Tag: cardiac death

Bioethics News

First case of deceased donor uterine transplantation. It is a relevant medical and social issue

Being able to resolve the reproductive problems suffered by women who have no uterus – whether due to an organic cause or functional abnormality of the uterus – is unquestionably a major medical and social issue.

The two possible solutions to this problem are uterus transplantation or surrogacy, the latter solution presenting objective ethical difficulties.

Uterus transplants to date have been performed using living donors, with unpredictable outcomes. Now, the first case of deceased donor uterine transplantation performed in the United States has been published. The recipient of the uterus was a woman with Mayer-Rokitansky-Kuster-Hauser syndrome, that is, she had no uterus.

The journal Fertility and Sterility has disseminated a video describing the essential steps in this transplantation process, particularly as regards selection of a suitable donor with no history of infertility or uterine malformations. The death of the donor should be determined by presentation of brain death but not cardiac death. The authors concluded that: “Uterine transplantation, although currently experimental, has gained the potential to become the first true treatment for uterine factor infertility. This procedure can become a promising option for the approximately 1.5 million women worldwide for whom pregnancy is not possible because of the absence of the uterus or presence of a nonfunctional uterus. Deceased donor uterine transplantation will further serve to broaden accessibility for this treatment.”

Ethical approach

For our part, as the organ donor is a deceased person with brain death (see true definition of this death HERE), we see no ethical issue for this practice; on the contrary, it seems an encouraging medical prospect to resolve the reproductive problem of women who have no uterus or whose uterus is not functionally useful, although the risk-benefit balance must always be taken into account, especially as regards the surgical act.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The Very Early Embryo & Its Moral Signifiance

by Andrew J. Prunty

As technology and biological research continue to develop in the twenty-first century, it is necessary to address and further define the ethical considerations of embryonic research and the appropriate rights that may limit the extent of human research on zygotes, blastocysts, and fetal scientific advancement. Because the area of harvesting embryonic stem cells remains significantly undefined, both legally and morally, there are vastly different opinions between researchers and bioethicists, mainly because of ethical limitations, on the rights that should be granted to cells with the potential to develop into human beings and the consequences of neglecting significant scientific research or advancement.

Current laws in the United States differ at the federal and state level, but there is no consistency in recognizing human embryos as humans, or affording them the same legal rights granted to a child; in fact, legal precedent actually detracts certain rights from developing embryos, favoring a human’s ability to destroy a potential human being (i.e. Roe v. Wade[i]) or the categorization of embryos as property (i.e. Davis v. Davis[ii], A.Z. v. B.Z.[iii], Marriage of Dahl[iv], or Reber v. Reiss[v]). These case law samples suggest the courts’ inability to reach a conclusion as to what is the status of an embryo.

The debate is not only circumscribed to matters of research, but to fundamental controversial and intertwined issues of bioethics such as: when life begins, embryonic stem cells, fetal rights, abortion, et cetera. All these topics are contentious and when one topic arises, they begin to comingle.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Euthanasia & Organ Donation in Canada

National Post reports that since Canada decriminalized euthanasia in June 2016, 26 of the 338 patients who have died by lethal injection in Ontario chose to donate tissue or organs.  Lethal injection, which causes cardiac death in two or three minutes, allows organs to be removed much more quickly than after natural death, which results in better organs for transplants.  Organ retrieval after euthanasia is thus an attractive prospect for some physicians.

Once one accepts the premise of euthanasia, it is easy to justify harvesting organs from consenting patients.  As Dr. James Downar argues, “If we accept people can make decisions to end life, and we accept the idea of cardiac death being sufficient for organ donation, this should be acceptable.”

However, even some proponents of euthanasia are uncomfortable with the idea, voicing concern that the opportunity to help others might pressure some to end their lives.  Others point out that it would be very difficult for a patient to change his or her mind after the process of the donation has been started and recipients for the organs have been found.

As this article demonstrates, accepting the morality of euthanasia makes it increasingly difficult to explain why other medical practices should be off-limits.  Questions of autonomy, consent, and coercion become harder to navigate once the basic moral principle that physicians should not kill is overturned. Indeed, it is not a long logical step from retrieving organs after lethal injection to harvesting before cardiac death.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

“MAID” and organ donation

An article in the Journal of Medical Ethics (JME) assesses the ethical issues around organ donation by someone who requests assisted suicide or (“voluntary”) euthanasia.  (Subscription or purchase is required for access to the full article.)  The authors, specifically looking at the situation under current law in Canada, refer to assisted suicide and euthanasia with the blanket term “medical assistance in dying,” or “MAID” for short.  As if it’s truly a service…

It’s a logical step, if one accepts assisted suicide specifically or “MAID” more broadly.  It can readily be seen as a form of organ “donation after cardiac death” (DCD), in which people who have suffered severe neurologic injury but are not brain dead have their organs harvested after removal of life-supporting, intensive medical treatment.  In that case, the big issue is how long a doctor must wait to be sure someone has really died, so that the organ donation is not the cause of death.  But those folks are usually unconscious.  Rarely, someone with severe neurologic injury may be conscious, and could conceivably request removal of life support and consent to or request organ donation in the DCD setting.   I have previously added my voice on this blog to those who worry that DCD is at serious risk for jumping the gun.  (Google it if you will, I don’t immediately recall when I last posted on this.)

So of course, there are ethical “issues” (an awfully anodyne word) with this.  It’s seen as an exercise in autonomy but is the potential donor free from being pressured, or having his own life devalued, by himself or others, as merely a source of spare parts? 

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Study of Sudden Cardiac Death Exposes Limits of Genetic Testing

August 19, 2016

(NPR) – Scientists have discovered that a common cause of sudden heart death has been misunderstood because researchers didn’t appropriately account for racial differences in their studies. The findings, published online Wednesday in the New England Journal of Medicine, have implications far beyond this particular inherited disease, called hypertrophic cardiomyopathy, or HCM. Researchers say the results also sound a cautionary note for many other illnesses that have been identified through genetic markers.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In The Journals – April Part II by Michelle Pentecost

Another set of great papers from the journals in April. Enjoy!

 

 Social Science & Medicine

‘I knew before I was told’: Breaches, cues and clues in the diagnostic assemblage

 Louise Locock, Sarah Nettleton, Susan Kirkpatrick, Sara Ryan and Sue Ziebland

Diagnosis can be both a ‘diagnostic moment’, but also a process over time. This paper uses secondary analysis of narrative interviews on ovarian cancer, antenatal screening and motor neurone disease to explore how people relate assembling procedural, spatial and interactional evidence before the formal diagnostic moment. We offer the idea of a diagnostic assemblage to capture the ways in which individuals connect to and re-order signs and events that come to be associated with their bodies. Building on the empirical work of Poole and Lyne (2000) in the field of breast cancer diagnosis, we identify how patients describe being alerted to their diagnosis, either through ‘clues’ they report picking up (often inadvertently) or through ‘cues’, perceived as a more intentional prompt given by a health professional, or an organisational process. For patients, these clues frequently represent a breach in the expected order of their encounter with healthcare. Even seemingly mundane episodes or behaviours take on meanings which health professionals may not themselves anticipate. Our findings speak to an emergent body of work demonstrating that experiences of formal healthcare during the lead-up to diagnosis shape patients’ expectations, degree of trust in professionals, and even health outcomes.

 

Socio-economic divergence in public opinions about preventive obesity regulations: Is the purpose to ‘make some things cheaper, more affordable’ or to ‘help them get over their own ignorance’?

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Screening Athletes for Heart Problems Does More Harm Than Good, Say Experts

April 21, 2016

(The Guardian) – The results, they argue, offer little support for the notion that screening saves lives. In an American study, they report, examining personal and family histories and carrying out a physical examination only raised suspicions of a heart disease in 3% of athletes who went on to die suddenly. The use of ECGs, the authors add, is also flawed and would not identify 25% of those who have a disease that could cause sudden cardiac death. What’s more, for the most common conditions picked up at screening, the majority of people “will never experience any symptoms and lead a normal life if the disease is left undetected,” they write.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Investigating Two Claims Against Planned Parenthood: Center of Medical Progress’s Secret Videos

by Craig Klugman, Ph.D.

Before you being reading, I have a disclaimer: Growing up, my mother worked for Planned Parenthood. As a nurse, she practiced in their clinics offering well women services, counseling, and contraception. After many years, she went on to direct their clinic’s in vitro fertilization program. I also heard the word “Planned Parenthood” stated with a quick northeastern accent. Said that way, as a child, I thought the place was called “Plant Parenthood” and wondered what plants had to do with women’s health.

Ironically, despite the numerous bomb threats while she worked there, her clinic did not perform abortions. I always viewed my mom as doing important community health work for women who could not get services elsewhere because of finances, lack of education, or living in fearful relationships.

By now you have seen parts of the Center for Medical Progress’s videos regarding secretly recorded conversations with two leaders from Planned Parenthood. In their original release (8:51 minutes), the videos were edited to appear to show that Planned Parenthood was selling fetal organs—an illegal and unethical enterprise. As the full video (2:42:22 hours) was released, it became clear that Planned Parenthood was donating organs and only requested to receive reimbursement to cover their costs for preparing and donating the fetal tissue—a legal and (debatably) ethical enterprise.

The Center for Medical Progress pretended to be a biologics company and secretly recorded these conversations. It is a bit of a mysterious organization. They list a postal box as their address. They claim a 30-month investigation, but did not exist on the Internet until a few weeks ago.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Organ donation should be encouraged in China

Organ donation in China is still a limited practice, so legal regulations have been enacted to try to encourage it. There were 1441 donations between 2010 and 2013 (after cardiac death was diagnosed in the donor), and 3903 organs were transplanted. If we consider that there are 846,510 violent deaths in China each year, we can infer that the number of donors could increase significantly (The Lancet 383; 1791-1792, 2014).

La entrada Organ donation should be encouraged in China aparece primero en Observatorio de Bioética, UCV.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Drug Discovery from A to Z … Arrhythmias to Zebrafish!

Healthy and mutated zebrafish

Caption: Healthy zebrafish (top) compared to zebrafish with arrhythmia-causing mutation (bottom). Their hearts are shown to the right, with enlargement indicating a weaker heart. The heart’s outflow tract is marked OFT; atrium, a; and ventricle, v.
Credit: Asimaki et al. Science Translational Medicine

Arrhythmia is a condition in which the heart loses its regular rhythm, beating either too rapidly or too slowly. Occasional irregular heartbeats are harmless, but if sustained they can cause dizziness, fainting, and even sudden death. There are a number of drugs available that can prevent arrhythmias, but none are perfect. Implanted devices can help—pacemakers can keep the heart from beating too slowly, and defibrillators can reset the heart’s rhythm with an electrical shock if a dangerously rapid rhythm develops.

But new treatments are needed. Now, an NIH-funded research team has created an animal model that is advancing efforts to find new drugs to prevent arrhythmia.  Led by Jeffrey Saffitz at Beth Israel Deaconess Medical Center, Boston, researchers used genetic engineering techniques to produce zebrafish with genetic mutations identical to those in some people who suffer from a rare inherited disease called arrhythmogenic cardiomyopathy (ACM). In humans, ACM leads to dangerous arrhythmias that can cause sudden cardiac death, usually in people under the age of 35.

The genetic mutations responsible for ACM disrupt proteins that make up the desmosome, which is a cellular junction structure that glues heart cells together and is vital for proper electrical signaling and regular heartbeats. Microscopic exams of ACM patients’ hearts show that many muscle cells have been replaced with fat and scar tissue.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.