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Science writer Dick Teresi examines how death is determined by the medical community and explores organ trafficking, brain death, and near-death experiences.

It is unclear how much information should be provided to families of potential organ donors about the benefits of organ donation. Whilst this information is material to the donation decision, it may also be perceived as coercive. Randomised, double blind, controlled trial in which community members watched one of two videos of a simulated organ donation conversation that differed only in the amount of information provided about the benefits of donation. Participants then completed a questionnaire about the adequacy of the information provided and the degree to which they felt the doctor was trying to convince the family member to say yes to donation. There was a wide variability in what participants considered was the \"right\" amount of information about organ donation. Those who watched the conversation that included information about the benefits of donation were more likely to feel that the information provided to the family was sufficient. They were more likely to report that the doctor was trying to convince the family member to say yes to donation, yet were no more likely to feel uncomfortable or to feel that the doctor was uncaring or cared more about transplant recipients than he did for the patient and their family. This study suggests that community members are comfortable with health care staff providing information to family members that may be influential in supporting them to give consent for donation.

This year, surgeons transplanted the first pig organs into human recipients. Researchers are keen to launch more human trials. This year, surgeons transplanted the first pig organs into human recipients. Researchers are keen to launch more human trials. Credit: University Of Maryland School Of Medicine/ZUMA A surgical team works to give patient Dave Bennett a gene-edited pig heart.

The COVID-19 pandemic has generated an imbalance between the clinical needs of the population and the effective availability of advanced life support (ALS) resources. Triage protocols have thus become necessary. Triage decisions in situations of scarce resources were not extraordinary in the pre-COVID-19 era; these protocols abounded in the context of organ transplantation. However, this prior experience was not considered during the COVID-19 outbreak in Spain. Lacking national guidance or public coordination, each hospital has been forced to put forth independent and autonomous triage protocols, most of which were, nonetheless, based on common ethical principles and clinical criteria. However, controversial, non-clinical criteria have also been defended by Spanish scientific societies and public institutions, including setting an age cut-off value for unilaterally withholding ALS, using ‘social utility’ criteria, prioritising healthcare professionals or using ‘first come, first served’ policies. This paper describes the most common triage criteria used in the Spanish context during the COVID-19 epidemic. We will highlight our missed opportunities by comparing these criteria to those used in organ transplantation protocols. The problems posed by subjective, non-clinical criteria will also be discussed. We hope that this critical review might be of use to countries at earlier stages of the epidemic while we learn from our mistakes.

The goal of this scoping review is to examine the published literature regarding ethical principles that guide solid-organ transplant candidate selection committees. The review will identify the available research and provide recommendations to selection committees. Transplantation is a field where ethics is involved with almost every juncture of treatment. Organ selection, pathways to donation, organ allocation, and recipient selection are just a few of the myriads of processes that require ethical thoughtfulness. However, the ethical insights involved in the decision-making during these processes are not well elucidated in the literature. An application of an ethical framework(s) to this process could substantially improve the equality of the process. This review will include studies focused on transplant candidate selection committees and/or the transplant candidate selection process. It will include full papers and abstracts published in English. PubMED, EMBASE, APA PsycInfo, SCOPUS, and CINAHL databases will be used for the literature search. Only articles published in English between the years 1960 and 2024 will be considered. The review will consist of title/abstract screening followed by full-text screening to determine which articles meet inclusion criteria. Each article will be reviewed by two independent reviewers, with a third stepping in to resolve conflicts in decision. After all articles have been screened, data will be extracted in duplicate from the selected included articles using a template in Covidence created by the study team. Results will then be summarized and presented in narrative summary. An examination of the transplant selection process is due and warranted as selection carries significant weight in determining who receives an organ and, indeed, the stakes are life and death. Yet few studies exist on transplant selection. Ultimately, the problem with selection is how committees can further improve their promise to patients: are they making the right decision and how they define \"the right decision.\" Thus, it is critical to review selection committees for systematic bias and discrimination, especially in a process that depends heavily on individuals utilizing judgment-based reasoning, in order to improve selection and rid it of historic biases. This way, the transplant candidate selection process can foster fairness, thereby instilling increased public trust.

We evaluate the introduction of monetary incentives in the market for live and cadaveric organ donations. We show that monetary incentives would increase the supply of organs for transplant sufficiently to eliminate the very large queues in organ markets, and the suffering and deaths of many of those waiting, without increasing the total cost of transplant surgery by more than about 12 percent. We build on the value-of-life literature and other parts of economic analysis to estimate the equilibrium cost of live transplants for kidneys and livers. We also show that market price for kidneys will be determined by the cost of live donations, even though most organs will come from cadavers.

Abstract Rationale Donation after circulatory determination of death (DCDD) has the potential to increase the number of organs available for transplantation. Because consent and management of potential donors must occur before death, DCDD raises unique ethical and policy issues. Objectives To develop an ethics and health policy statement on adult and pediatric DCDD relevant to critical care and transplantation stakeholders. Methods A multidisciplinary panel of stakeholders was convened to develop an ethics and health policy statement. The panel consisted of representatives from the American Thoracic Society, Society of Critical Care Medicine, International Society for Heart and Lung Transplantation, Association of Organ Procurement Organizations, and the United Network of Organ Sharing. The panel reviewed the literature, discussed important ethics and health policy considerations, and developed a guiding framework for decision making by stakeholders. Results A framework to guide ethics and health policy statement was established, which addressed the consent process, pre- and post mortem interventions, the determination of death, provisions of end-of-life care, and pediatric DCDD. Conclusions The information presented in this Statement is based on the current evidence, experience, and clinical rationale. New clinical research and the development and dissemination of new technologies will eventually necessitate an update of this Statement.

Uterus transplantation (UTx) is an experimental surgery likely to face the issue of organ shortage. In my article, I explore how this issue might be addressed by changing the prevailing practices around live uterus donor recruitment. Currently, women with children – often the mothers of recipients – tend to be overrepresented as donors. Yet, other potentially eligible groups who may have an interest in providing their uterus – such as transgender men, or cisgender women who do not wish to gestate or to have children – tend to be excluded as potential donors. Moving forward, I recommend that donor inclusion criteria for UTx be broadened to be more inclusive of these latter groups.

Why has Egypt, a pioneer of organ transplantation, been reluctant to pass a national organ transplant law for more than three decades? This book analyzes the national debate over organ transplantation in Egypt as it has unfolded during a time of major social and political transformation—including mounting dissent against a brutal regime, the privatization of health care, advances in science, the growing gap between rich and poor, and the Islamic revival. Sherine Hamdy recasts bioethics as a necessarily political project as she traces the moral positions of patients in need of new tissues and organs, doctors uncertain about whether transplantation is a “good” medical or religious practice, and Islamic scholars. Her richly narrated study delves into topics including current definitions of brain death, the authority of Islamic fatwas, reports about the mismanagement of toxic waste predisposing the poor to organ failure, the Egyptian black market in organs, and more. Incorporating insights from a range of disciplines, Our Bodies Belong to God sheds new light on contemporary Islamic thought, while challenging the presumed divide between religion and science, and between ethics and politics.