Sex cells Almeling, Rene
2011., 20110821, 2011, 2011-09-20, 20110101
eBook
Unimaginable until the twentieth century, the clinical practice of transferring eggs and sperm from body to body is now the basis of a bustling market. In Sex Cells, Rene Almeling provides an inside ...look at how egg agencies and sperm banks do business. Although both men and women are usually drawn to donation for financial reasons, Almeling finds that clinics encourage sperm donors to think of the payments as remuneration for an easy "job." Women receive more money but are urged to regard egg donation in feminine terms, as the ultimate "gift" from one woman to another. Sex Cells shows how the gendered framing of paid donation, as either a job or a gift, not only influences the structure of the market, but also profoundly affects the individuals whose genetic material is being purchased.
Each year, tens of thousands of children are conceived with donated sperm or eggs, aka donated gametes. By some estimates, there are over 1 million donor-conceived people in the United States and, of ...course, many more the world over. Some know they are donor-conceived. Some don’t. Some know the identity of their donors. Others never will. Conceiving People: Identity, Genetics and Gamete Donation argues that people who plan to create a child with donated gametes should choose a donor whose identity will be made available to the resulting child. This is not because having genetic knowledge is fundamentally important. Rather, it is because donor-conceived people are likely to develop a significant interest in having genetic knowledge and parents must help satisfy their children’s significant interests. In other words: because a donor-conceived person is likely to care about having genetic knowledge, their parents should care too. Questions about what the donor-conceived should know about their genetic progenitors are hugely significant for literally millions of people, including donor-conceived people, their parents, and donors. But the practice of gamete donation also provides a vivid occasion for thinking about questions that matter to everyone. What value, if any, is there in knowing who your genetic progenitors are? To what extent are our identities bound up with knowing where we come from? What obligations do parents have to their children? And what makes someone a parent—the person responsible for lovingly raising a child—in the first place?
Living kidney donation is widely practiced throughout the world. During the past 2 decades, various groups have provided guidance about the evaluation and care of living donors. However, during this ...time, our knowledge in the field has advanced substantially and many agreed on the need for a comprehensive, unifying document. KDIGO (Kidney Disease: Improving Global Outcomes) addressed this issue at an international level with the publication of its clinical practice guideline on the evaluation and care of living kidney donors. The KDIGO work group extensively reviewed the available literature and wrote a series of guideline recommendations using various degrees of evidence when available. As has become recent practice, NKF-KDOQI (National Kidney Foundation–Kidney Disease Outcomes Quality Initiative) convened a work group to provide a commentary on the KDIGO guideline, with a focus on how these recommendations apply in the context of the United States. In the United States, the United Network for Organ Sharing (UNOS) guides and regulates the practice of living kidney donation. While the KDIGO guideline for the care of living kidney donors and UNOS policy are similar in most aspects of the care of living kidney donors, several important areas are not consistent or do not align with common practice by US transplantation programs in areas in which UNOS has not set specific policy. For the time being, and recognizing the value of the KDIGO guidelines, US transplantation programs should continue to follow UNOS policy.
Background
Previous studies have demonstrated low first‐time donor return rates (DRR) following catastrophic events. Little is known, however, about the influence of demographic factors on the DRR of ...first‐time donors during the COVID‐19 pandemic, including the unique motivation of COVID‐19 convalescent plasma (CCP) donors as compared to non‐CCP donors.
Study Design and Methods
Thirteen blood collection organizations submitted deidentified data from first‐time CCP and non‐CCP donors returning for regular (non‐CCP) donations during the pandemic. DRR was calculated as frequencies. Demographic factors associated with returning donors: race/ethnicity, gender, and generation (Gen Z: 19–24, Millennial: 25–40, Gen X: 41–56, and Boomer: ≥57 years old), within the CCP and non‐CCP first‐time cohorts were compared using chi‐square test at p < .05 statistical significance.
Results
From March 2020 through December 2021, there were a total of 44,274 first‐time CCP and 980,201 first‐time non‐CCP donors. DRR were 14.6% (range 11.9%–43.3%) and 46.6% (range 10.0%–76.9%) for CCP and non‐CCP cohorts, respectively. Age over 40 years (Gen X and Boomers), female gender, and White race were each associated with higher return in both donor cohorts (p < .001). For the non‐CCP return donor cohort, the Millennial and Boomers were comparable.
Conclusion
The findings demonstrate differences in returning donor trends between the two donor cohorts. The motivation of a first‐time CCP donor may be different than that of a non‐CCP donor. Further study to improve first‐time donor engagement would be worthwhile to expand the donor base with a focus on blood donor diversity emphasizing engagement of underrepresented minorities and younger donors.
Little is known regarding the profiles of whole body donors in Muslim majority countries where donation is scarce. Therefore, this study aims to profile registered donors in Turkey by means of a ...survey. The explored data could be used to improve ongoing campaign efforts and ethical practices such as commemoration services. Registered donors of the donation programs at the two faculties of medicine of Istanbul University were compared with the national population and a cluster analysis was performed to reveal any concealed sub‐groups. Data from 188 respondents were analyzed. The majority of registered donors were married (42%), male (65.4%), aged over 50 years (76%), held a tertiary education degree (49.7%), and were irreligious (58.5%). Cluster analysis revealed two groups with significantly different educational levels, marital statuses, and religious choices. Regarding whether their bodies could be used for education or research, the majority (64.5%) of the respondents left the decision to the anatomy department. Similarly, 73.8% approved indefinite use of their organs, body parts and/or skeletons. The respondents were also willing to share their medical history (94.2%) and personal information (81.6%) if needed. Motivational themes for body donation including usefulness, impermanence, religion, awareness, and kinship were devised after a thematic analysis. Among the respondents, 56.5% were registered organ donors and 63.3% were frequent blood donors. The results of this study provide data that may help revising informed consent forms, developing and implementing thanksgiving ceremonies, and selecting additional targets for supporting body donation campaign activities such as organ and blood donation units.
Changes in organ allocation policy in 2002 reduced the number of adult patients on the liver transplant waiting list, changed the characteristics of transplant recipients and increased the number of ...patients receiving simultaneous liver–kidney transplantation (SLK). The number of liver transplants peaked in 2006 and declined marginally in 2007 and 2008. During this period, there was an increase in donor age, the Donor Risk Index, the number of candidates receiving MELD exception scores and the number of recipients with hepatocellular carcinoma. In contrast, there was a decrease in retransplantation rates, and the number of patients receiving grafts from either a living donor or from donation after cardiac death. The proportion of patients with severe obesity, diabetes and renal insufficiency increased during this period. Despite increases in donor and recipient risk factors, there was a trend towards better 1‐year graft and patient survival between 1998 and 2007. Of major concern, however, were considerable regional variations in waiting time and posttransplant survival. The current status of liver transplantation in the United States between 1999 and 2008 was analyzed using SRTR data. In addition to a general summary, we have included a more detailed analysis of liver transplantation for hepatitis C, retransplantation and SLK transplantation.
The status of liver transplantation was examined using SRTR data, with additional detailed analysis of liver transplantation for hepatitis C, retransplantation and simultaneous liver‐kidney transplantation.
Pretransplant mortality rates in the US remain high and are connected to effective organ donation and utilization. Thus, there is a need to maximize the utilization of available donors. In some ...cases, this has been safely achieved using organs from donors with infectious complications. For example, several studies describe the use of organs from donors with bacterial meningitis due to pathogens such as Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenza, and Escherichia coli, with good outcomes. Listeria is an aerobic and facultatively anaerobic, nonspore-forming, Gram-positive rod that can affect the central nervous system, causing meningitis and meningoencephalitis. Due to its virulence, ability to cause intracellular infection, and lack of clinical data, people dying with listeria may not be evaluated for organ donation, may not have organs recovered, or may have their organs recovered but not transplanted. Herein, we describe the outcomes of 7 solid organ transplant recipients who received organs from 2 donors with Listeria monocytogenes central nervous system infection.
Implementing uncontrolled donation after circulatory determination of death (uDCDD) in the United States could markedly improve supply of donor lungs for patients in need of transplants. Evidence ...from US pilot programs suggests families support uDCDD, but only if they are asked permission for using invasive organ preservation procedures prior to initiation. However, non‐invasive strategies that confine oxygenation to lungs may be applicable to the overwhelming majority of potential uDCDD donors that have airway devices in place as part of standard resuscitation. We propose an ethical framework for lung uDCDD by: (a) initiating post mortem preservation without requiring prior permission to protect the opportunity for donation until an authorized party can be found; (b) using non‐invasive strategies that confine oxygenation to lungs; and (c) maintaining strict separation between the healthcare team and the organ preservation team. Attempting uDCDD in this way has great potential to obtain more transplantable lungs while respecting donor autonomy and family wishes, securing public support, and enabling authorized persons to affirm or cease preservation decisions without requiring evidence of prior organ donation intent. It ensures prioritization of life‐saving, the opportunity to allow willing donors to donate, and respect for bodily integrity while adhering to current ethical norms.
The authors propose an ethical framework for lung uncontrolled donation after circulatory determination of death in countries having opt‐out organ donation systems.
Background
Recruitment of committed unrelated hematopoietic stem cell donors from the most‐needed demographics remains a challenge for donor recruitment organizations worldwide. Multimedia resources ...are gaining attention as a modality to support recruitment efforts; however, there is a lack of guidance for the development of such tools. This qualitative study explores the perspectives of eligible stem cell donors on an educational whiteboard video about stem cell donation, generating insights into how whiteboard videos and related multimedia may be optimized for donor recruitment.
Study Design and Methods
Eight semistructured focus groups were conducted with 38 potential donors from the most‐needed demographics (young, male, and non‐Caucasian) after they had watched a 3.5‐minute whiteboard video explaining key concepts in stem cell donation (https://youtu.be/V4fVBtxnWfM). Constructivist grounded theory was used to identify themes and to develop a framework for understanding participants' preferred features of recruitment multimedia.
Results
Participants identified a range of features contributing to the effectiveness of recruitment multimedia, adding that the whiteboard video is an effective, integrated, and readily accessible format for supporting donor recruitment. Topics that participants felt are important to address include knowledge gaps regarding donation procedures, concerns about donor safety, and the particular need for specific donor demographics. Suggested avenues for improvement include the addition of donor/recipient/patient personal experiences, attention‐grabbing hooks, and a call to action including opportunities for further learning.
Conclusions
Several considerations were generated to inform the development of future multimedia for donor education/recruitment and are relevant to donor recruitment organizations worldwide.
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