Case Reports and Literature Review About Family Autonomy in the Process of Donation of Organs and Gametes: An Ethical and Legal Analysis.

The recovery or collection of postmortem semen raises relevant ethical and social concerns. In this study we report 2 cases witnessed by the authors in an organ procurement organization in Brazil. The patients had a diagnosis of brain death, were organ donors, and had no consent for the use of postmortem sperm. In Brazil, the diagnosis of brain death has been clearly established since 1997, with the most recent update in 2017, but has not considered the possibility of the collection of sperm or eggs from the donor. A review of the world literature has been carried out, as well as current legislation in different countries, including Brazil, with special interest in the impact on the autonomy of the deceased (informed consent or not), the wife, the generation of the child and their rights, and the ethical role of the physician.

Semen collection requirement from multiple-organs brain-dead donors: report of two cases and analysis of the available Brazilian legislation.

Along with developments in transplantation there have been major breakthroughs in the techniques of assisted reproduction. The areas of common interest include requesting semen collection from organ donors with a diagnosis of brain death. After the recent report of two cases in the Search Service of Organs and Tissues, we analyzed legislation in our country, which still lacks specific guidance in such situations. Organ transplantation progressively established itself as an effective therapeutic option in our country since the 1960s. It represents viable alternative to improve both the quality and length of life as well as to decrease long-term costs of patients with severe end-stage organ failure. These programs have specific rules and laws that are necessary to guide all stages of transplantation: donor identification, authorization and execution as well as recipients selection of implantation techniques. Assisted reproduction also needs legislation specific for human infertility, a public health problem that affects medical, psychological, and legitimate desires of people. The World Health Organization estimates that infertility reaches 20% of the population demanding the development and use of techniques for its treatment. Brazilian legislation includes regulations for transplantation of organs and tissues in law no. 9434 of February 04, 1997; it provides for the removal of organs, tissues, and human body parts for transplantation and other treatments. This law is regulated by Decree no. 2268 of June 30, 1997, establishing the National Transplant System, which standardizes these processes. The postmortem organ and tissue provision must be preceded by a diagnosis of via the Brain Death Protocol (Federal Council of Medicine-Brazil). The sole paragraph of Article 1 makes clear that its provisions do not apply to blood, sperm, or ovules as confirmed by the sole paragraph of Article 1 in the Decree 2.268/97 regulation. Since there is no specific legislation, assisted reproduction in our country is also regulated by The Federal Council of Medicine resolution, which was recently updated (Resolution no. 1957 December 15, 2010 in item VIII), which provides ethical standards for the use of assisted reproduction techniques provides that "It is unlawful ethical assisted reproduction postmortem since there is specific prior authorization of (a) late (a) to the use of cryopreserved biological material, in accordance with current legislation." Standardization is specific to material collected before the diagnosis of brain death, including being subject to expressed and informed consent of both spouses (item 3, item 1, attached single Resolution 1.957/2010 Federal Council of Medicine). We cannot yet find support in these legal provisions even after brain death for postmortem collection of sperm or ovules. Despite the evolution of the assisted reproduction techniques and the recognition of people's rights and wishes to procreate, this matter still creates complicated ethical and legal issues that seem to be far from being solved in our country.

Efficacy of social worker role in corneal donation in two different periods.

INTRODUCTION: The Brazilian National System of Transplantation and the Ministry of Health in Brazil establish procedures and effective actions for occupational health care so that there are increasing numbers of organ and tissue donations. OBJECTIVE: This study analyzes the performance of social workers at the Intrahospital Donation of Organs and Tissues for Transplantation, Clinical Hospital, State University of Campinas, Brazil (CIHDOTT). METHODS: We retrospectively analyzed the number of potential cornea donors, effective donations, family refusal, and the reasons for nonimplementation of the donations in 2009 (period studied with the presence of social workers) compared with 2006 (period studied without the presence of social workers). RESULTS: Data analysis revealed that in 2006 there were 141 potential cornea donors achieving 35 (25%) donations and 106 (75%) refusals. In 2009 there were 73 potential donors with 25 (34%) donations and 48 (66%) refusals. The causes of family refusal prevalent in both periods were similar: 65% from indecision and 25% from the family's wishes to maintain the patient's body intact. CONCLUSION: The performance of social workers in this case was satisfactory, achieving an increase in donations and reducing the number of patients awaiting corneal transplantation while promoting their quality of life.

Reviewing the causes for 1432 discharged liver donors: can donations be increased?

Thousands of patients are awaiting liver transplantation, mainly owing to the lack of donors. The aim of this study was to analyze the characteristics of discarded livers from donors seeking to understand how to increase the number of grafts. A retrospective analysis of 1432 discarded donor livers was performed in the period between 1994 and 2007. Data were stored in a standardized database in accordance with expanded donor criteria. The average donor age was 35.2 years with; 67.7% male subjects and 20.9% over age 50 years. The main cause of donor discard was family refusal (46.6%), followed by cardiorespiratory arrest (CRA) in 28.3%, and surgeon discard (16.9%), principally owing to sepsis (24.5%). Vasopressor drugs were used in 97.2%. Alcoholism was detected in 44.56% and drug addiction in 12.4%. There was infections documented in 23.9% of records, mainly of the respiratory type (75%). Intensive care time was over 120 hours in 11.0%. Hepatitis B infection was detected in 22.5%, (n = 338), and hepatitis C in 3.5% (n = 593). Finally, there were losses due to hypotension in 45.7% (516/1130) and also loss due to CRA. As family refusal was the principal cause for discarding a donor, it is necessary to investigate the role of information about organ transplantation to increase acceptance.

Arachnoid cyst: adversity and plasticity.

We report four cases of surgically treated intracranial arachnoid cysts, one with cyst-peritoneal shunt and three with craniotomy and arachnoid membrane resection. Their classification and etiopathogeny are discussed, and especially the different methods of treatment comparing the drastic complications (adversities) with the favorable solutions in severe clinical cases (plasticity) treated at our institution.

[Thrombosis of the internal artery secondary to soft palate injury: case report]. / Trombose da artéria carótida interna devida a trauma penetrante no pálato mole. Relato de caso.

Stroke following intraoral trauma is a rare complication of a common childhood injury. In the literature these complications have been well documented, however this condition is still infrequent. In order to alert the physicians about this possible injury we report our experience with one case. Computer tomography and magnetic resonance imaging evidenced complete occlusion of the internal carotid artery. Pathogenesis of this oral trauma is discussed.

[Breast adenocarcinoma metastatic to the pituitary gland: report of a case]. / Metástase de adenocarcinoma mamário para a hipófise: relato de caso.

A case of breast adenocarcinoma metastatic to the pituitary gland in a 57-year-old Brazilian female is presented. The computerized imaging may cause differential diagnostic confusion between a benign primary pituitary process and metastatic disease. Resolution of doubts by surgery is important for determining appropriate treatment.

[Spinal cord cysticercosis: report of 2 cases, review of the literature, and comments on its pathogeny]. / Cisticercose medular. Relato de dois casos, revisão da literatura e comentários sobre a patogenia.

A case of spinal intramedullary cysticercosis in a 13-year-old Brazilian female and a case of spinal leptomeningeal infestation by cysticercosis in a 51 year-old Brazilian female are presented. A review of 95 published cases of medullar cysticercosis since 1856 shows the incidence of this condition. Extramedullary forms are explained by the downward migration of larvae from the cerebral to the spinal subarachnoid space and most larvae are expected to be stopped in the upper portions of the spinal canal due to peculiarities of the anatomy of the spinal cord.