Medicine and Health Sciences Commons^™

Finding Your Way: A Medical Ethics Handbook For Patients And Families, Katrina Bramstedt

Katrina A. Bramstedt

A medical ethics book geared for the lay audience. Current books in the marketplace are for medical professionals, academics, or students. This book is meant as a handbook for patients, families, and caretakers. The book will be of interest to those patients and families confronting major health-care decisions and to the professionals who work with these patients and families.

Managing Patients Whose Family Members Are Physicians, Katrina Bramstedt, M. Popovich

Katrina A. Bramstedt

The ethical complexities involving physicians who treat their own family members are well known and it is generally accepted that such practice should not occur. We present three anonymous cases in which patient family members who worked as physicians complicated the medical care of their hospitalized relatives. When a health care worker’s family member becomes a hospital patient, the situation can be emotionally charged due to the medical insight the multiple parties have, as well as the desire of relatives to be protective of their family members. Clinician-relatives need to allow the medical team to assume the role of caretaker …

The Ethical Complexities Of Online Organ Solicitation Via Donor-Patient Websites: Avoiding The "Beauty Contest"., E. Neidich, A. Neidich, J Cooper, Katrina Bramstedt

Katrina A. Bramstedt

The proliferation of the Internet has spurred the creation of websites dedicated to facilitating living directed organ donations. We argue that such sites potentially devolve into “beauty contests” where patients in need are evaluated on the basis of their personal appearance and biography—variables which should have no relevance to organ allocation. Altruism should be the guiding motivation for all donations, and when it does, there is no place for a beauty contest. The power of the Internet is optimally used when it facilitates Good Samaritan donations—donations to any stranger, rather than handpicked ones. Social networking sites which aim to match …

The Organ Donor Experience: Good Samaritans And The Meaning Of Altruism, Katrina Bramstedt

Katrina A. Bramstedt

With a current US need of over 115,000 organs one would think that Good Samaritan donors would be welcomed with open arms by transplant centers and society in general; however, this is often not the case. Tell someone that you have donated an organ to a stranger and the reaction is likely to be one of astonishment and disbelief. Some doctors even consider people who offer their organs to strangers crazy. Why would anyone do that? Who are these people so committed to helping others-strangers-that they would undergo surgery, discomfort, and disruption of their lives? This book profiles donors who …

Stranger Donors: A Key Link In Transplant Chains, Christopher Veys, Katrina Bramstedt

Katrina A. Bramstedt

Living donation to strangers is a complex issue that has caused some transplant centers to ban the practice altogether. Most prominent of the troublesome issues is the common source of these donors; namely, the Internet. These "stranger donors," however, are critical to both paired kidney transplants and chain kidney transplants. This article presents the ethical complexities of donors in these transplant arrangements and offers 2 case examples from our facility. Rigorous donor screening and informed consent processes are crucial, and together they help make transplant pairs and chains ethically feasible.

Probing Transplant And Living Donor Candidates About Their Participation In Organ Vending, Katrina Bramstedt

Katrina A. Bramstedt

The selling of human organs for transplant is illegal in the United States and in most countries; however, such transactions still occur. Transplant hospitals and their personnel have multiple ethical duties, including (1) protecting the safety of their living donors and transplant recipients and (2) protecting the integrity of living donation and transplantation as clinical practices. To date, few psychosocial screening tools exist that pertain specifically to a person's risk or intent of pursuing organ vending (buying or selling). This article presents a series of transplant ethics case consultations that spawned the creation of a set of behavioral prompts for …

Too Poor For Transplant: Finance And Insurance Issues In Transplant Ethics, Kyle Laurentine, Katrina Bramstedt

Katrina A. Bramstedt

Context: Donor organs are a scarce gift. Additionally, transplantation is very expensive and the United States lacks universal health insurance for all citizens. These facts combine to make personal finance and insurance some of the criteria for wait listing at US transplant centers. Previous research has shown that the poor and the uninsured (as well as women and nonwhites) are less likely to receive a transplant. Living donor candidates are also limited by the US insurance system. Objective: To determine the effect of finance and insurance variables on access to transplant and living donation. Design: A qualitative descriptive study of …

Exploring Transplant Opportunities In Hmong Culture: A Case Report, Alon Neidich, Harish Maranty, Katrina Bramstedt

Katrina A. Bramstedt

A clinical case is used to explore the ethical complexities of solid organ donation and transplantation within the Hmong community in the United States. Although many cultures can present various ethical issues, the challenges of the Hmong belief system are unique and distinctly complex. Ways for the medical team to integrate with the Hmong value system to attempt to create an environment of transcultural respect and appreciation are described.

Being Sherlock Holmes: The Internet As A Tool For Assessing Live Organ Donors, Katrina Bramstedt, Steven Katznelson

Katrina A. Bramstedt

Donor advocacy is a critical feature of live donor transplantation. Donor Advocates and Donor Advocate Teams (DAT) are now routine to the practice of live donor evaluation in the USA. Multidisciplinary in nature, DATs gather both medical and psychosocial information about potential live organ donors and then render a decision as to whether or not these individuals are suitable to participate. Because of the critical ethical and psychosocial concerns about live donation, thorough donor evaluations are essential. Additionally, the information gathered must be accurate, and this requires honest disclosure by the donor candidate. In this paper, we describe how DATs …

Hoping For A Miracle: Supporting Patients In Transplantation And Cardiac Assist Programs, Katrina Bramstedt

Katrina A. Bramstedt

Purpose of review: Palliative medicine is often viewed as a medical specialty reserved for end of life care. This review focuses on the role that palliative care can play in transplant and cardiac assist device programs, along the continuum of a patient's disease course. Recent findings: In general, transplant and cardiac assist programs do not incorporate palliative medicine during the treatment course, but rather reserve it for when the patient is approaching death and is no longer a candidate for transplant or device therapy. There is a new shift, however, to viewing the practice of aggressive medicine and palliative medicine …

Deactivating Implanted Cardiac Devices In Terminally Ill Patients: Practices And Attitudes, Paul Mueller, Sarah Jenkins, Katrina Bramstedt, David Hays

Katrina A. Bramstedt

Background: Clinicians may receive requests to deactivate pacemakers and implantable cardioverter-defibrillators (ICDs) in terminally ill patients. Methods: We describe practices and attitudes regarding deactivation of pacemakers and ICDs in terminally ill patients among physicians, nurses, and others who manage treatment of patients with implanted cardiac devices and among field representatives of device manufacturers. A Web-based survey was provided to Heart Rhythm Society members and to representatives of two manufacturers of implantable cardiac devices. Measurements were the answers of 787 respondents. Results: Of the respondents, 86.8% reported involvement in requests for ICD deactivation and 77.6% reported involvement in pacemaker deactivation (P …

Alcohol Abstinence Criteria For Living Donors And Their Organ Recipients, Katrina Bramstedt

Katrina A. Bramstedt

Purpose of review: Psychosocial criteria for live organ donors and their organ recipients are important for their safety and welfare. In liver transplantation, alcohol use by either party is problematic. This article reviews this topic and offers guidance for donor and recipient selection. Recent findings: The '6 month rule' for alcohol abstinence is the standard approach for many hospitals when evaluating patients for transplant candidacy. Recently, clinicians have explored the rationale for this quantitative rule and discovered additional factors that can help to predict the risk for post-transplant alcohol relapse. Guidance for live liver donors is a newer topic and …

Destination Nowhere: A Potential Dilemma With Ventricular Assist Devices, Katrina Bramstedt

Katrina A. Bramstedt

Increasingly, ventricular assist devices (VADs) are used as destination therapy for those who are not candidates for heart transplantation. Although these devices can benefit patients by improving their functional status and quality of life, they can, in some cases, facilitate an end-point known as destination nowhere. In such situations, patients and clinicians find themselves in medical limbo where the patient's net benefit is, in fact, a burden, or the continued use of the device has no utility in light of the goals of the technology. This article presents guidance for avoiding destination nowhere, as well as guidance for ethical care …

China: A Case Study Regarding Transplant Publishing Issues, Katrina A. Bramstedt, Jun Xu

Katrina A. Bramstedt

A Survey Method For Investigating Ethical Decision Making In Family Practice, Barry Hoffmaster, Moira Stewart, Ronald Christie

C. Barry Hoffmaster

BACKGROUND: The tension between respect for patient autonomy versus concern for patient welfare is a challenging ethical issue for physicians. The purpose of this research was to describe a method for analyzing ethical decisions and to report the results of a survey of ethical decision making among family physicians.

METHODS: We developed a survey instrument that used simulated case scenarios, each of which posed an ethical dilemma. The ethical problems on the survey included the extent to which diagnostic information should be revealed to patients, the extent to which physicians should become involved in patients' life-style issues, and how to …