Making sense of risk. Donor risk communication in families considering living liverdonation to a child

This paper contributes to the growing line of thought in bioethics that respect for autonomy should not be equated to the facilitation of individualistic self determination through standard requirements of informed consent in all healthcare contexts. The paper describes how in the context of donation for living related liver transplantation (LRLT) meaningful, responsible decision making is often embedded within family processes and its negotiation. We suggest that good donor risk communication in families promote “conscientious autonomy” and “reflective trust”. From this, the paper offers the suggestion that transplant teams and other relevant professionals have to broaden their role and responsibility for risk communication beyond proper disclosure by addressing the impact of varied psychosocial conditions on risk interpretation and assessment for potential donors and family stakeholders. In conclusion, we suggest further research questions on how professional responsibility and role-taking in risk communication should be morally understood

Do Nutrient Limitation Patterns Shift from Nitrogen Toward Phosphorus with Increasing Nitrogen Deposition Across the Northeastern United States?

Atmospheric nitrogen (N) deposition is altering biogeochemical cycling in forests and interconnected lakes of the northeastern US, and may shift nutrient limitation from N toward other essential elements, such as phosphorus (P). Whether this shift is occurring relative to N deposition gradients across the northeastern US has not been investigated. We used datasets for the northeastern US and the Adirondack sub-region to evaluate whether P limitation is increasing where N deposition is high at two geographic scales, based on N:P mass ratios. Using a model-selection approach, we determined that foliar N for dominant tree species and lake dissolved inorganic N (DIN) increased coincident with increasing N deposition, independent of relationships between foliar N or lake DIN and precipitation or temperature. Foliar P also increased with N deposition across the northeastern US for seven of eight deciduous species, but changed less across the Adirondacks. Foliar N:P therefore declined at the highest levels of N deposition for most deciduous species across the region (remaining nearly constant for most conifers and increasing only for black cherry and hemlock), but increased across all species in the Adirondacks. Ratios between DIN and total P (DIN:TP) in lakes were unrelated to N deposition regionally but increased across the Adirondacks. Thus, nutrient limitation patterns shifted from N toward P for dominant trees, and further toward P for predominantly P-limited lakes, at the sub-regional but not regional scale. For the northeastern US overall, accumulated N deposition may be insufficient to drive nutrient limitation from N toward P; alternatively, elements other than P (for example, calcium, magnesium) may become limiting as N accumulates. The consistent Adirondack foliar and lake response could provide early indication of shifts toward P limitation within the northeastern US, and together with regional patterns, suggests that foliar chemistry could be a predictor of lake chemistry in the context of N deposition across the region