Global Bioethics

Two new factor have been added to the ideological change in the second half of the past century: the “ecological impact” of humankind on the environment due to the population increase; and the “ innovative impact of science, first with atomic physics, which introduced the scission of the fundamental unit of matter, the atom, and then witch molecular biology, which led to the decoding of genetic information and intervention of biological engineering that annihilate our concepts of individual and species as fundamental units in biology. This stage of fundamental rethinking is however overshadowed by the threat of ecological disaster and catastrophic population increase, which not only impose limits to development, but undermine the very survival of Humankind. The future survival our species in fact depends on the interaction between its reproductive characteristics and the productivity of the territory, which, even if increased by the intellectual capability of the human brain, has intrinsically limits. The adaptive choices (which are also biotechnological and biomedical) of the interaction between human population and the natural ambience is the conceptual basis of the new discipline “Global Bioethics”

Ethical Challenges of Organ Transplantation: Current Debates and International Perspectives

This collection features comprehensive overviews of the various ethical challenges in organ transplantation. International readings well-grounded in the latest developments in the life sciences are organized into systematic sections and engage with one another, offering complementary views. All core issues in the global ethical debate are covered: donating and procuring organs, allocating and receiving organs, as well as considering alternatives. Due to its systematic structure, the volume provides an excellent orientation for researchers, students, and practitioners alike to enable a deeper understanding of some of the most controversial issues in modern medicine

The gift of life: an existential phenomenological exploration of receiving a lifesaving organ transplant and how this affects life subsequently

At present, there is little research conducted on organ transplantation from the perspective of the organ recipient. This study aimed to explore the experience of undergoing lifesaving organ transplantation and how this may affect life subsequently. For the purpose of this research, lifesaving transplants constituted as solid organ transplants, these being heart, lung, liver, and kidney. Six participants were interviewed using semi-structured interviews focusing on the experience of undergoing the transplantation procedure, and how this affected their life following this. The data in the form of the participants' accounts were analysed using Interpretative Phenomenological Analysis - IPA. Five superordinate themes were identified with 19 subordinate themes falling within these. The superordinate themes were; Embodied Experience which related to the participants’ physical world and their experiences of this, Life & Death relating to the participants’ experience of existence and mortality, Relationships relating to the participants’ actual or intended modes of relating to others in the world, Temporality relating to the participants’ experience of time, and The Psychological relating to the participants’ experiences of their inner world and the relationship they hold with themselves. Consideration and discussion of these themes were conducted, highlighting the implications these findings hold for the field of Counselling Psychology and Psychotherapy, with a nod to Existential literature and philosophy interwoven within this. The study concludes that organ recipients undergoing transplantation experience an array of bio-psycho-social-spiritual issues that professionals working with this population need to be aware of. It is argued that appropriate and sufficient evidence-based interventions should be developed and offered to all those undergoing the transplant treatment as standard in the provision of care provided to this population. Unfortunately, at present psychological support for organ recipients is only offered as and when a need ‘arises’

A comparison of health technology adoption in four countries (Japan, Korea, the UK, and the US)

This research empirically examines and compares the adoption of health technologies through case studies. The health technologies under review are assisted reproductive technologies, cochlear implants, haematopoietic stem cell transplantations, caesarean section deliveries, Gamma knife units and kidney transplants in four countries: Japan, Korea, the UK and the US. The interactions between the micro factors of health technologies and the macro environment in the adoption of health technologies are examined on the basis of a literature review and analysis of data. The micro factors were evaluated in terms of economic, clinical and technical aspects. In assessing the macro factors, payment systems and regulations related to the selected health technologies were taken into account. To examine the micro factors, the results of health technology assessments in earlier studies were reviewed. In order to explore the macro factors, historical changes in the payment systems affecting the selected health technologies and legal regulations, including legislation, directives, guidelines and court orders related to the technologies, were investigated. The adoption level of health technologies was evaluated in time-series and cross-sectional terms, measuring the trend of technology adoption and comparing the experience of the four countries under review. This research suggests clustering health technologies into “welfare oriented technology” and “private benefit oriented technology” by considering the economic incentives of adopters, individual desires of consumers and public concern over the technology. Private benefit oriented technologies are those which adopters expect to increase income from the providers or which meet the personal desires of the consumers. For welfare oriented technology, the decision is dominated by the aims of public welfare. As the model predicted, the adoption of welfare oriented technologies was higher in the health systems under national planning, while that of private benefit oriented technologies was higher in the systems whose health provisions accept market conditions

Clinical Studies, Big Data, and Artificial Intelligence in Nephrology and Transplantation

In recent years, artificial intelligence has increasingly been playing an essential role in diverse areas in medicine, assisting clinicians in patient management. In nephrology and transplantation, artificial intelligence can be utilized to enhance clinical care, such as through hemodialysis prescriptions and the follow-up of kidney transplant patients. Furthermore, there are rapidly expanding applications and validations of comprehensive, computerized medical records and related databases, including national registries, health insurance, and drug prescriptions. For this Special Issue, we made a call to action to stimulate researchers and clinicians to submit their invaluable works and present, here, a collection of articles covering original clinical research (single- or multi-center), database studies from registries, meta-analyses, and artificial intelligence research in nephrology including acute kidney injury, electrolytes and acid–base, chronic kidney disease, glomerular disease, dialysis, and transplantation that will provide additional knowledge and skills in the field of nephrology and transplantation toward improving patient outcomes

Psychological adjustment to lung transplantation

Lung transplantation (LTx) is an effective treatment for end-stage lung failure. Despite great advances in transplant medicine over the last few decades, LTx does not result in complete recovery of health, as transplant recipients continue to be confronted by various health problems that must be psychologically processed and overcome. Many suffer from frequent emotional distress and psychological disorders that can negatively influence their ability to cope with their new organ, negatively impacting both their adherence to immunosuppressive therapy and health-related quality of life (HRQoL). Therefore, it is both clinically and scientifically relevant to assess the postoperative HRQoL and mental health of LTx recipients to identify those at risk for poor post-transplant outcomes and to improve patients’ symptom experience. This manuscript consists of three studies that review psychological adjustment to lung transplantation in terms of HRQoL and psychosocial outcomes via three different approaches. Study 1 is a systematic review of the literature to compile and interpret the evidence on measures to assess HRQoL and psychological outcomes following LTx, summarizing psychological outcomes in studies published between 1994 and 2013. Of 371 articles, 63 studies were selected for final review. Considerable heterogeneity was found in methodology, operational concepts and applied outcome measures in the existing literature on HRQoL and psychological outcomes after LTx. Nevertheless, eligible studies generally point to significant improvements in both mental health and HRQoL post-transplant. A huge opportunity for future research lies in the development of guidelines to aid in the selection of outcome measures to assess psychological outcomes of lung transplant recipients. The second study investigated the psychosocial outcome trajectories of 40 lung transplant recipients related to psychological distress and HRQoL over their first six months posttransplant. Three distinctive clusters were identified: (1) patients with optimal postoperative trajectories (35%); (2) patients with good postoperative trajectories (42%); and (3) patients with poor postoperative trajectories (23%). The last group tended to be older, to suffer from more severe disease, to have more co-morbid conditions, and to have had a prolonged ICU and/or hospital stay. Disease severity, length of stay, and HRQoL two weeks post-transplant were strong predictors of psychological distress and impaired HRQoL at six months of follow-up. The results underscore the psychosocial needs of patients with poor post-transplant trajectories. The third study qualitatively analyzed patient experiences with transplantation and their adjustment to normal life within the first six months post-transplant. ‘Physical benefits’, ‘fear of rejection’, ‘gratitude towards the donor’, and ‘side effects’ were the most frequently named themes with respect to the transplantation process, new lungs, donor and medication regimen. Most themes remained unchanged over time. While comments about ‘intensive care unit delirium’ and ‘worries regarding donated organ quality’ diminished significantly over time, mentions of ‘restrictions in everyday life’ increased significantly. Gender comparison revealed only marginal differences in the response categories. Improvements in physical function during the early postoperative phase may be limited by the onset of clinical complications, fear of rejection and infections, medication side effects, and restrictions in everyday life. Generally, studies on HRQoL and psychological outcomes after lung transplantation have been limited by lost to follow-up, cross-sectional designs, small sample sizes and, great variability in the use of validated and non-validated outcome measures, such that comparisons between different studies are difficult. One area of future research is the development of consensus guidelines to aid in the selection of outcome measures to assess HRQoL and psychological outcomes among LTx patients. In addition, longitudinal studies, including pre- vs. post-transplant assessment with adequately-sized samples are needed to further investigate outcome profiles and identify additional outcome predictors in these patients

Living kidney donor follow-up in a statewide health information exchange: health services utilization, health outcomes and policy implications

Indiana University-Purdue University Indianapolis (IUPUI)Living donors have contributed about 6,000 kidneys per year in the past 10 years, but more than 100,000 individuals are still waiting for a kidney transplant. Living kidney donors undergo a major surgical procedure without direct medical benefit to themselves, but comprehensive follow-up information on living donors’ health is unfortunately limited. Expert recommendations suggest capturing clinical information beyond traditional sources to improve surveillance of co-morbid conditions from living kidney donors. Currently the United Network for Organ Sharing is responsible for collecting and reporting follow-up data for all living donors from U.S. transplant centers. Under policy implemented in February of 2013, transplant centers must submit follow-up date for two years after donation, but current processes often yield to incomplete and untimely reporting. This dissertation uses a statewide Health Information Exchange as a new clinical data source to 1) retrospectively identify a cohort of living kidney donors, 2) understand their follow-up care patterns, and 3) observe selected clinical outcomes including hypertension, diabetes and post-donation renal function

Scientific utilisations of reproductive tissues: “good eggs”, women and altruism

This thesis examines debates regarding whether women should donate oöcytes for research in Somatic Cell Nuclear Transfer (SCNT) or be paid. Payment is expected to increase the number of providers by providing an impersonal rather than personal incentive: cheaper fertility treatment or interest in the therapeutic benefits of SCNT research for a friend or family member. The contemplation of a payment system marks a shift from Titmuss’s model of altruistic donation. However, in both models the provider is disinterested in some way: by giving in the spirit of the public rather than private sphere. To shed light on these issues, I analyse empirical data collected with qualitative methods. I report findings that indicate providing oöcytes for SCNT research is unappealing for two reasons: first, ‘good eggs’ are essential to achieve one’s maternal aspirations; second the process of oöcyte extraction is perceived as requiring an extraordinary amount of physical and emotional discipline. Yet the results indicate that these issues are mitigated when oöcyte provision occurs for a personal incentive. This affective framework—the identification of a specific benefit or beneficiary—can change perceptions of effort, risk and reward. A woman may be transformed into a ‘good egg’ – a donor providing social benefit – if there are concrete, rather than abstract, dimensions to the process of scientific research. Hence, these findings indicate that connections between femininity and altruism are flexible. I also argue that the advocates of a payment model recall the figure of the citizen who ‘should’ be motivated by the spirit of the public sphere. However, for the participants in this study, payment represents an inappropriate motivation. I show that contributions to science are interested and occur in relationship between an individual, the tissue and the collective the research claims to benefit