Doctor can I buy a new kidney? I've heard it isn't forbidden: what is the role of the nephrologist when dealing with a patient who wants to buy a kidney?

Organ trafficking is officially banned in several countries and by the main Nephrology Societies. However, this practice is widespread and is allowed or tolerated in many countries, hence, in the absence of a universal law, the caregiver may be asked for advice, placing him/her in a difficult balance between legal aspects, moral principles and ethical judgments. In spite of the Istanbul declaration, which is a widely shared position statement against organ trafficking, the controversy on mercenary organ donation is still open and some experts argue against taking a negative stance. In the absence of clear evidence showing the clinical disadvantages of mercenary transplantation compared to chronic dialysis, self-determination of the patient (and, with several caveats, of the donor) may conflict with other ethical principles, first of all non-maleficence. The present paper was drawn up with the participation of the students, as part of the ethics course at our medical school. It discusses the situation in which the physician acts as a counselor for the patient in the way of a sort of “reverse” informed consent, in which the patient asks advice regarding a complex personal decision, and includes a peculiar application of the four principles (beneficence, non-maleficence, justice and autonomy) to the donor and recipient parties

Securing Transparency and Governance of Organ Supply Chain Through Blockchain

The governance and supply chain of organs is a complicated process throughout the life cycle; from the outset of pre-assessment of organ placement, it’s supply chain journey and important post donor analysis. Healthcare organisations face a huge challenge in the diverse collation of data that are held in systems which are mostly in silo operation and little scope for interoperability or accessibility of medical data. Lack of data access or trust in its accuracy makes the task more challenging and problematic for healthcare institutions whose preference undoubtedly would be to focus their energies on the decision-making side of a patient’s health in assessing organ donor suitability and urgency to organ match due to the receiving patient criticalities, rather than time and resources spent on validating data authenticity, etc. There are further complications that can occur in potential mix-ups of organs, contamination of DNA during organ transplant, non-ethical organ supply and audit trail transparency related to these activities. There is a serious question on how to create a single source of the truth and blockchain may provide the best possibilities. Blockchain is becoming a more sought-after technology being used in the healthcare space due to its attributes of immutability, traceability and security whilst providing that assurance of transparency and audit trail. Blockchain looks to be a good fit to manage the supply chain of organ procurement/placement and an audit control method to analyse data in any pre or post operation event. Combined with the right processes, in the form of a cyber security framework/maturity model for the healthcare industry, would ensure that all those who signed up to the blockchain deployed for the supply chain logistics would respect the ethics and requirements and expect transparency for those authorised to access. However, some challenges exist in GDPR compliancy of data that would exist on a certain proposed blockchain models and needs further exploring with regards to benefits in data held off-chain

Knowledge, attitudes and practices survey on organ donation among a selected adult population of Pakistan

<p>Abstract</p> <p>Background</p> <p>To determine the knowledge, attitudes and practices regarding organ donation in a selected adult population in Pakistan.</p> <p>Methods</p> <p>Convenience sampling was used to generate a sample of 440; 408 interviews were successfully completed and used for analysis. Data collection was carried out via a face to face interview based on a pre-tested questionnaire in selected public areas of Karachi, Pakistan. Data was analyzed using SPSS v.15 and associations were tested using the Pearson's Chi square test. Multiple logistic regression was used to find independent predictors of knowledge status and motivation of organ donation.</p> <p>Results</p> <p>Knowledge about organ donation was significantly associated with education (p = 0.000) and socioeconomic status (p = 0.038). 70/198 (35.3%) people expressed a high motivation to donate. Allowance of organ donation in religion was significantly associated with the motivation to donate (p = 0.000). Multiple logistic regression analysis revealed that higher level of education and higher socioeconomic status were significant (p < 0.05) independent predictors of knowledge status of organ donation. For motivation, multiple logistic regression revealed that higher socioeconomic status, adequate knowledge score and belief that organ donation is allowed in religion were significant (p < 0.05) independent predictors. Television emerged as the major source of information. Only 3.5% had themselves donated an organ; with only one person being an actual kidney donor.</p> <p>Conclusion</p> <p>Better knowledge may ultimately translate into the act of donation. Effective measures should be taken to educate people with relevant information with the involvement of media, doctors and religious scholars.</p