Liver Allocation to Non-Citizen Non-Residents: An Ethical Framework for a Last-In-Line Approach

The incidence of non-U.S. citizen non-U.S. resident patients coming to the United States specifically for deceased donor liver transplantation raises compelling ethical questions that require careful consideration. The inclusion of these often financially and/or socially privileged patients in the pool of potential candidates for an absolutely scarce and life-saving liver transplant may exacerbate disparities already existing in deceased donor liver allocation. In addition, their inclusion on organ transplant waiting lists conflicts with recognized ethical principles of justice and reciprocity. Moreover, preliminary data suggest that public awareness of this practice could discourage organ donation, thereby worsening an already profound supply–demand gulf. Finally, U.S. organ allocation policies and statutes are out of step with recently promulgated international transplant guidelines, which prioritize self-sufficiency of organ programs. This article analyzes each of these ethical conflicts within the context of deceased donor liver transplantation and recommends policy changes that align the United States with international practices that discourage this scenario

Anticipatory Waivers of Consent for Pediatric Biobanking

As pediatric biobank research grows, additional guidance will be needed about whether researchers should always obtain consent from participants when they reach the legal age of majority. Biobanks struggle with a range of practical and ethical issues related to this question. We propose a framework for the use of anticipatory waivers of consent that is empirically rooted in research that shows that children and adolescents are often developmentally capable of meaningful deliberation about the risks and benefits of participation in research. Accordingly, bright‐line legal concepts of majority or competency do not accurately capture the emerging capacity for autonomous decision‐making of many pediatric research participants and unnecessarily complicate the issues about contacting participants at the age of majority to obtain consent for the continued or first use of their biospecimens that were obtained during childhood. We believe the proposed framework provides an ethically sound balance between the concern for potential exploitation of vulnerable populations, the impetus for the federal regulations governing research with children, and the need to conduct valuable research in the age of genomic medicine

The First English Translation of the Ebers Papyrus

Presentation slides for lecture delivered by Colin Halverson, PhD (Faculty Investigator, Indiana University Center for Bioethics) and Jane Hartsock, JD, MA (Director of the Department of Clinical and Organizational Ethics, Indiana University Health) on March 1, 2023. While the Ebers Papyrus is famous as one of the oldest and most complete contemporary perspectives on ancient Egyptian healing practices, little has yet been said about the biography of its first English-language translator, Dr. Carl H. von Klein. Von Klein, a German immigrant and surgeon in the American Midwest, and his linguist daughter Edith Zitelmann spent twenty-some years meticulously translating and annotating the papyrus, but the manuscript was ultimately destroyed. In this talk, Hartsock and Halverson examine the convoluted and dramatic history of the Ebers Papyrus and its “rediscovery” by Edwin Smith, and discuss the equally convoluted and dramatic societal- and personal-scale forces that thwarted von Klein and Zitelmann’s efforts to translate it. Presentation recording available online: [LINK]https://purl.dlib.indiana.edu/iudl/media/019s06b61s[/LINK

International Travel for Living Donor Kidney Donation: A Proposal for Focused Screening of Vulnerable Groups

As the gap between organ donors and patients on the recipient waiting list grows, residents of the US who are in need of kidney transplantation occasionally contract with living donors from outside the US. Those donors then travel to the US to undergo living donor kidney donation at US transplant centers. This practice is not limited to the US and occurs with some regularity around the world. However, there is very little written about this practice from the perspective of the US transplant system, and there is little in the way of guidance (either legal or ethical) to assist centers that accommodate it in distinguishing between ethically permissible travel for transplant and what could potentially be human trafficking for organ removal. This paper will present an ethical analysis of travel for organ donation with particular attention to lessons that can be drawn from living donor donation in other countries. This inquiry is particularly germane because OPTN has promulgated guidelines with respect to obligations owed to living donors, but those guidelines appear to assume that the donor is a US resident. The critical question then, is whether and/or to what extent those guidelines are applicable to the instant scenario in which the living donor is a non-resident. In addition, this paper addresses several critical ethical concerns implicated by the often vulnerable populations from which donors are drawn. Finally, this paper proposes that focused inquiry by transplant centers is necessary when donors are non-residents

Experimental nitrogen addition alters structure and function of a boreal bog: critical load and thresholds revealed

Bogs and fens cover 6% and 21%, respectively, of the 140,329 km2 Oil Sands Administrative Area in northern Alberta. Development of the oil sands has led to increasing atmospheric N deposition, with values as high as 17 kg N.ha-1yr-1; regional background deposition is N.ha-1yr-1. Bogs, being ombrotrophic, may be especially susceptible to increasing N deposition. To examine responses to N deposition, over five years, we experimentally applied N (as NH4NO3) to a bog near Mariana Lake, Alberta, unaffected by oil sands activities, at rates of 0, 5, 10, 15, 20, and 25 kg N.ha-1yr-1, plus controls (no water or N addition). Increasing N addition: (1) stimulated N2 fixation at deposition .ha-1yr-1, and progressively inhibited N2 fixation as N deposition increased above this level; (2) had no effect on Sphagnum fuscum net primary production (NPP) in years 1, 2, and 4, but inhibited S. fuscum NPP in years 3 and 5; (3) stimulated dominant shrub and Picea mariana NPP; (4) led to increased root biomass and production; (5) changed Sphagnum species relative abundance (decrease in S. fuscum, increase in S. magellanicum, no effect on S. angustifolium); (6) led to increasing abundance of Rhododendron groenlandicum and Andromeda polifolia, and to vascular plants in general; (7) led to increasing shrub leaf N concentrations in Andromeda polifolia, Chamaedaphne calyculata, Vaccinium oxycoccos, V. vitis-idaea, and Picea mariana; (8) stimulated cellulose decomposition, with no effect on S. fuscum peat or mixed vascular plant litter decomposition; (9) had no effect on net N mineralization rates or on porewater NH4+-N, NO3--N, or DON concentrations; and (10) had minimal effects on peat microbial community composition. Increasing experimental N addition led to a switch from new N being taken up primarily by Sphagnum to being taken up primarily by shrubs. As shrub growth and cover increase, Sphagnum abundance and NPP decrease. Because inhibition of N2 fixation by increasing N deposition plays a key role in bog structural and functional responses, we recommend a N deposition critical load of 3 kg N.ha-1yr-1 for northern Alberta bogs

Reducing auditory nerve excitability by acute antagonism of Ca2+-permeable AMPA receptors

Hearing depends on glutamatergic synaptic transmission mediated by α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs). AMPARs are tetramers, where inclusion of the GluA2 subunit reduces overall channel conductance and C

A National Survey Assessing SARS-CoV-2 Vaccination Intentions: Implications for Future Public Health Communication Efforts

With SARS-CoV-2 vaccines under development, research is needed to assess intention to vaccinate. We conducted a survey (N = 3,159) with U.S. adults in May 2020 assessing SARS-CoV-2 vaccine intentions, intentions with a provider recommendation, and sociodemographic and psychosocial variables. Participants had high SARS-CoV-2 vaccine intentions (M = 5.23/7-point scale), which increased significantly with a provider recommendation (M = 5.47). Hierarchical linear regression showed that less education and working in health care were associated with lower intent, and liberal political views, altruism, and COVID-19-related health beliefs were associated with higher intent. This work can inform interventions to increase vaccine uptake, ultimately reducing COVID-19-related morbidity and mortality.The study team is thankful to their individual departments for providing monetary support for this survey project (Department of Communication Studies, IUPUI; Department of Public Health, Purdue University; Department of Pediatrics, IU School of Medicine; and Department of Clinical Ethics, IU Health)

How is rape a weapon of war?: feminist international relations, modes of critical explanation and the study of wartime sexual violence

Rape is a weapon of war. Establishing this now common claim has been an achievement of feminist scholarship and activism and reveals wartime sexual violence as a social act marked by gendered power. But the consensus that rape is a weapon of war obscures important, and frequently unacknowledged, differences in ways of understanding and explaining it. This article opens these differences to analysis. Drawing on recent debates regarding the philosophy of social science in IR and social theory, it interprets feminist accounts of wartime sexual violence in terms of modes of critical explanation – expansive styles of reasoning that foreground particular actors, mechanisms, reasons and stories in the formulation of research. The idea of a mode of critical explanation is expanded upon through a discussion of the role of three elements (analytical wagers, narrative scripts and normative orientations) which accomplish the theoretical work of modes. Substantive feminist accounts of wartime sexual violence are then differentiated in terms of three modes – of instrumentality, unreason and mythology – which implicitly structure different understandings of how rape might be a weapon of war. These modes shape political and ethical projects and so impact not only on questions of scholarly content but also on the ways in which we attempt to mitigate and abolish war rape. Thinking in terms of feminist modes of critical explanation consequently encourages further work in an unfolding research agenda. It clarifes the ways in which an apparently commonality of position can conceal meaningful disagreements about human action. Exposing these disagreements opens up new possibilities for the analysis of war rape

Experimental nitrogen addition alters structure and function of a boreal poor fen: Implications for critical loads

Bogs and fens cover 6 and 21%, respectively, of the 140,329 km2 Oil Sands Administrative Area in northern Alberta. Regional background atmospheric N deposition is low (b2 kg N ha−1 yr−1 ), but oil sands development has led to increasing N deposition (as high as 17 kg N ha−1 yr−1 ). To examine responses to N deposition, over five years, we experimentally applied N (as NH4NO3) to a poor fen near Mariana Lake, Alberta, unaffected by oil sands activities, at rates of 0, 5, 10, 15, 20, and 25 kg N ha−1 yr−1 , plus controls (no water or N addition). At Mariana Lake Poor Fen (MLPF), increasing N addition: 1) progressively inhibited N2-fixation; 2) had no effect on net primary production (NPP) of Sphagnum fuscum or S. angustifolium, while stimulating S. magellanicum NPP; 3) led to decreased abundance of S. fuscum and increased abundance of S. angustifolium, S. magellanicum, Andromeda polifolia, Vaccinium oxycoccos, and of vascular plants in general; 4) led to an increase in stem N concentrations in S. angustifolium and S. magellanicum, and an increase in leaf N concentrations in Chamaedaphne calyculata, Andromeda polifolia, and Vaccinium oxycoccos; 5) stimulated root biomass and production;6) stimulated decomposition of cellulose, but not of Sphagnum or vascular plant litter; and 7) had no or minimal effects on net N mineralization in surface peat, NH4 +-N, NO3 −-N or DON concentrations in surface porewater, or peat microbial composition. Increasing N addition led to a switch from new N inputs being taken up primarily by Sphagnum to being taken up primarily by shrubs. MLPF responses to increasing N addition did not exhibit threshold triggers, but rather began as soon as N additions increased. Considering all responses to N addition, we recommend a critical load for poor fens in Alberta of 3 kg N ha−1 yr−1