Increasing family consent for organ donation: findings and challenges

There is a growing disparity between the number of organs and tissues needed for transplantation and the number available for donation. As a result, thousands of people die every year while waiting for a transplant. Much of the shortage can be explained by the failure of families to consent to donation. This paper reviews the research that has been conducted to elucidate reasons why families deny consent. This research, together with theoretically motivated research in the areas of persuasion and behavior change, can be used to inform the design of educational and promotional campaigns and to guide policy decisions.     

Balancing law,ethics and reality in informed consent for surgery

Informed consent has different implications and requirements in law and bioethics, and some irreconcilable disputes with the reality of surgical practice in the National Health Service. This article explores and discusses various aspects of informed consent that are of critical importance for practising surgeons in all specialties.     

Hepatocyte transplantation: new horizons and challenges

Hepatocyte transplantation represents an alternative strategy for treating liver disease. Liver repopulation following acute liver failure could, potentially, eliminate the requirement for orthotopic liver transplantation. Similarly, the ability to repopulate the liver with disease-resistant hepatocytes offers new opportunities for correcting genetic disorders and treating patients with chronic liver disease. Recent advances concerning the fate of transplanted cells in the recipient liver, the efficacy of cell therapy in outstanding animal models of human disease, and the isolation of progenitor liver cells capable of differentiating into mature hepatocytes have renewed optimism in regard to treating people with hepatocyte transplantation. Recruitment of an increasing number of investigators to the field and the success of recent pilot studies indicate that hepatocyte transplantation will become routine clinical practice in the near future. Received: July 4, 2000 / Accepted: October 12, 2000     

Ethical aspects of informed consent in obstetric anesthesia--new challenges and solutions

Informed consent is a cornerstone and routine component of the ethical practice of modern medicine. Its full theoretical application to specific clinical situations, however, presents a number of ethical dilemmas for health care providers. Obstetric anesthesia, in particular, presents many unique challenges to the process of informed consent. In this review, the ethical background to the doctrine of informed consent within the context of “principlism” is explored and critiqued. The application of principlism to actual clinical situations, the limitations of principlism in the peculiarities of the patient-physician encounter, as well as possible alternative models of ethical discourse is discussed. The process of informed consent can be broken down into seven elements: Threshold elements or preconditions, which include 1) decision-making capacity or competency of the patient, 2) freedom or voluntariness in decision-making, including absence of over-riding legal or state interests; informational elements, including 3) adequate disclosure of material information, 4) recommendation, and 5) an understanding of the above; consent elements, which include 6) decision by the patient in favor of a plan and 7) authorization of that plan. Each of these elements is discussed in turn, and their implications, especially for the anesthesiologist and the obstetric patient, are addressed.     

Informed consent to proposed course of medical treatment: recent case law stances

Developments in ethics, deontology and case law, along with the related increasing demand for patient autonomy in decision-making in health care, led the President of SIAARTI in 2000 to request the Bioethics Commission to revise the documentation on informed content the Study Group on Anesthesia Safety had issued. In response to the request, a multidisciplinary study group was called to examine the ethical, psychological, clinical, legal and medicolegal issues related to informed consent and to draw up a document that would provide for the implementation of the procedure for information and consent proposed in the model of disclosed information and consent for anesthesia approved by the SIAARTI Advisory Board. The model is to be viewed as evidence for an established anesthetist-patient relationship and as a useful record in case of legal or insurance liability litigation. In Italy, failure to obtain consent to medical treatment has assumed growing legal implications. Since 1992, the failure to obtain consent has become part of case law, an exemplary instance of which is the case of a surgeon that was closed in 2002 with the judgment of the Corte di Cassazione (Italian Supreme Court), section I, of 29/05/2002. The judgment found that, in the absence of express implementation of the Oviedo Convention, a physician is always legitimated to performed therapeutic treatment deemed necessary for preserving the life of a patient in his or her care, even in the absence of explicit consent, with the sole but significant exception of unequivocal refusal of treatment.     

General surgery and the digestive system: new program, same challenges

On 8 may 2007, the Official Bulletin (BOE) published the new Specialist Training Program. The Post-Graduate Training Section of the Spanish Surgeons Association (AEC), conscious of the importance of this situation, has carried out a reflective analysis of this Program and proposes a series of objectives. The new plan coordinates a training program that sets out three general objectives as regards, knowledge, skills and attitudes that the resident must assimilate and develop, it strictly defines the final product, without substantially changing the previous program and emphasises two fundamental aspects: training in minimally invasive surgery and research training, although the inclusion of previously unpublished new rotations and the continuation of the current assessment model. The logic in the definition of general surgery as "a major discipline paradigm" should lead to important structural changes. Aspects such as regulating work and training times, European Directives, lack of professional motivation and changes in the vocational spectrum of new residents, will make the optimisation of the results difficult a priori. The year 2017 will be the time to judge the results after five groups of surgeon graduates have been trained by this program.     

Family override of valid donor consent to postmortem donation: issues in law and practice

In 2005, 3974 Canadians were on waiting lists for organ transplants and 275 patients died while waiting. Canada's organ shortage has led to calls for changes to Canada's organ donation system and its legal framework. Herein we examine an issue in which law reform could both increase the number of available organs and better align practice with respect for autonomy, a core value underpinning the Canadian legal system: the issue of family overrides of a valid donor consent to postmortem donation. That is, we examine what should happen when an individual consented to postmortem donation but the family would like to override that consent. First, we examine the requirements for valid donor consent. Second, we consider the legal status of family overrides of valid donor consent in relation to postmortem donation. Third, we describe the available data with regard to the practice of permitting families to override valid donor consent and discuss the possible reasons for this practice. Finally, we describe and defend the desired results with respect to law reform and describe the actions needed to realize these results.     

Partial irradiation of the breast: Old challenges, new solutions

Breast-conserving treatment, characteristically consisting of surgical removal of the tumor and post-operative whole breast irradiation, is nowadays considered as the standard therapeutic approach for most women with stage I/II, invasive breast cancer. Recently, a number of institutions started investigating the feasibility and safety of novel approaches in radiotherapy, modulating concomitantly treatment time and irradiation volume. Whilst this strategy is still under investigation, recent clinical studies on accelerated partial breast irradiation with intra-operative radiotherapy or high conformality irradiation strongly suggest that the way patients with early breast cancer are irradiated should be revisited.