Tampilkan postingan dengan label biomedical ethics. Tampilkan semua postingan
Tampilkan postingan dengan label biomedical ethics. Tampilkan semua postingan

Old Kidneys and Young Kidneys

Recently I discussed the topic of organ trading. The ST article below raises an interesting point not previously mentioned in my old blog post nor by the readers who had commented.
ST July 17, 2008
Short queues for kidneys in Spain and Norway: Here's why
Kidneys from the elderly are accepted and more people are willing to be donors
By Salma Khalik

BEFORE considering organ trading, Singapore can increase its supply of kidneys by learning from Spain and Norway, says a top kidney specialist here.

The two European countries have short waiting lists for kidney transplants - unlike Singapore, where the average wait is nine years for the 560 people on the list.

Both countries accept kidneys from the elderly, whereas in Singapore, kidneys are taken only from people 60 years old and younger.

This immediately cuts off the supply of many kidneys every year. In Spain, a third of the cadaveric kidneys are from people over 60 years old.

Spain and Norway stand out in the world for their short list of patients waiting for kidney transplants. Their success has been cited in the current debate raging over whether Singapore should consider legalising the organ trade to meet the high demand here.

Organ trading is a criminal offence here and, in the last month, five men were charged in connection with the offence, the first such cases here.

The cases have resulted in some people calling on the Health Ministry to reconsider the ban on organ trading.

But before going down that route, Professor A. Vathsala, director of the kidney transplant programme at the National University Hospital, said Singapore should expand its organ donation programme first.

She has visited Norway and Spain and believes that some of their practices, such as removing the age restriction on cadaveric donation, could be adopted here.

Spain transplants both kidneys from an older donor - even someone in his or her 80s - into an elderly recipient.

'No organ goes 'wasted' to be buried needlessly when it can save the lives of so many others with organ failure,' she said.
The obvious question that comes to mind is whether older cadaveric kidneys and younger cadaveric kidneys yield equally good transplant results. (Strangely, the Straits Times article did not discuss this at all).

I did a quick Google search. The answer seems to be that younger cadaveric kidneys deliver better transplant results than older ones. How significant that difference is, I must leave to the experts to comment (a fair number of doctors regularly read my blog).

The next point to consider is whether the kidney patient would be better off with a transplanted old kidney, or with no kidney transplant at all. This could be a "beggars can't be choosers" situation. Your best bet might be with the old kidney, since a young kidney might never become available before you die.

Finally, back to the question of whether organ trading should be legalised. The way I see it, there are many ways to skin a cat, and they don't have to be mutually exclusive. For example, we could legalise organ trading and at the same time, accept the use of older cadaveric kidneys. At the same time, we could continue to encourage "altruistic" donations from living donors etc.

The goal is to save lives. We can simultaneously pursue different paths to that goal.
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The Uselessness of Not Saying Yes

Well, the good news is that if you take part in a medical research project, they will protect your confidentiality.
ST May 8, 2007
New privacy laws to protect data of research participants
Information such as name and age will be out-of-bounds to researchers
By Tania Tan & Michelle Neo

NEW privacy laws will soon be in place to boost biomedical research here.

As Singapore moves into research using human subjects, the legislation will ensure that the personal data of those who take part in these studies remains strictly confidential.

The move is aimed at assuring the public that biomedical research here is carried out 'with the greatest care', said Professor Lim Pin, chairman of the Bioethics Advisory Committee (BAC).

Several research projects here have had difficulty attracting participants because of the confidentiality issue.

Two years ago, for example, an ambitious medical study - one that aimed to explore the relationship between genes, environment and disease, and billed as the nation's largest - ran into problems when only half of those approached were willing to disclose their medical histories.

In 2004, poor participation hampered the first twin registry study - only 11 out of 5,000 needed pairs signed up in the first year.

Yesterday, the BAC tabled 11 recommendations in a 48-page report aimed at allaying the public's fears of a lack of privacy. The Cabinet has given the report its thumbs-up; about 70 health care, research and governmental institutions were asked for their views on it.

The arguably not-so-good news is that even if you didn't choose to take part in a medical research project, they can use your medical data anyway:
Your body could be an open book
No consent may be needed for researchers to access anonymous medical records
Tuesday • May 8, 2007
By Tan Hui Leng

YOU are warded with a serious medical condition and, as is standard practice, your case is entered into the hospital's computer system. What you might not expect is that your medical records could end up in the hands of researchers, without your consent.

Not only would this be perfectly legal, but if a recommendation by the Bioethics Advisory Committee (BAC) gets the green light, the researchers would be permitted to publish the findings — as long as they do not identify you.

"The study of patients' medical records has engendered much valuable medical knowledge. However, obtaining consent is not always practicable," said the committee, which released its report yesterday, in a statement.

It is thus proposing that institutional review boards of research organisations be allowed to waive the need for a patient's consent, in situations where the research involves only the use of medical records — with no patient contact — and as long as confidentiality is not compromised.
It's interesting to compare the titles of the two articles - "New privacy laws to protect data of research participants" versus "Your Body is an Open Book".
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