Medicine and Health Sciences Commons^™

Harms And Responsibilities Associated With Battery-Operated Implants (Boi): Who Controls Postmortem Explantation?, Katrina Bramstedt

Katrina A. Bramstedt

The postmortem issues raised by battery-operated implants (BOI) are complex and issues of consent, setting (clinical vs research), and environmental risks have received little attention in bioethics literature. Analyzing the issues, the following are argued: (1) Patients receiving BOIs should sign a consent form that includes a requirement for postmortem explant of the device; (2) BOI consent forms should require the explanted devices be returned to their manufacturers for Returned Product Analysis; (3) Failure to explant and analyze devices from the research setting fails the research goal of generation of knowledge for the benefit of future patients; (4) Failure to …

Informed Consent For Facial Transplantation, Katrina Bramstedt

Katrina A. Bramstedt

Here, we outline the ethical presentation of patients’ informed consent.

The Silence Of Good Samaritan Kidney Donation In Australia: A Survey Of Hospital Websites, Katrina Bramstedt, Sameer Dave

Katrina A. Bramstedt

It is common for living donor candidates to use the Internet as a tool to enhance their decision-making process. Specifically, the websites of transplant hospitals can potentially be a vital source of information for those contemplating living donation. In an effort to explore the low incidence of Good Samaritan kidney donation (donations to strangers) in Australia, two raters conducted a nine-attribute website content analysis for all hospitals which participate in these transplants (n = 15). Overall, the concept of living donation is relatively silent on Australian hospital websites. Only four hospitals mention their living donor program, and only one mentions …

Family Refusals Of Registered Consents: The Disruption Of Organ Donation By Double-Standard Surrogate Decision-Making, Katrina Bramstedt

Katrina A. Bramstedt

Some countries such as Australia, Spain, Norway, Italy and Canada allow next of kin to override the consent of registered organ donor candidates if they personally do not concur with the donation desire of their relative. This form of surrogate decision-making represents a double standard in terms of the principle of substituted judgment (the surrogate's duty). Further, double-standard surrogate decision-making in the setting of organ donation is a slippery slope to unethical surrogate decision-making while patients are alive. Concerns about family distress and donor candidate revocation of consent can still be managed without permitting double-standard surrogate decision-making.

Book Review: Pathological Altruism, Katrina Bramstedt

Katrina A. Bramstedt

In my work as a transplant ethicist I have always been interested in the topic of altruism. Thus, when a book appeared with the title, Pathological Altruism, I was very intrigued to read it. An exceedingly heavy book, however, arrived in my mailbox, and I admit I was taken aback. But upon reading Pathological Altruism, edited by Barbara Oakley, Ariel Knafo, GuruprasadMadhavan, and David SloanWilson, I was not disappointed. In fact, chapter 1 baited me with the line, “Altruism can be the back door to hell.”

Art Review: Edo-Kingyo's Coolness And The Night Aquarium Museum Lounge, Katrina Bramstedt

Katrina A. Bramstedt

Extract:As with circuses, aquariums have been the subject of concern for animal welfare experts (Tilikum, Katina, Corky, Kasatka, and Ulises v. SeaWorld 2011): Is captivity the best place for these animals? Are these settings merely entertainment venues? If they provide an educational experience for viewers, does the learning experience outweigh the risks to the animals? Could the education be gained by other modes? What are the elements of animal welfare in the setting of an aquarium? After viewing the Edo—Kingyo’s Coolness Tokyo art exhibit online using the creator’s YouTube video (Kimura 2011), the importance of all of these questions becomes …

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.

Assessing The Motives Of Living, Non-Related Donors, Katrina Bramstedt, Francis Delmonico

Katrina A. Bramstedt

Extract

Cases such as the one described by Dr. Tan are not uncommon at transplant centers in the United States. The Internet and social media tools are now being used to facilitate access to transplantation [1, 2]. Most adults are users of the Internet in some format (e.g., web browsing, e-mail, blogs, Facebook, Twitter), so it is not surprising that it could be a resource for those with end-stage disease seeking an organ donor. Formal websites that attempt to link potential donors and patients include matchingdonors.com, kidneymitzvah.com, and kidneyregistry.org. Informal mechanisms include Internet chat rooms and message boards.

Society (and …

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 …

Ethical Minefields In Medical Tourism, Katrina Bramstedt

Katrina A. Bramstedt

Extract: Crystal blue waves lapping on the beach and glimmering shopping malls with bargains galore. Would you like a little sun, surf and safari with your surgery, all for a price much less than the surgery alone would cost in the United States? It only takes a few clicks of a computer mouse to find enticing lures bundled with cardiac bypass surgery, vision correction, bariatric surgery, organ transplants, dental implants, and total hip arthroplasty.

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 …

Closing The Medical Buffet, Katrina Bramstedt

Katrina A. Bramstedt

Extract:The standard hotel breakfast buffet includes trays of eggs Benedict, bacon, oatmeal, sliced fruit, muffins and bagels. Now imagine another type of buffet: the medical buffet. Instead of food, imagine a long table with segmented areas containing dialysis machines, ventilators, feeding tubes, organs for transplant, ventricular assist devices, blood for transfusion, transcutaneous electrotherapy devices, and spinal cord stimulation implants. Patients and families sometimes feel that the mere existence of a bounty of medical technology equates to their right to use it, even if the technology will offer no benefit. Skillful language from clinicians is needed in order that a message …

Examining The Root Cause Of Surrogate Conflicts In The Icu And General Wards, Katrina Bramstedt, Allison Rubin

Katrina A. Bramstedt

This study is an analysis of surrogate-focused ethics consultations in the Intensive Care Unit (ICU) and the general wards (Ward) of a large community hospital in Northern California. We identified the major themes of surrogate-focused ethics consultations to better understand the root cause of surrogate conflicts, and identified the similarities and differences between surrogate-based conflicts in the two settings. Consults requested because the surrogate had desires that conflicted with the physician’s medical opinion of ‘best interest’, or cases involving surrogates not upholding a patient’s known values reflected the root cause of the majority of surrogate conflicts (72.7% ICU, 83.3% Ward).

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 …

Optimising The Documentation Practices Of An Ethics Consultation Service, Katrina Bramstedt, A. Jonsen, W. Andereck, J. Mcgaughey, A. Neidich

Katrina A. Bramstedt

A formal Ethics Consultation Service (ECS) can provide significant help to patients, families and hospital staff. As with any other form of clinical consultation, documentation of the process and the advice rendered is very important. Upon review of the published consult documentation practices of other ECSs, we judged that none of them were sufficiently detailed or structured to meet the needs and purposes of a clinical ethics consultation. Thus, we decided to share our method in order to advance the practice of ethics consultation. Here, we describe a method of ECS documentation practice, including use of a formal consult report …

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