A donation to life: organ procurement.

1. Only 15% of brain dead patients become organ donors. This is due to a lack of public education regarding the benefits of organ donation, lack of recognition of potential donors, poor donor management, and unfortunately, even the reluctance of health-care workers to approach families with the choice to donate. 2. Once the patient has been officially accepted as an organ donor and the consents have been signed, the donor goes through a thorough evaluation involving physician consultations and lab work, and the medical history is reviewed for possible complications. 3. As many as four surgical teams may be involved in organ procurement, and good communication between nurses, physicians, and coordinators is vital to promote successful recovery of donor organs.     

Promoting health and wellbeing at the end of life: the contribution of care pathways

Enhancing end-of-life care (EoLC) is a core component of international governments' health policies. Across the globe, nurses make significant contributions to EoLC and, at this delicate time, have the power to positively influence the health and wellbeing of those facing death. Indeed, health promotion is a core component of the nurse's role. Originating in the UK, EoLC pathways have been adopted around the world. Their broad aim is to optimise the quality of the dying process, enabling people to 'die well' across care settings. This paper examines EoLC pathways in terms of promoting health and wellbeing in this discrete stage of the dying trajectory. Concepts of health and health promotion are described briefly and the idea of health-promoting palliative care and its association with a good death examined. The ensuing discussion relates to two EoLC documents. While acknowledging that much has been achieved it is argued that, despite the potential for promoting health and wellbeing, a professionally led, biomedical approach predominates, and in terms of promoting health and wellbeing at the end of life there is a pressing need for proactive advance care planning at an earlier point in the illness trajectory.     

Welsh Government proposals: organ and tissue donation reforms

In November 2011, the Welsh Government published a consultation document setting out proposals for legislation on organ and tissue donation. The scheme would introduce a notable change in the law from a consent-based 'opt-in' scheme for transplantation to an 'opt-out' one. This article explores the scope of the current law concerning organ transplantation. It considers the proposals for reform and some of the challenges which might arise in implementing the legislation.     

Antiretroviral therapy for human immunodeficiency virus infection: hope and despair

While considering AIDS as an infectious disease with a direct relation between the etiologic agent and the deep immunodeficiency, antiretroviral drugs created much hope. The only transient effect observed with AZT treatment may not be due only to resistance occurrence but to effects that AZT does not target. These effects seem to be related to cytokines secretion which major the immunodepression. Efficient treatment should restore a normal cytokines network.     

Psychosocial factors influencing nurses' involvement with organ and tissue donation

This paper focuses on the first phase of a 3-year study that explored the psychosocial factors that influence nurses' willingness to discuss post-mortem donation intentions with relatives of potential organ and tissue donors. The United Kingdom's donation system is dependent upon such discussions taking place. A cross-sectional survey of 776 randomly selected nurses, from two health regions in the United Kingdom, found that personal negative attitudes to aspects of donation and transplantation, fears and misconceptions about the donation process, clinical area of work, past experience, and socio-historical factors influence discussion behaviour. Knowledge deficits were discovered, together with requests for general information about the donation process and specific information about the organ and tissue donor exclusion criteria.     

Beyond denial and despair: ALS and our heroic potential for hope

Because the patient with amyotrophic lateral sclerosis (ALS) knows at the outset that he or she is facing an incurable and always fatal illness, the experience of hope may be different in the ALS community from that in the general palliative care community. Although the word "hope" is frequently and passionately used by both patients and professionals in the ALS community, to date there has been little published on the subject. Hopelessness and despair are a very real part of the ALS experience. But true hope, of a kind more powerful than mere physical survival, can also be part of the ALS journey. What is this "hope" the professional is expected to engender and the patient is encouraged not to lose? How can professionals help the ALS patient find hope and meaning? This article is an exploration of hope by someone who has experienced ALS, first as an occupational therapist, then as the daughter and caregiver of an ALS patient. Based on literature review and personal experience, factors leading to both hope and hopelessness are explored. Finally, the author offers several strategies that palliative care professionals can use to help ALS patients find hope.