Case Vignettes in Transplant Psychiatry Ethics.

The demand for liver transplants continues to far exceed the number of available viable donor organs; hence, it is of utmost importance to determine those individuals who are best able to care for these valuable, limited resources as potential recipients. At the same time, psychiatric comorbidity is common in the course of end-stage liver disease and can be mutually complicating. This article focuses on liver transplant candidacy from a psychiatric perspective, using illustrative cases to underscore the foundational facets of medical ethics that serve as the guide to these complex medical and ethical decisions.

Building a bridge between patients and transplant healthcare professionals - a descriptive study.

This article describes a pathway for collaboration between transplant healthcare professionals and organ recipients. Under the umbrella of the European Society for Organ Transplantation (ESOT) a joint initiative started from three Sections and Committees of ESOT: EDTCO (European Donation and Transplant Coordination Organisation), ETHAP (European Transplant Allied Healthcare Professionals) and ELPAT (Ethical, Legal and Psycho-social Aspects of Transplantation). The formal 'kick-off' of the Advisory Board Meeting of the European Transplant Patient Organisation (ETPO) was during the ESOT congress in 2019. The aim was to produce a series of statements to serve as a path to dialogue between patients and transplant professionals and to define the next steps towards giving a voice to the patient network. To include the patients' perspectives, two surveys have been performed. The results identified the unmet needs and lead to a proposal for future plans. Educational activities have since started leading to a patient learning workstream. All initiatives taken have one purpose: to include patients, give them a voice and build a foundation for collaboration between patients and transplant professionals. ESOT has created a platform for mutual understanding, learning and a collaborative partnership between ETPO and European donation and transplant professionals.

[Laws regulating transplantation should express the contemporaneity. Questions to the constitutionalist Francesco Paolo Casavola and to the philosophers Remo Bodei and Aldo Masullo about the possibility deciding the destiny of one's own organs at the time one decides on how to die and on contacts between donor families and recipients.]

Transplantation represents modernity thus the laws regulating the procedure should be continuously renovated and remodeled in order to take full advantage of progress. The debate is about Law no. 219, December 22, 2017 and on Law no. 222, April 1, 1999. The quests are a) about the possibility to modify the first so that people deciding on how they want to die, may also decide about their willingness to allow the removal of their organs for transplantation and b) the possibility for donor families and recipients to have contacts after transplantation in the case both sides agree. Questions were emailed to the constitutionalist Francesco Paolo Casavola, immediate Past President of the National Committee for Bioethics, and to the philosophers Remo Bodei and Aldo Masullo. Their answers received by September 16, support the idea a) to include in the Law no. 219, 2017 the possibility to decide not only on the modality one wants to die but also on the possibility to allow his own organs to be removed for transplantation and b) to liberalize contacts between donor families and recipients when both side agree. For both changes there is enough evidence of their feasibility-necessity. The answers related to contacts between donor families and recipients support the decision of the National Committee for Bioethics on September 27, 2018. Professor Casavola also suggests that contacts should organized and supervised by the ethical committees of the hospitals where the transplantation procedure is accomplished.

Ethical disputes over living organ transplant and the applicable solutions to these disputes in China / Disputas éticas sobre el trasplante de órganos vivos y soluciones aplicables a esta disputas en China / Disputas éticas sobre transplante de órgãos vivos e as soluções aplicáveis a estas disputas na China

Objectives: In this study, we examine the ethical issues concerning living organ transplant in China. We attempt to review and analyze the ethical disputes that the living organ transplant faces in China and try to find applicable solutions to these disputes. Design: Ethical Analysis. Setting: Living organ transplant in China. Results: The ideal approaches to solving the ethical disputes involve (1) preventing disease, strengthening physical fitness, and improving the health of the national citizen; (2) encouraging the citizens to donate their organs after death; and (3) developing new technologies for organ transplant. Realistic approaches to addressing the ethical disputes over the living organ transplant include choosing the lesser of two evils, reducing the harm to the donor as much as possible and improving the transplant quality. Conclusions: The living organ transplant in China is an expedient measure instead of an ideal option and should be conducted under strict laws and regulations.

Objetivos: Neste estudo, examinamos as questões éticas relativas ao transplante de órgãos vivos na China. Vamos tentar rever e analisar os conflitos éticos que o transplante de órgãos vivos enfrenta na China e tentar encontrar soluções aplicáveis a estas disputas. Projeto: Análise ética. Configuração: Transplante de órgão vivo na China. Resultados: As abordagens ideais para resolver os conflitos éticos envolvem (1) prevenção de doenças, fortalecimento da aptidão física e melhora da saúde do cidadão nacional; (2) incentivar os cidadãos a doar seus órgãos após a morte; e (3) desenvolvimento de novas tecnologias para transplante de órgão. Abordagens realistas para enfrentar as disputas éticas sobre o transplante de órgão vivos incluem escolher o menor de dois males, reduzindo o dano ao doador o máximo possível e melhorar a qualidade do transplante. Conclusões: Transplantes de órgãos vivos na China é uma medida conveniente ao invés de uma opção ideal e deve ser conduzida sob estritas leis e regulamentos.

O artigo traz à discussão a compreensão atual do comportamento ecológico do ser humano, a partir de uma relação de dominação utilitária do ambiente em contraste com a sua compreensão do ponto de vista ecológico, a qual responde a um modelo natural que faz parte de relações de seu funcionamento no ecossistema. A este respeito, é colocado em discussão o paradigma de crise ambiental, em que tal comportamento supõe um problema grave da sociedade. Para os autores, a questão está intimamente ligada ao sistema produtivo e econômico que promove a artificialização do ser humano, criando falsas necessidades que, por meio de seu consumo, garantam a sustentabilidade do modelo econômico. É realizada uma reflexão crítica a partir da educação, no sentido de uma nova compreensão do comportamento humano, cuja perspectiva ecológica impulsiona novas relações ecossistêmicas baseadas na cooperação.

Screening recipients of increased risk donor organs: A multicenter retrospective study.

Organ Procurement & Transplantation Network policy requires post-transplant screening of recipients of organs from donors at increased risk for transmission of HIV, hepatitis B virus, and hepatitis C virus. Available data suggest that follow-up testing of recipients is not routinely conducted. Data on increased risk donors and recipients of their organs from 2008 to 2012 were retrospectively collected from 6 transplant centers after IRB approval. Descriptive statistics were performed. About 363 (60%) recipients were screened for transmission of HIV, HBV, and/or HCV at some time point; 257 (70.8%) within 90 days of transplant. The type of test used to screen for infection was variable with many recipients (25%-43%) screened with serology alone. Our results reveal that post-transplant screening for HIV, HBV, and HCV in recipients of increased risk donor organs did not universally occur and testing methods were variable.

De novo head and neck cancer arising in solid organ transplantation recipients: The Asan Medical Center experience.

OBJECTIVE: De novo cancers of head and neck area in solid organ transplantation recipients show standardized incidence ratio (SIR) of 3.8. Immunosuppression following transplantation is suggested to play as a crucial factor in pathogenesis of secondary malignancy. Prognosis of head and neck cancer arising in solid organ transplantation recipients is proven to have poor prognosis. The incidence, risk, prognosis, and survival of de novo malignancy of head and neck area in solid organ transplantation recipients in single-tertiary medical center followed up for 20 years. METHODS: A retrospective medical record review of the patients who received solid organ transplantation in Asan Medical Center from 1997 to 2016 was conducted. Patients confirmed as de novo malignancy in the head and neck area after organ transplantation were included, and presented as in the case-series format. Patients with previous history of head and neck malignancy, irradiation history of head and neck area, cutaneous malignant lesion, hematopoietic malignant lesion, malignancy of thyroid and parathyroid gland and metastatic lesions newly developed in head and neck area were excluded. The incidence of head and neck malignancy in South Korea were reviewed from the National Cancer Information Center of South Korea. For the statistical analysis, standardized incidence ratio (SIR) was obtained with 95% confidence interval. RESULTS: Solid organ transplantation recipients show 20 times higher incidence of de novo cancer of head and neck area compared to general population. Of 13 de novo head and neck malignancy arising after solid organ transplantation, 2 (15.4%) patients were unable to withstand definitive management due to poor general condition. 2 (15.4%) patients had loco-regional recurrence, 1 (7.7%) patient with distant metastasis, and 3 (23.1%) patients died of cancer progression. CONCLUSION: Immunosuppression following solid organ transplantation gives a twenty-fold increased risk for the development of de novo head and neck cancer. A more precise and frequent checkup on head and area should be planned, suggesting a multi-disciplinary approach in combination with organ transplantation team.

Screening recipients of increased-risk donor organs: a survey of transplant infectious diseases physician practices.

BACKGROUND: In 1994, the Public Health Service published guidelines to minimize the risk of human immunodeficiency virus (HIV) transmission and to monitor recipients following the transplantation of organs from increased-risk donors. A 2007 survey revealed the post-transplant surveillance of recipients of organs from increased-risk donors (ROIRD) is variable. METHODS: An electronic survey was sent to transplant infectious diseases physicians at US solid organ transplant centers. RESULTS: A total of 126 surveys were sent to infectious diseases physicians, and we received 51 (40%) responses. We found that 22% of respondents obtain only verbal, 69% verbal and written, and 8% do not obtain any special consent from ROIRD, despite an Organ Procurement and Transplantation Network policy requiring such consent. Post-solid organ transplantation serologies for HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) are performed by 6-8% of respondents in all recipients, by 69% of respondents in ROIRD only, and 25% of respondents do not perform them at all. Post-transplant nucleic acid testing is carried out by 55-64% of respondents in ROIRD, by 0-2% in all recipients, and not performed by 35-43% of respondents. CONCLUSION: Screening RIORD for HIV, HBV, and HCV has increased since 2007, but remains less than optimal and is incomplete when screening for disease transmission at many centers.