Electrospinning of nanofibres for construction of vital organ replacements

This paper described the production of a novel biosynthetic material using the manufacturing technique of electro spinning for the construction of scaffold for organ replacement. This electrostatic technique uses an electric field to control the deposition of polymer fibres onto a specific substrate to fabricate fibrous polymer constructs composed of fibre diameters ranging from several microns down to 100 nm or less. Two areas of research, in particular, heart valve leaflets and blood vessel will be discussed. Here, a sandwich structure nanofibre mesh was used to construct materials for leaflets of heart valve and blood vessel. In the case of heart valve leaflet, the randomly oriented polyurethane nanofibres were prepared as the first layer, followed by gelatin-chitosan complex layer. Complex nanofibres were initially used to spin on the PU layer with cross orientation to mimic the fibrosa layer. A gelatin and chitosan complex was then spun onto the other side of PU nanofibre mesh to mimic the ventricularis layer. This particular sandwich structure using the PU layer was designed to simulate the mechanical properties of natural tissue. In addition, this design was aimed to provide good biocompatibility and improved cellular environment to assist in adhesion and proliferation. Smooth muscle cells adhered and flattened out onto the surface of the gelatin-chitosan complex as early as 1 day post seeding. There is great potential for this biosynthetic biocompatible nanofibrous material to be developed for various clinical applications.

Protection behaviour : a phenomenon affecting organ and tissue donation in the 21st century?

UK statistics show that whilst waiting lists for transplantation surgery continue to increase, donor numbers are static. This paper describes the hermeneutic phase of a mixed method study and puts forward the concept of protection behaviour as one explanation for nurses’ reticence to discuss post-mortem donation wishes with patients’ relatives. The desire to protect appears to influence attitudes, confidence levels and perceived ability to become involved in donor identification and donation discussion, consequently affecting the availability of transplantable organs and tissue. By understanding more fully why protective behaviours are employed, it increases the likelihood of a solution being found.

Trapped in white space : the allegations and denials of organ trafficking

Allegations of body parts trafficking implicating the West have been surfacing persistently in the media of many non Western countries for almost 20 years. Western media has responded to the allegations with denials and denunciations. This thesis considers the competing accounts and places them in a framework for analysis.

Converting potential organ donors : a situational analysis of Australian physicians

This theory-building research suggests that the key to unlocking Australia's potential organ donor pool is to reduce the ethical ambiguity and legal uncertainty plaguing physicians' interepretation of the patients's best interests standard. This may generate a greater acceptance of organ donation as part of end-of-life patient care amongst our physicians.

A profile of Australian adults who have discussed their posthumous organ donation wishes with family members

Next of kin who are aware of the deceased's organ donation wishes usually will honor those wishes, while next of kin who are unaware of these wishes typically withhold consent for posthumous donation. Encouraging individuals to communicate or register their organ donation wishes is therefore important. Using a sample of 409 participants, the current study sought to develop a profile of Australian adults who had communicated their organ donation wishes to family members. Christian participants and those who had a higher income were more likely to have communicated their donation wishes. Conversely, participants were less likely to have communicated their donation wishes if they were unregistered and undecided/opposed to organ donation, unregistered but willing to donate, or fearful of death. Finally, whether participants had communicated, registered, or communicated and registered their donation wishes was associated with their age, religion, attitude toward organ donation, and recall of media content about organ donation. Messages encouraging the communication of organ donation wishes to family members should therefore be targeted toward those individuals who are most likely to be receptive toward enacting this behavior.

The organ of repetition

This paper considers the practice of learning-by-heart and argues for its relevance to learning, to thought (as defined by Gilles Deleuze) and as a way of turning towards the ‘new’ or ‘the future’, via the operation of repetition. It considers two modes in which rote learning can be productive and provocative—firstly, when the content itself is something worth retaining, and secondly, when the actual process of the learning itself and then the repeating align themselves with the criteria of ‘practice’, as framed by the author here. In the face of rote learning’s reputation as an out-moded pedagogical tool, the paper argues that it inhabits a paradoxical and productive site, whereby what begins as a repetition of the same, can open towards pure repetition (as Deleuze frames this notion), and facilitate inventiveness and a courting of the new. In this way, poetry, and the learning of it by rote, constitute a unique constellation, disputing the platitude that learning is ‘only discovering what one already knew’ and instead proposing that learning is closer to an awesome ordeal, one that leads to concepts and collisions that did not exist before and cannot be predicted in advance.

Understanding organ donation in the collaborative era: a qualitative study of staff and family experiences

BACKGROUND: Despite the success of the Breakthrough Collaborative Methodology (BCM) in increasing organ donation rates there has been little published evidence on the effect of the BCM on the wider attitudes and experiences of those involved in organ donation. This study sought to identify whether the National Organ Donation Collaborative in Australia had any additional influence on improving the experiences of staff and family members in the organ donation process. METHODS: IN-depth qualitative interviews with 17 family members from 13 families who had agreed to the organ donation of a deceased relative and 25 nurses and intensive care specialists at the Alfred Hospital, Melbourne, Victoria were carried out. RESULTS: The key factor in family members' decision to donate was prior knowledge of the deceased's donation wish. Although most family members did not regret their decision to donate, many were deeply dissatistified and, at times, confused by the technical and administrative nature of the donation process. Most staff members commented that the key community message about donation should be to encourage people to discuss donation rather than urging people to sign donor registers. CONCLUSION: This study identified valuable insights into the processes by which family members and intensive care unit staff deal with the actual processes of donation. Findings suggest that the process for families is far more complex than a simple agreement or refusal to donate. This study suggests that we should not assume that 'rates' of donation in Australia would increase merely through administrative programmes or marketing campaigns.

Implementation of China's new policies on organ procurement: An important but challenging step forward

In the last decade, health authorities in China have made a series of policy announcements concerning organ procurement programs and changes in practice have been intermittently reported (1). The international community of transplant professionals has followed these reports closely, preoccupied with one fundamental issue: the procurement of organs from executed prisoners, a practice that for many years has provided the majority of organs transplanted in China. Sharif et al. describe this practice as “ethically indefensible” (2), an evaluation that reflects the position embraced by the international community for more than two decades (3-5). Sharif et al. express concern that whilst some transplant programs in China have ceased using organs from executed prisoners, others continue to do so, and that all organs procured from the deceased may be allocated through a collective pool as part of the new China Organ Transplant Response System, effectively “laundering” organs obtained from prisoners. They also note that one of the new strategies to encourage deceased donation of organs among the Chinese public has involved financial incentives for donor families, another practice that has been strongly critiqued by the international professional community and global health authorities (6,7).

In China and in the United States, proponents of organ procurement from executed prisoners have argued that prisoners should not be denied the option to donate organs after their death if they so choose, as this may provide them or their families solace and an opportunity for moral, spiritual or social redemption (8,9). However, the predominant argument in favour of the practice appears to be essentially pragmatic: prisoners condemned to death represent an additional pool of potential “donors” with organs that will otherwise “go to waste” (10). In contrast, international professional societies and the World Health Organization among others have argued that the practice not only violates the core principles of medical ethics but also thereby undermines efforts to establish a sufficient supply of deceased donor organs. In this commentary, we reaffirm the ethics policy of The Transplantation Society (TTS) concerning organ procurement from executed prisoners (4), and briefly discuss the implications of this policy for international professional engagement with China at this time of significant evolution of Chinese organ procurement programs.

Living and deceased organ donation should be financially neutral acts

The supply of organs—particularly kidneys—donated by living and deceased donors falls short of the number of patients added annually to transplant waiting lists in the United States. To remedy this problem, a number of prominent physicians, ethicists, economists and others have mounted a campaign to suspend the prohibitions in the National Organ Transplant Act of 1984 (NOTA) on the buying and selling of organs. The argument that providing financial benefits would incentivize enough people to part with a kidney (or a portion of a liver) to clear the waiting lists is flawed. This commentary marshals arguments against the claim that the shortage of donor organs would best be overcome by providing financial incentives for donation. We can increase the number of organs available for transplantation by removing all financial disincentives that deter unpaid living or deceased kidney donation. These disincentives include a range of burdens, such as the costs of travel and lodging for medical evaluation and surgery, lost wages, and the expense of dependent care during the period of organ removal and recuperation. Organ donation should remain an act that is financially neutral for donors, neither imposing financial burdens nor enriching them monetarily.

The Doha model of organ donation and transplantation: thinking beyond citizenship

This paper reviews the policy and practice of organ donation and transplantation in Qatar that has developed since January 2011. The important features of the Doha Model (the ‘Model’) are explored, including: (i) all legal residents of Qatar have an equal right to access deceased donor organs and transplantation regardless of their citizenship status; (ii) no prioritisation in organ allocation is given to Qatari citizens; (iii) a multilingual and multicultural education and promotional program about donation has been implemented to engage the diverse national communities resident within Qatar; (iv) financial incentives or fungible rewards for living or deceased donation are prohibited. The ethical framework of this policy will be examined in the light of the national self-sufficiency paradigm, which advocates reciprocity and solidarity among resident populations seeking to meet all needs for transplantation equitably. We review some preliminary evidence of the impact of the Model with respect to engagement of a highly diverse multinational population in a donation and transplantation program, and argue that the Model may inform policy and practice in other countries, particularly those with non-citizen resident populations.