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Moonajilin MS, Banik R, Islam MS, Ishadi KS, Hosen I, Gesesew HA, Ward PR. Understanding the Public's Viewpoint on Organ Donation Among Adults in Bangladesh: An Exploratory Cross-Sectional Study. Health Sci Rep 2024; 7:e70254. [PMID: 39698525 PMCID: PMC11652383 DOI: 10.1002/hsr2.70254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 11/08/2024] [Accepted: 11/15/2024] [Indexed: 12/20/2024] Open
Abstract
Background and Aims Organ donation is the last option for patients with end-stage organ failure, but the number of people in need of transplantation outweighs the supply of donor organs. A thorough analysis of public understanding is required to design educational programs that increase public commitment to organ donation. Therefore, the present study aimed to explore Bangladeshi adults' understanding, attitudes, and willingness towards organ donation, while also investigating the sources of information, gender-specific knowledge, intentions, and the factors influencing their decisions. Methods A cross-sectional survey was conducted between October 15 and November 25, 2021, using a non-probability convenience sampling technique. Data were analysed using both descriptive and inferential statistics. Results Among 592 participants, only 35.8% were knowledgeable about organ donation. Internet/online sources were the most reported source of knowledge (37.8%), followed by social media (36%). Despite having limited knowledge, 63.7% had a positive attitude, with females demonstrating a more positive attitude than males (β = 0.09, p = 0.024). Males were significantly more likely than females to follow Bangladesh's specific organ donation laws (29.3% vs. 25%, p = 0.004). Besides, 48.6% of females, compared to 40.4% of males, believe that the health service related to organ donation in Bangladesh is ineffective (p = 0.016). More than one-third (35.1%) of the participants indicated a willingness to donate their organs after death. The participants' significant barriers to organ donation were found to be family objections (40.4%), health complications (34.4%), fear of disfigurement (31.1%), and religious barriers (26.8%). Conclusion Although Bangladeshi adults have a positive attitude regarding organ donation, they lack adequate knowledge, which renders them unlikely to be eager to donate organs. Therefore, it is crucial to update policy within a sociocultural framework to boost organ donation for transplantation. National education campaigns and awareness-raising events should be held in Bangladesh to increase public knowledge of organ donation and transplants.
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Affiliation(s)
| | - Rajon Banik
- Department of Public Health and InformaticsJahangirnagar UniversitySavarBangladesh
| | - Md. Saiful Islam
- Department of Public Health and InformaticsJahangirnagar UniversitySavarBangladesh
| | | | - Ismail Hosen
- Department of Public Health and InformaticsJahangirnagar UniversitySavarBangladesh
| | - Hailay Abrha Gesesew
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
- Department of Epidemiology, School of Health SciencesMekelle UniversityMekelleEthiopia
| | - Paul R. Ward
- Centre for Health Policy ResearchTorrens UniversityAdelaideSouth AustraliaAustralia
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Abstract
In 1999, the Bangladesh government introduced the Human Organ Transplantation Act allowing organ transplants from both brain-dead and living-related donors. This Act approved organ donation within family networks, which included immediate family members such as parents, adult children, siblings, uncles, aunts, and spouses. Subsequently, in January 2018, the government amended the 1999 Act to include certain distant relatives, such as grandparents, grandchildren, and first cousins, in the donor lists, addressing the scarcity of donors. Nobody, without these relatives, is legally permitted to donate organs for transplantation in Bangladesh. The focus of this study was to investigate who should donate organs for transplantation in Bangladesh. The ethnographic fieldwork revealed that potential donors are not always available to immediate family members, and even when they are, they might be medically unsuitable for transplants. These considerations influenced the government in the revision of the Act. Secondly, the findings of the study suggest maintaining the current family-based regulations for living organ donation in Bangladesh. Furthermore, the study highlighted a potential consequence: amending the regulation to permit donations to unrelated recipients could significantly amplify the issue of organ selling and buying. While Islam advises Muslims to be compassionate towards all humankind, it also encourages Muslims to prioritize saving the lives of family members. This religious belief limits Muslims from donating organs to family members.
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Affiliation(s)
- Md Sanwar Siraj
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
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Vincent BP, Sood V, Thanigachalam S, Cook E, Randhawa G. Barriers and Facilitators Towards Deceased Organ Donation: A Qualitative Study Among Three Major Religious Groups in Chandigarh, and Chennai, India. JOURNAL OF RELIGION AND HEALTH 2024; 63:4303-4322. [PMID: 39369372 DOI: 10.1007/s10943-024-02148-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/25/2024] [Indexed: 10/07/2024]
Abstract
This study aimed to examine the barriers and facilitators of the public toward deceased organ donation in Chandigarh, and Chennai, India, from three major religious groups, Hinduism, Islamism, and Christianity. Twenty-five focus groups were conducted (n = 87) stratified by study region, religion, sex, and age. Data were analysed using framework analysis. The results revealed that individuals were primarily willing to donate their organs. However, their religious views regarding death, after-life beliefs, funeral ritual practices, and lack of knowledge regarding their religion's position toward deceased organ donation created tension and ambiguity in the decision-making. However, younger age groups (18-30 years) appeared more open and positive toward deceased organ donation. The conclusion demands a clear need for religious leaders and stakeholders to address their religion's stance, which creates tension and ambiguity in any uncertainties surrounding cultural and religious-based views among the Indian population.
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Affiliation(s)
- Britzer Paul Vincent
- Institute for Health Research, Faculty of Health and Social Sciences, University of Bedfordshire, Putteridge Bury Campus, Hitchin Road, Luton, LU2 8LE, UK
| | - Vibhusha Sood
- OHUM Healthcare Solutions Private Ltd, Pune, 411014, India
| | - Srinivasan Thanigachalam
- Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Madurai, Tamil Nadu, 625006, India
| | - Erica Cook
- Department of Psychology, University of Bedfordshire, Vicarage Street, Luton, LU1 3JU, UK
| | - Gurch Randhawa
- Institute for Health Research, Faculty of Health and Social Sciences, University of Bedfordshire, Putteridge Bury Campus, Hitchin Road, Luton, LU2 8LE, UK.
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Bharadwaj HR, Tan JK, Ali SH, Shah MH, Nicholas A, Ahmed KAHM, Irfan K, Dalal P, Mehta A, Awuah WA, Dhali A. Exploring the current provision of pancreatic transplantations in low- and middle-income countries: Current landscape, challenges, future prospects. World J Gastrointest Pathophysiol 2024; 15:94590. [DOI: 10.4291/wjgp.v15.i6.94590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 10/06/2024] [Accepted: 10/22/2024] [Indexed: 11/19/2024] Open
Abstract
This comprehensive review addresses the global health challenge of disparities in pancreas transplant access, particularly in low- and middle-income countries (LMICs) compared to high-income countries. Despite advancements in surgical techniques and immunosuppression for procedures like simultaneous pancreas-kidney, pancreas-after-kidney, and pancreas-transplant alone, LMICs face significant challenges, including limited infrastructure, financial constraints, and a shortage of skilled medical professionals. Donation after brain death remains constrained by sociocultural barriers. Region-specific analyses highlight progress in Latin America, Asia, Russia, and South Africa, showcasing the regional disparities in access and outcomes. Future prospects involve minimally invasive surgeries, telemedicine for enhanced post-operative care, international collaborations with organizations like the European Union of Medical Specialists, and robust funding networks to improve organ availability. In conclusion, the review underscores the importance of multifaceted strategies to address economic, sociocultural, and infrastructural barriers, aiming to improve accessibility, quality, and effectiveness of pancreas transplantation services in LMICs.
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Affiliation(s)
- Hareesha Rishab Bharadwaj
- Faculty of Biology Medicine and Health, University of Manchester, Manchester M13 9PL, United Kingdom
| | - Joecelyn Kirani Tan
- Faculty of Medicine, University of St Andrews, St Andrews KY16 9AJ, United Kingdom
| | - Syed Hasham Ali
- Faculty of Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Muhammad Hamza Shah
- School of Medicine, Queen's University Belfast, Belfast BT7 1NN, United Kingdom
| | - Aderinto Nicholas
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomosho 210214, Oyo, Nigeria
| | | | - Khansa Irfan
- School of Medicine, University of Central Lancashire, Preston PR2 1SG, United Kingdom
| | - Priyal Dalal
- School of Medicine, University of Central Lancashire, Preston PR2 1SG, United Kingdom
| | - Aashna Mehta
- Faculty of Medicine and Surgery, University of Debrecen, Debrecen 4032, Hungary
| | | | - Arkadeep Dhali
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield S10 2JF, United Kingdom
- School of Medicine and Population Health, University of Sheffield, Sheffield S10 2HQ, United Kingdom
- Deanery of Clinical Sciences, The University of Edinburgh, Edinburgh EH16 4SB, United Kingdom
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LN, United Kingdom
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Siraj S. Family-Oriented Living Organ Donation in Bangladesh: A Bioethical Defence. JOURNAL OF BIOETHICAL INQUIRY 2024; 21:415-433. [PMID: 39037640 DOI: 10.1007/s11673-024-10361-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 03/18/2024] [Indexed: 07/23/2024]
Abstract
This study focuses on issues related to living organ donation for transplantation in Bangladesh. The policy and practice of living organ donation for transplantation in Bangladesh is family-oriented: close relatives (legal and genetic) are the only ones allowed to be living donors. Unrelated donors, altruistic donors (directed and non-directed), and paired/pooled or non-directed altruistic living donor chains-as many of these are implemented in other countries-are not legally allowed to serve as living donors in Bangladesh. This paper presents normative arguments explaining why the family-oriented nature of regulations and practices surrounding living organ donation for transplantation is essential for Bangladesh. In this article, I specifically argue that if the Bangladesh government revises the current biomedical policy robustly beyond relatives and allows unrelated donors to donate organs legally, this may foster organ selling due to the poverty and corruption problems in Bangladesh. The family-oriented requirement of the living organ donation policy and practice is defensible and morally justifiable as it preserves common notions of the family unit and family bonding in Bangladesh. Maintaining the current living-donation regulations and promoting deceased donation is the way forward, as this safely preserves the family values, protects against organ selling, and increases access to organ transplantation.
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Affiliation(s)
- S Siraj
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
- Centre for Medical Ethics and Law, Faculty of Law and Li Ka Shing Faculty of Medicine, Medical Ethics and Humanities Unit, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Shatin, Hong Kong SAR.
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Gadelkareem RA, Abdelgawad AM, Mohammed N, Zarzour MA, Khalil M, Reda A, Hammouda HM. Challenges to establishing and maintaining kidney transplantation programs in developing countries: What are the coping strategies? World J Methodol 2024; 14:91626. [PMID: 38983660 PMCID: PMC11229866 DOI: 10.5662/wjm.v14.i2.91626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/31/2024] [Accepted: 03/12/2024] [Indexed: 06/13/2024] Open
Abstract
Kidney transplantation (KT) is the optimal form of renal replacement therapy for patients with end-stage renal diseases. However, this health service is not available to all patients, especially in developing countries. The deceased donor KT programs are mostly absent, and the living donor KT centers are scarce. Single-center studies presenting experiences from developing countries usually report a variety of challenges. This review addresses these challenges and the opposing strategies by reviewing the single-center experiences of developing countries. The financial challenges hamper the infrastructural and material availability, coverage of transplant costs, and qualification of medical personnel. The sociocultural challenges influence organ donation, equity of beneficence, and regular follow-up work. Low interests and motives for transplantation may result from high medicolegal responsibilities in KT practice, intense potential psychosocial burdens, complex qualification protocols, and low productivity or compensation for KT practice. Low medical literacy about KT advantages is prevalent among clinicians, patients, and the public. The inefficient organizational and regulatory oversight is translated into inefficient healthcare systems, absent national KT programs and registries, uncoordinated job descriptions and qualification protocols, uncoordinated on-site investigations with regulatory constraints, and the prevalence of commercial KT practices. These challenges resulted in noticeable differences between KT services in developed and developing countries. The coping strategies can be summarized in two main mechanisms: The first mechanism is maximizing the available resources by increasing the rates of living kidney donation, promoting the expertise of medical personnel, reducing material consumption, and supporting the establishment and maintenance of KT programs. The latter warrants the expansion of the public sector and the elimination of non-ethical KT practices. The second mechanism is recruiting external resources, including financial, experience, and training agreements.
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Affiliation(s)
- Rabea Ahmed Gadelkareem
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Amr Mostafa Abdelgawad
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Nasreldin Mohammed
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mohammed Ali Zarzour
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mahmoud Khalil
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Ahmed Reda
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Hisham Mokhtar Hammouda
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
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Siraj MS. Living Organ Donation for Transplantation in Bangladesh: Reality and Problems. HEC Forum 2024; 36:207-243. [PMID: 36355267 DOI: 10.1007/s10730-022-09500-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
Abstract
The stipulation of living organ transplantation policy and practice in Bangladesh is family-oriented, with relatives being the only people legally eligible to donate organs. There have been very few transplantations of bone marrows, liver lobes, and kidneys from related-living donors in Bangladesh. The major question addressed in this study is why Bangladesh is not getting adequate organs for transplantation. In this study, I examin the stipulations of the policy and practice of living organ donation through the lens of 32 key stakeholders including physicians and nurses, a health administrator, organ donors and recipients, and their family members, as they can shed light on the realities and problems of organ donation for transplantation in Bangladesh. My ethnography reveals that the family members are always encouraged to donate organs for transplantation, and saving the lives of relatives through organ donation is seen as a moral obligation. Many view saving the life of a relative by donating one's organs as equivalent to saving one's own life. An assessment of the dynamics of biomedicine, religion, and culture leads to the conclusion that the family-oriented organ donation policy and practice have been widely endorsed and accepted in Bangladesh, and Islamic ethical principles and collective family ethos undergird that policy and practice. However, the unavailability of medical resources, lack of post-operative coverage for organ donors, religious misconceptions and unawareness of the general public, and the absence of posthumously donated vital organs for transplantation are perceived to be the most common barriers to a successful living donor-recipient pair organ transplantation. By overcoming these obstacles, Bangladesh can develop a successful living donor-recipient pair organ transplantation program that will ensure improved healthcare outcomes, promote altruism and solidarity among Bangladeshi families, and protect the poor from having their organs sold to wealthy patients.
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Affiliation(s)
- Md Sanwar Siraj
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.
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Silva AMD, Benites PT, Zulin MEG, Ferreira Júnior MA, Cardoso AIDQ, Cury ERJ. Global legislation regulating the donation, procurement and distribution processes of organs and tissues from deceased donors for transplants: A scoping review. Heliyon 2024; 10:e26313. [PMID: 38375299 PMCID: PMC10875591 DOI: 10.1016/j.heliyon.2024.e26313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction Organ transplantation is one of the most successful advances in modern medicine. However, a legal system is necessary for its practice to be free from ethical flaws and to respect donors, recipients, and family members. Objective To map the global legislation regulating the donation, capture and distribution processes of organs and tissues from deceased donors for transplants. Method A scoping review according to the Joanna Briggs Institute was conducted in the following databases: Medline, CINAHL, Virtual Health Library, SCOPUS, Web of Science, Science Direct, and EMBASE, as well as gray literature, and reported according to the PRISMA extension for scoping reviews. Results We identified 3302 records, of which 77 were analyzed which enabled mapping the type of consent adopted and the existence of current legislation for harvesting organs and tissues after circulatory and brain death. Conclusion Opt-out consent predominates in Europe, and there is harvesting after brain and circulatory death. Opt-out predominates in the Americas, while Opt-in and harvesting of organs and tissues after brain death predominate in Asia and Oceania. The procurement of organs and tissues from deceased donors is practically non-existent in Africa.
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Affiliation(s)
- Aline Moraes da Silva
- Doctoral student in Health and Development of the Midwest Region at the Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | | | - Marcos Antonio Ferreira Júnior
- Graduate and Post-Graduation Program in Nursing, Integrated Health Institute, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | - Elenir Rose Jardim Cury
- Post-Graduation Program in in Health and Development of the Midwest Region at the Federal University of Mato Grosso do Sul, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
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Machry M, Ferreira LF, Lucchese AM, Kalil AN, Feier FH. Liver volumetric and anatomic assessment in living donor liver transplantation: The role of modern imaging and artificial intelligence. World J Transplant 2023; 13:290-298. [PMID: 38174151 PMCID: PMC10758682 DOI: 10.5500/wjt.v13.i6.290] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/17/2023] [Accepted: 10/17/2023] [Indexed: 12/15/2023] Open
Abstract
The shortage of deceased donor organs has prompted the development of alternative liver grafts for transplantation. Living-donor liver transplantation (LDLT) has emerged as a viable option, expanding the donor pool and enabling timely transplantation with favorable graft function and improved long-term outcomes. An accurate evaluation of the donor liver's volumetry (LV) and anatomical study is crucial to ensure adequate future liver remnant, graft volume and precise liver resection. Thus, ensuring donor safety and an appropriate graft-to-recipient weight ratio. Manual LV (MLV) using computed tomography has traditionally been considered the gold standard for assessing liver volume. However, the method has been limited by cost, subjectivity, and variability. Automated LV techniques employing advanced segmentation algorithms offer improved reproducibility, reduced variability, and enhanced efficiency compared to manual measurements. However, the accuracy of automated LV requires further investigation. The study provides a comprehensive review of traditional and emerging LV methods, including semi-automated image processing, automated LV techniques, and machine learning-based approaches. Additionally, the study discusses the respective strengths and weaknesses of each of the aforementioned techniques. The use of artificial intelligence (AI) technologies, including machine learning and deep learning, is expected to become a routine part of surgical planning in the near future. The implementation of AI is expected to enable faster and more accurate image study interpretations, improve workflow efficiency, and enhance the safety, speed, and cost-effectiveness of the procedures. Accurate preoperative assessment of the liver plays a crucial role in ensuring safe donor selection and improved outcomes in LDLT. MLV has inherent limitations that have led to the adoption of semi-automated and automated software solutions. Moreover, AI has tremendous potential for LV and segmentation; however, its widespread use is hindered by cost and availability. Therefore, the integration of multiple specialties is necessary to embrace technology and explore its possibilities, ranging from patient counseling to intraoperative decision-making through automation and AI.
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Affiliation(s)
- Mayara Machry
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
| | - Luis Fernando Ferreira
- Postgraduation Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
| | - Angelica Maria Lucchese
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
| | - Antonio Nocchi Kalil
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
- Postgraduation Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
| | - Flavia Heinz Feier
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
- Postgraduation Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
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Atreya A, Bastola P, Bhandari S, Nepal S, Bhandari PS. Brain Death and Organ Transplantation in Nepal: Navigating Cultural, Legal, and Ethical Landscapes. Transpl Int 2023; 36:11882. [PMID: 38089003 PMCID: PMC10713729 DOI: 10.3389/ti.2023.11882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/10/2023] [Indexed: 12/18/2023]
Abstract
Organ transplantation after brain death is challenging in Nepal due to cultural beliefs, legal frameworks, and ethical considerations. The Human Body Organ Transplantation (Regulation and Prohibition) Act (HBOTA) has not met with substantial success after its amendment. This review critically appraises the current state of brain death and organ transplantation in Nepal. It explores challenges, evaluates progress, and provides recommendations. Literature review of databases was conducted to find articles on brain death, organ donation, and transplantation in Nepal. Analysis of cultural, legal, ethical, and practical factors influencing implementation. Key challenges include limited awareness, religious beliefs, infrastructure gaps, and family consent barriers. HBOTA amendments in 2016 enabled brain death donations, however, donation rates remain low. Strategies are needed to improve public education, resources, personnel training, and collaboration. Cultural sensitivity and stakeholder engagement are crucial. A multifaceted approach addressing cultural, legal, ethical and practical dimensions is essential to improve organ donation rates in Nepal. Despite progress, substantial challenges persist requiring evidence-based strategies focused on awareness, capacity building, policy improvements, and culturally appropriate community engagement.
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Affiliation(s)
- Alok Atreya
- Department of Forensic Medicine, Lumbini Medical College, Palpa, Nepal
| | - Priska Bastola
- Department of Cardiothoracic and Vascular Anaesthesiology, Maharajgunj Medical Campus, Kathmandu, Nepal
| | | | - Samata Nepal
- Department of Community Medicine, Lumbini Medical College, Palpa, Nepal
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Soqia J, Alhomsi R, Ataya J, Al-Mashhour O, Hamzeh F, Hamwy R, Sulayman S, Alhomsi N, Hamzeh A. Clearing the path to vision restoration: an analysis of attitudes and associated factors towards cornea donation in Syria. BMJ Open Ophthalmol 2023; 8:bmjophth-2023-001290. [PMID: 37278433 DOI: 10.1136/bmjophth-2023-001290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/16/2023] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE This study aims to assess attitudes and associated factors towards cornea donation among visitors of a main public hospital in Damascus. Findings of this study can contribute to the development of effective donation campaigns and applying cornea donation in Syria. METHODS This cross-sectional study included individuals who were above 18 years old and were visitors of Al-Mouwasat University Hospital in Damascus, Syria. Data were gathered using a questionnaire administered through face-to-face interviews with the participants. A validated questionnaire was used and consisted of three sections: demographic information, awareness assessment and evaluation of participants' attitudes towards corneal donation. Associations between participants' demographics and variables were tested using χ2 test, and a p value of <0.05 was considered significant. RESULTS 637 participants were randomly interviewed. 70.8% of the sample were female and 45.7% have heard about cornea donation. 68.3% of the participants accepted donation of their cornea after death, but this decreased to 56.2% when it comes to donation from relatives after their death. The main reasons for refusing and accepting cornea donation were religious beliefs (10.8%) and intention to help others (65.8%), respectively. Women were more likely to accept donation after death than men (71.4% vs 60.8%, p=0.009). Finally, acceptance of cornea donation would increase if participants lived in a more developed country (71.7% vs 68.3%). CONCLUSION Despite the high willingness, corneal donation in Syria is still not enough. Corneal donation requires an ensured donation system that supports and organises the processes, a simplified education about the importance of donation, and clarifying the right instructions of religion.
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Affiliation(s)
- Jameel Soqia
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Rawan Alhomsi
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
- Department of Ophthalmology, Al Baath University, Homs, Syrian Arab Republic
| | - Jamal Ataya
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Obaida Al-Mashhour
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
- Department of Ophthalmology, Damascus University, Damascus, Syrian Arab Republic
| | - Farah Hamzeh
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Romeo Hamwy
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Siba Sulayman
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Nadimah Alhomsi
- Faculty of Medicine, Al Baath University, Homs, Syrian Arab Republic
| | - Ammar Hamzeh
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
- Department of Ophthalmology, Damascus University, Damascus, Syrian Arab Republic
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Siraj MS. How a compensated kidney donation program facilitates the sale of human organs in a regulated market: the implications of Islam on organ donation and sale. Philos Ethics Humanit Med 2022; 17:10. [PMID: 35897010 PMCID: PMC9331153 DOI: 10.1186/s13010-022-00122-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/05/2022] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Advocates for a regulated system to facilitate kidney donation between unrelated donor-recipient pairs argue that monetary compensation encourages people to donate vital organs that save the lives of patients with end-stage organ failure. Scholars support compensating donors as a form of reciprocity. This study aims to assess the compensation system for the unrelated kidney donation program in the Islamic Republic of Iran, with a particular focus on the implications of Islam on organ donation and organ sales. METHODS This study reviews secondary documents for philosophical argumentation and ethical analysis of human organ donation and sale for transplantation. RESULTS AND DISCUSSION According to Islamic law, organ donation is an act of sadaqatul jariyah, and individuals are permitted to donate organs with the intention of saving lives. The commercialization of humans as organ sellers and buyers is contrary to the Islamic legal maxim eethaar, undermining donors of 'selfless' or 'altruistic' motivations. Such an act should be considered immoral, and the practice should not be introduced into other countries for the sake of protecting human dignity, integrity, solidarity, and respect. I, therefore, argue that Iran's unrelated kidney donation program not only disregards the position of the Islamic religion with respect to the provision or receipt of monetary benefits for human kidneys for transplantation but that it also misinterprets the Islamic legal proscription of the sale of human organs. I also argue that the implementation of Iran's unrelated kidney donor transplantation program is unethical and immoral in that potential donors and recipients engage in a bargaining process akin to that which sellers and buyers regularly face in regulated commodity exchange markets. Conversely, I suggest that a modest fixed monetary remuneration as a gift be provided to a donor as a reward for their altruistic organ donation, which is permissible by Islamic scholars. This may remove the need to bargain for increased or decreased values of payment in exchange for the organ, as well as the transactional nature of 'buyer and seller', ensuring the philosophy of 'donor and recipient' is maintained. CONCLUSIONS Offering a fixed modest monetary incentive to organ donors would serve to increase organ supply while protecting donors' health and reducing human suffering without legalizing the human organ trade.
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Affiliation(s)
- Md Sanwar Siraj
- Department of Government and Politics, Jahangirnagar University, Savar, Dhaka, Bangladesh.
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Siraj MS. Ethical Analysis of Appropriate Incentive Measures Promoting Organ Donation in Bangladesh. Asian Bioeth Rev 2022; 14:237-257. [PMID: 35791329 PMCID: PMC9250557 DOI: 10.1007/s41649-022-00208-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/26/2022] [Accepted: 05/03/2022] [Indexed: 01/10/2023] Open
Abstract
Bangladesh, a Muslim-majority country, has a national organ donation law that was passed in 1999 and revised in 2018. The law allows living-related and brain-dead donor organ transplantation. There are no legal barriers to these two types of organ donations, but there is no legislation providing necessary costs and incentive measures associated with successful organ transplants. However, many governments across the globe provide different types of incentives for motivating living donors and families of deceased donors. This study assesses the merits and demerits of incentive measures already in use around the world and proposes ethical measures that can promote organ donation in Bangladesh. The primary focus of this paper is to present an ethical analysis of the comparison of incentive measures on organ donation between Bangladesh and the Islamic Republic of Iran as two Muslim countries that operate organ donation for transplantation practices according to Islamic principles. In this paper, I mainly argue that providing a fixed bare minimum financial incentive measure to distantly related living donors and families of deceased donors will encourage Bangladeshis to donate organs in a manner that is ethically justifiable, morally permissible, and socio-economically appropriate. The government of Bangladesh should revise the existing biomedical law to include a provision related to incentive measures and set a strict policy to properly regulate these measures as key stewardship that can ethically promote organ donation for transplantation.
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Affiliation(s)
- Md. Sanwar Siraj
- Department of Government and Politics, Jahangirnagar University, Dhaka, Bangladesh
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Cherry MJ. Bioethics: An International, Morally Diverse, and Often Political Endeavor. HEC Forum 2022; 34:103-114. [PMID: 35604507 DOI: 10.1007/s10730-022-09482-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
Abstract
Bioethicists often remind health care professionals to pay close attention to issues of diversity and inclusion. Approaches to ethics consultation, where the perspective of the bioethicist is taken to be more morally correct or necessarily authoritative, have been critiqued as inappropriately authoritarian. Despite such apparent recognition of the importance of respecting moral diversity and the inclusion of different viewpoints, authoritarianism is all too often the approach adopted, especially as bioethics has shifted evermore into concerns for public policy. Yet, secular values and philosophical principles are not morally neutral; nor are the private moral convictions of bioethicists. Such analysis is always grounded in particular understandings of the right and the good, the virtuous and the just. Critical examination of common treatments and new alternatives is essential for the careful scientific practice of medicine. The same is true with regard to bioethics. Stagnating in customary or accepted claims of a common secular morality or a standard set of bioethical principles out of an unwillingness to explore the real diversity of moral thought, including traditional religious and cultural worldviews, fails to tap the human capacity to find innovative solutions to the complex challenges facing medicine.
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Affiliation(s)
- Mark J Cherry
- Department of Philosophy, St. Edward's University, 3001 S. Congress Ave., Austin, TX, USA.
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Siraj MS. The Human Organ Transplantation Act in Bangladesh: Towards Proper Family-Based Ethics and Law. Asian Bioeth Rev 2021; 13:283-296. [PMID: 33868489 PMCID: PMC8035595 DOI: 10.1007/s41649-021-00170-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 11/28/2022] Open
Abstract
The Human Organ Transplantation Act came into officially force in Bangladesh on April 13, 1999, allowing organ donations from both living and brain-dead donors. The Act was amended by the Parliament on January 8, 2018, with the changes coming into effect shortly afterwards on January 28. The Act was revised to extend a living donor pool from close relatives (e.g., parents, adult sons and daughters, adult brothers and sisters, uncles and aunts from both the paternal and maternal sides, and spouses) to include certain other relatives such as grandparents, grandchildren, and first cousins (Section 2:4). The Act was also revised to allow individuals to prioritize family members in receiving their organs after their death (Section 7c:3). The aim of this paper is not to carry out an ethical analysis of the Act as a whole but only to focus on aspects relating to priority access for family members to organs. Despite Islam encouraging Muslims to be sympathetic, and to save the life of any member of humankind (Quran 5:32), saving the life of a relative through organ donation is even more highly valued. The collective and extended structure of the family impacts on the provisions of the Act that only allows Bangladeshis to legally donate their organs to save the lives of relatives and allows individuals to prioritize family members. Recent progress in the practice of organ transplantation raises a number of ethical dilemmas around the allocation of available organs in the context of organ scarcity. A key purpose of introducing incentive into the system of organ allocation is to increase the number of donations from living relatives and initiation of vital organ donations from brain-dead donors. However, allocation criteria based on a living organ donation incentive system would appear to be unethical because there is no provision in the Act with regard to financial compensation for a distant relative donor’s post-operative care in the absence of healthcare coverage. Receiving organs from a distant relative without giving financial compensation for post-operative care places them in a grave health condition and violates the biomedical principle of non-maleficence. An incentive system around brain-dead donors would appear to be ethical as the amended Act allows individuals to prioritize relatives in receiving their organs after death. This provision is intended to initiate the transplantation of vital organs (e.g., kidney, liver, heart, pancreas, bone marrow) from brain-dead donors as families might bear the cost of keeping the organs alive for transplantation. Regular reassessment of the impact of the Act is necessary to maximize the donation rate of transplantable organs using ethical means.
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Affiliation(s)
- Md Sanwar Siraj
- Department of Government and Politics, Jahangirnagar University, Dhaka, Bangladesh
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