דיאטה חושבה לבריאות. כדאי לשמור עליה .

לרדת במשקל

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דיאטת אטקינס זה לא בדיוק בריא ?

שומרי משקל

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תוכניות שותפים רק ככה מתחילים.

תוכנית שותפים

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וילונות חשובים למראה בית מעניין.

וילונות לבית

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ממש חשובה תזונה נכונה לבריאות.

חיטוב

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אומגה 3 חשובה לבריאות. כדאי לצרוך מהמזון.

קיצור קיבה

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קופירייטינג, חשוב מאוד בהצלחה שלך.

כתיבת מאמרים

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In Finland we have 21 organ donors / million people, which is a little above the average of the European Union but far too little compared with their demand. There are several things we need to do in order to increase the number of donors, and the first of them is detection: all possible organ donors should be recognised as such. However, one issue is consent. Even though 83 % of Finnish people would like to be organ donors in case of brain death, only 17 % have signed an organ donor card, and in about 20 - 30 % of cases the relatives decide against donation. Therefore, we are thinking about changing legislation to have a presumed consent: A person is considered to be a donor, unless there is indication that he/she would have objected to this during his/her lifetime.

Do you have presumed or explicit consent? If the former, what are your experiences?

Also, we would need to increase the number of live kidney donations. We may have been too hesitant about bringing up the issue of live donations, this in order to avoid undue pressure on the family. However, there is another side of the coin. The relative has a right to know that he could save someone by donating a kidney, and he might feel very bad if he wouldn`t do this for his child/wife/aunt. In Norway, 95 % of donors were later satisfied with their decision.

How do you approach this issue? Also, do you accept living liver donors? In Finland we don´t, because of the dangers to the donor.

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Some current data from Israel (The numbers and statistics are based on information from the Israeli National Center for Tranplantations):

On January 1st 2009 there were 923 Israelis waiting for Organ transplantation. In 2008 there were 280 Transplantation procedures performed in Israel, out of which 56 were kidney transplantation from a live donor and 2 were a liver segment transplantation from a live donor.

There are also a few hundred cornea transplantation performed in Israel each year.

The rate of people who carry a donor card amounts to about 10% of the population.
Even if a potential donor carries a donor card, it is costmary to request for an explicit consent of the deceased donor before harvesting organs for transplantation. In such cases the family''s consent rate is about 50%.

There were several suggestions in the past to pass a law of presumed consent, which were all denied for various reasons. Although the "opt out" system experience in countries such as spain suggest that such a system can dramatically improve availability of organs, it seems that the parliamentarians couldn''t form a strong bulk of supporters to this proposal and the new organ transplantation law from 2008 does not include this arrangement.

As far as live donations go:
Kidneys: Live donor kidney donation is considered of better success rate than harvesting a kidney from a dead donor and hence, Kidney donation which was first allowed from family members only is now allowed from any person donating for altruistic reasons.


Liver transplant: more than 30 live donor kidney transplantation were performed in
Israel since 1994, including donations from a parent to a child and from one grown family member to another.

An issus that is now being discussed in our National Center for Transplantation is the issue of transplantation in foreigners (non civilians and non residents such as tourists and people from other countries/territories). An important general consultation will be conducted next week and I will try to update this forum from this meeting.

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Interesting BMJ article about mechanism of consent (opt in or opt out). England has a opt in system for consent (citizens have to register for donation) and France (Europe too !) a "soft" opt out system.
The article: http://www.bmj.com/cgi/content/full/340/may04_1/c2188
My comment (reproduced from BMJ online): In their analysis(1), Bird and Harris propose to move to presumed consent to increase organ donation in UK. We would like to put an international perspective from France, a country that moved to presumed consent 34 years ago(2). All individuals are considered to consent to organ donation after death unless they recorded opposition whilst alive (Laws of Bioethics)(3). Interestingly, despite this encouraging policy that’s being advocated by the authors for their country, French refusal rates are still high with 32.2% in 2009(4), comparable to those currently observed in UK. Presumed consent failed to substantially increase the number of organs available in France.

Even more strikingly, the policy of presumed consent (or opt-out system) for organ donation is very difficult to apply in practice. Indeed, physicians are legally responsible for asking the patient''s family if the deceased had expressed opposition to organ donation. The boundaries between expressed opposition by the deceased and relatives’ refusal are extremely difficult for families and physicians to define. Therefore, relatives’ refusal often overrides the decision and presumed consent does not change this attitude.

Furthermore, recent public debate organized by the French government before a planned revision of the Laws of Bioethics has brought clear evidence that citizens misunderstand and distrust our current presumed consent system with the little known opt-out register(5). In order to guarantee an informed choice for organ donation, citizens have strongly expressed their support for the system to evolve to a more transparent and balanced opt-out and …opt-in register !

References

1. Bird SM, Harris J. Time to move to presumed consent for organ donation. BMJ. 2010;340:c2188.

2. French Parliament. Law N° 76-1181 of december 22th, 1976 on organ donation (Accessed on May 8th, 2010 at http://legifrance.gouv.fr/affichTexteArticle.do;jsessionid=945E5DEE5935970F302302A09EEBDC92.tpdjo13v_2?cidTexte=JORFTEXT000000699407&idArticle=LEGIARTI000006696422&dateTexte=19761223&categorieLien=cid#LEGIARTI000006696422)

3. French Parliament. Law n°2004-800 of August 6th, 2004. Art. L1232- 1. (Accessed on May 8th, 2020 at http://www.legifrance.gouv.fr/affichCodeArticle.do;jsessionid=2D4D089A94088A94717352D900278D32.tpdjo03v_3?idArticle=LEGIARTI000006686157&cidTexte=LEGITEXT000006072665&dateTexte=20080708)

4. The Agence de la biomédecine. Some important figures. (Accessed on May 8th, 2010 at http://www.agence-biomedecine.fr/agence/nationaux.html)

5. Final report. Les Etats Généraux de la bioéthique/Public debate about bioethics. (Accessed on May 8th, 2010 at http://www.etatsgenerauxdelabioethique.fr/uploads/rapport_final.pdf)

Competing interests: None declared

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Dr Gerald KIERZEK, MD, MPH, PhD
http://gkierzek.blog.lemonde.fr/

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