their relatives, this could be a much better method of realising individuals' wishes. It would also achieve a better balance between the duties owed to the deceased and those owed to people awaiting a transplant.

Genetic privacy: orthodoxy or oxymoron?

In this paper we question whether the concept of "genetic privacy" is a contradiction in terms. And, if so, whether the implications of such a conclusion, inevitably impact on how society comes to perceive privacy and responsibility generally. Current law and ethical discourse place a high value on self-determination and the rights of individuals. In the medical sphere, the recognition of patient "rights" has resulted in health professionals being given clear duties of candour and frankness. Dilemmas arise, however, when patients decline to know relevant information or, knowing it, refuse to share it with others who may also need to know. This paper considers the notions of interconnectedness and responsibility to others which are brought to the fore in the genetic sphere and which challenge the primacy afforded to personal autonomy. It also explores the extent to which an individual's perceived moral obligations can or should be enforced.

Facilitation of sympathetic neurotransmission contributes to angiotensin regulation of body weight.

Previous studies demonstrated that angiotensin II (AnglI) decreases body weight. The purpose of this study was to determine if AngII-reductions in body weight result from stimulation of sympathetic neurotransmission to interscapular brown adipose tissue (ISBAT). Following 7 days of chronic AngII infusion (350ng/kg/min), body weight decreased compared to controls. Using superfused ISBAT tissue slices preloaded with [3H]norepinephrine (NE), evoked [3H]overflow was greater in ISBAT slices from AngII-infused rats compared to controls. When AngII was included in the buffer, evoked [3H]overflow increased in a concentration-dependent manner in ISBAT slices from AngII-infused and control rats. The EC50 for the presynaptic effect of AngII was shifted to the left in ISBAT slices from AnglI-infused rats compared to controls; however, the maximal response to AngII was decreased. These results demonstrate that chronic AngII infusion enhances evoked release of NE from ISBAT sympathetic nerve terminals. Moreover, responsiveness to the presynaptic effect of AngII was altered following chronic AngII infusion. Increased sympathetic neurotransmission to ISBAT may contribute to AnglI-regulation of body weight.

Pyruvate kinase isoenzyme transitions in cultures of fetal rat hepatocytes.

Changes in the expression of two isoenzymic forms of pyruvate kinase in fetal hepatocyte cultures derived from 15- and 19-day gestation rats are studied by immunocytochemical localization of the respective antigens. Initially, in cultures established from 15-day gestation rats only the 'embryonic' form of the enzyme (M2-PK) is detected in all cells. Cells which stain positively for the liver specific form of the enzyme (L-PK) are not observed. After 2 days' culture, a significant number of cells have become positive for L-PK. All the positive cells have a morphology which is typical of liver parenchymal cells. However, the majority of parenchymal cells remain negative for L-PK while retaining M2-PK. In contrast, all cells which display a fibroblastic morphology, as well as clear epithelial cells are M2-PK positive, but L-PK negative. In 5-day-old cultures, all hepatocytes have become L-PK positive. Hepatocytes derived from 19-day gestation rat liver stain positively for L-PK on day 1 of culture in agreement with previously published biochemical data. A minor population of negative cells is non-parenchymal in appearance. All parenchymal cells are negative when the culture is stained with M2-PK specific antibody. Five days after the culture is established, many non-parenchymal cells are present. Such cells are L-PK negative and M2-PK positive and their presence in cultures derived from both 15- and 19-day gestation rats explains the persistence of M2-PK. This study reveals that during enzymic differentiation of fetal hepatocytes, all immature hepatocytes are initially capable of expressing M2-PK while they do not produce L-PK. During culture, a sub-population of these cells initiates synthesis of L-PK, indicating that only a fraction of the cells differentiate. At the same time, hepatocytes which do not stain for M2-PK appear, which suggests that cells which initiate L-PK synthesis have ceased to make M2-PK. Eventually all hepatocytes are L-PK positive and M2-PK negative, indicating that a switchover in expression of the pyruvate kinase isoenzymes has occurred.

Isolation of Vibrio alginolyticus from wounds and blood of a burn patient.

Isolation of Vibrio alginolyticus from the wounds and blood of a burn patient is reported. Numerous tissue biopsy sites as well as one blood culture yielded the organism. The case history and a review of the hospital course of the patient is provided where relevant to the presence and identification of the organism. The bacteriologic, biochemical, and anti-microbial identification of the organism is described. Taxonomy, habitat, and pathogenicity of V. alginolyticus are discussed.