Bakgrund: Omkring 90 000 personer avlider i Sverige varje år varav cirka 200–270 personer kan vara potentiella organdonationer. Det är betydelsefullt att intensivvårdssjuksköterskan känner sig väl förtrogen med rutiner kring identifiering av en potentiell donator och riktlinjer kring monitorering och behandlingsmål för organdonatorn. Syfte: Syftet med studien var att beskriva intensivvårdssjuksköterskors upplevelser av donationsprocessen utifrån två frågeställningar; vilka var de främjande respektive utmanande faktorerna i samband med donationsprocessen? Metod: En kvalitativ intervjustudie med ett ändamålsenligt urval genomfördes. Inklusionskriterierna var specialistsjuksköterska inom intensivvård med erfarenhet av donationsprocessen. En semistrukturerad intervjuguide användes och data analyserades enligt kvalitativ manifest innehållsanalys. Resultat: Sexkategorier framkom; Behov av utbildning och praktisk träning, att frågan om donation av någon anledning inte ställs, en sällan förekommande process som är resurskrävande och annorlunda, en positiv inställning och en uttalad vilja, betydelsen av stöd och information, intensivvårdsmiljö är rätt miljö. Slutsats: Studien visade att intensivvårdssjuksköterskor upplevde ett flertal utmanande och främjande faktorer under donationsprocessen. Det finns behov av fler studier inom området. En interventionsstudie före och efter specifik utbildning med både teoretisk och praktisk undervisning behöver utföras för att studera hur och i vilken grad utbildning påverkar donationsprocessen. Det finns en brist på studier som berör varför frågan om donation inte ställs och även detta behöver studeras vidare.

Infertility politics implies a role for the state in regulating the relationships between different parties involved in the medicalized process of reproduction, namely would-be-parents (infertile couples or individuals), gamete donors, surrogate mothers, fertility specialists, etc. Policies adopted by the Canadian federal government in 2004 as regards assisted reproductive technologies (ARTs) were largely inspired by British regulations. Despite this similar start, Canadian policies never lead to implementation; the province of Quebec rapidly contested the federal Assisted Human Reproduction Act before the courts; and many issues of assisted conception were regulated in a heterogeneous manner by the provinces. Meanwhile in Britain, the implementation of the policies created many disparities among the regions of the country; the principle of the law was thoroughly contested and scrutinized; and the sites of deliberation were multiple in spite of the existence of a national regulatory agency. First, the author argues that assisted reproduction technologies cannot be taken as one policy domain, but is an umbrella label for a variety of policy issues. In that context, ARTs are unpacked in order to study, at the system level, the practices related to the overcoming of infertility. I focus on three sub-issues: access to fertility treatments, including the question of public funding and access criteria; gamete and embryo donation, including the question of filiation and donor conceived children’s right to know their biological origins; and surrogacy or the enforcement of pre-natal gestational surrogacy arrangements. Second, by mapping the variety of discourses and arenas mobilized by a range of actors, this study shows how framing and reframing dynamics influence public policies and their implementation. Third, by comparing frame mobilization and discursive dynamics between Quebec, Ontario and England this analysis demonstrates how frame alignment can be a necessary condition for a frame to be performative and influence policy outcomes. Depending on the context in which it occurs, frame transformation, amplification, extension or bridging can induce stability or trigger a cascade of events that will lead to policy change or to a change in the implementation of a policy.

La greffe repose sur le don d’un organe qui, dans le cadre du don cadavérique, est issu d’un donateur qui n’a pas la conscience de donner. Le donneur et le receveur ne se connaitront jamais, et ce don prend le sens d’une réduction à la donation. Tout se passe comme si le donateur redonnait une chose dont il n’était pas propriétaire ; ce procès prend dès lors la forme d’un sacrifice ou redondance du don, au sens où celui qui a reçu redonne à son tour et sans retour. Il illustre également le concept d’hospitalité qui peut être mobilisé autant par le greffé, que par le soignant. Durant cet intervalle requis par la greffe, au sein de ce rituel symbolique et technique, le greffé est soumis à une réalité chaotique inconcevable et imprévisible. Ainsi, le mot peut manquer et l’écriture, par exemple, peut pallier cette carence, sous la forme d’ateliers ; expérience qui fut menée durant cette recherche et qui sera poursuivie. Sans s’opposer à la démarche des ateliers et outre l’avantage d’une mise en œuvre plus simple, le récit narratif s’est imposé pour trois raisons. - C’est une forme d’action, la plus élémentaire, la première possible après une longue période où toute action était devenue improbable. - C’est une façon de donner une cohérence au parcours subi et, même s’il s’agit d’une construction narrative, celle-ci participe à l’individuation du greffé, condition préalable pour envisager de nouvelles actions. - Enfin, ce récit peut être restitué au médecin qui a vécu l’acte de greffer, contrairement au malade. L’hypothèse est que cette hospitalité faite au récit permet d’une part, de renverser le schéma habituel – le soignant est dans la position de celui qui reçoit, non de celui qui donne –, d’autre part, de donner crédit au récit. Et, de proposer que la phase de réhabilitation, en rapport avec les actes thérapeutiques lourds, débute par ce type de récit où le malade parle et le soignant écoute, sans autre finalité, pour ce dernier, que d’accepter et de recevoir. / The transplant bases of the donation of an organ which, within the framework of the deathly donation, arises from a donor who is not conscious to give. The donor and recipient will never know each other, and this donation takes the senses of a reduction in the donation. It’s as if the donor gave a thing which he didn’t own ; this process takes from then on the form of a sacrifice or a redundancy of the donation, meaning that the one who received becomes the one to give, with no return expectations. It also illustrates the concept of hospitality which can be mobilized by the transplanted and the caregiver. During this interval required by the transplant, within this symbolic and technical rite, the transplante is subjected to an inconceivable and unpredictable chaotic reality.The transplanted can be wordless, and the writing, for example, can mitigate this deficiency, in the form of workshops. Such an experience was carried out during this research and will be pursued.Without opposing the approach of workshops and besides the advantage of a simpler implementation, the narrative was imperative for three reasons :- it is the first possible form of action after a long period of inactivity.- It helps the transplanted to give a coherence to the tranplantation. Even if it is narrative construction, it participates in the individuation of the transplanted, a precondition to envisage new actions.- Finally, this narrative can be restored to the doctor who experienced the act to tranplant, contrary to the sick person. The hypothesis is that this hospitality made for the narrative allows on one hand, to reverse the ususal plan – the caregiver is in the position of the one who receives, not of the one who gives - , on the other hand, to give credit to the narrative.And, to propose that the rehabilitation phase, related to the heavy therapeutic acts, begins with this type of narrative where the sick person speaks and the caregiver listen to, without no other purpose, for the latter, than to accept and receive.

The thesis examines the influence of the tax deduction by reason of granting the donation on the taxpayers' behavior. The examination is working with Household Expenditure Survey (2004, 2005) of Czech Statistical Office and with author's own questionnaire survey (2007). In the first part the regression of demographical and economic characteristics on the amount of donation and its probability is run. There are the internal opinions of informant according to the filled questionnaire described in the second part. The regression was processed using Logit, Probit and Tobit models; the following section consists of frequency analysis.

Les nouvelles pratiques d’aide médicale à la procréation, notamment celle qu’on appelle « le don d’ovocyte » bouleverse le sens de la parentalité. Elle oblige chacun d’entre nous à expliciter ses conceptions de la vie, à énoncer ses priorités, mais elle oblige aussi la collectivité à prendre conscience d’elle-même et de ce qui peut être acceptable. Est-il moralement satisfaisant qu’une femme donne ses ovocytes pour qu’une autre ait un enfant ?En interrogeant 50 donneuses d’ovocytes, ce travail a cherché à mieux comprendre la signification d’un tel geste.La procréation par don, défie nos habitudes et nos manières de penser. Elle nous réinterroge sur notre capacité de fraternité comme réponse d’un appel de l’un pour l’autre, elle cherche à donner une juste place à ce tiers-donneur qui s’insinue (presque malgré lui) dans un arbre généalogique. Elle bouleverse notre rapport à l’enfant qui se pose comme « un ayant droit à connaître ses origines ». En définitive, ce n’est pas tant la question de l’anonymat du don qui nous importe que ce qu’il en est de l’homme, de son altérité et de ses responsabilités / Reproductive technology, in particular oocyte or egg donation, upsets the meaning of parenthood and raises questions about the circumstances surrounding those who decide to have a child by means of this technology. A woman using egg donation must come to grips with questions such as the meaning of life, and what it means to be a mother. But it also requires that society become aware of what is morally acceptable. Is it morally acceptable for the egg donor to give her eggs to anotherwoman who wants to have a child? We would like to gloss over these issues by the power of love or by the growth of the uterus, but these issues will remain in the minds of everyone and will circulate in the subconscious. The purpose of this essay is to grapple with these issues. Reproduction by gift, it challenges our habits and ways of thinking. It causes us to re-examine the companionship among two people, it creates a role for the egg donor who, almost despite herself, inserts herself into the family tree. It disrupts the relationship being the parents and the child who demands the right to know where they came from. Ultimately, the focus rests not on the anonymity of the egg donor but on the father, his otherness and his responsibility.

Background: Involuntary childlessness and infertility affect a large group of people and WHO calls it a global public health issue. Donated gametes can be used when a pregnancy is not achieved. Embryo donation involves the full genetic material of the donating couple and embryo donation for reproductive purposes are often associated with many emotional, ethical, legal and psychosocial aspects. Aim: The aim of the study was to examine views on embryo donation for reproductive purposes among couples with experience of cryopreserved embryos. Methods: A literature review was conducted in order to answer the aim. Two databases (PubMed and Web of Science) were used to identify relevant qualitative literature. A smaller search on Google Scholar was also included. Inclusion and exclusion criteria were pre-determined in order to limit which studies to include. Results: A total of 20 studies were included in the results. The results show that there are different views towards the status of the human embryo, views towards the genetic link, information sharing and screening, views towards the selection of recipients, views towards the contact and relationship between donors, recipients and offspring, and views towards the decision-making and whether to donate surplus embryos or not. Conclusion: The multiple understandings of the status of the human embryo emphasizes the complex nature of human embryos and may explain couples’ views on embryo donation for reproductive purposes. It has also the potential to explain what couples decide to do with their surplus embryos. The interests of the receiving couple, the donors, the future child, and the society should continuously be assessed and balanced when society regulates ART and embryo donation. / Bakgrund: Ofrivillig barnlöshet och infertilitet påverkar många människor och WHO kallar det ett globalt folkhälsoproblem. Donerade könsceller kan användas när en graviditet inte kan uppnås. Vid embryodonation innebär det att det donerande paret har full genetisk koppling till embryot och embryodonation för reproduktiva syften associeras ofta med många emotionella, etiska, rättsliga och psykosociala aspekter. Syfte: Syftet med studien var att undersöka synen på embryodonation för reproduktiva ändamål hos par med erfarenhet av frysförvarade embryon. Metod: En allmän litteraturstudie genomfördes för att besvara syftet. Två databaser (PubMed och Web of Science) användes för att identifiera relevanta kvalitativa studier. En mindre sökning utfördes även i Google Scholar. Inklusions- och exklusionskriterier bestämdes i förväg för att begränsa vilka studier som skulle ingå. Resultat: Totalt inkluderades 20 artiklar i resultatet. Resultatet visar att det finns olika uppfattningar om det mänskliga embryots status, om den genetiska kopplingen, informationsutbyte och screening, om synen på kontakt och relationen mellan donatorer, mottagare och avkomma samt synen på beslutsfattandet och om överskott av embryon ska doneras eller inte. Slutsats: De många uppfattningarna om det mänskliga embryots status betonar den komplexa karaktären hos det mänskliga embryot och kan förklara parens syn på embryodonation för reproduktiva ändamål. Det har också potential att förklara vad par väljer att göra med sina överskott av embryon. Det mottagande parets, donatorernas, det framtida barnets och samhällets intressen bör kontinuerligt bedömas och balanseras när samhället reglerar ART och embryodonation.

Titel From then till now - A study of changes in sustainability reports from 1998-2019. Level Bachelor thesis in Business Administration Authors William Johansson, Johan Finn Rydberg, Thom Werner Tutor Esbjörn Segelod Date 2020-06-09 Keywords Sustainability, Sustainability reports, Signalling theory, Stakeholder theory, Business emissions, Equality, Corruption, Donation, Business Research, GRI, CSR, CSR history, Voluntary disclosure and Legitimacy theory. Research Questions How have the sustainability reports changed in different GRI frameworks and how have it affected companies in different branches, depending on pages and line of business between 1998–2019? How have the word in the categories: environment, social and economic responsibility changed in companies sustainability reports between the years 1998–2019? Purpose The purpose with this study is to examine how businesses sustainability reports associated with energy-, automotive- and forest and paperproduct have effected their sustainability reports from an environmental, social and economical perspecitve from year 1998–2019. Method The method of this study is a quantitative method with a content analysis that consists of 75 sustainability reports in total where 62 of these 75 reports was used. These 62 reports are coming from 25 different companies associated to energy-, automotive and forest and paperpoduction. The study was made of sustainability reports from the year 1998 to 2019. The result of the study encoded to a scheme of code. Conclusion The conclusion of this study shows an increase of the sustainability reports in all three branches. The most of the words shows an increase from 1998-2019. / Titel Från dåtid till nutid - En studie om förändringar i hållbarhetsredovisning mellan åren 1998–2019. Nivå Kandidatuppsats Författare William Johansson, Johan Finn Rydberg, Thom Werner Handledare Esbjörn Segelod Datum 2020-06-09 Nyckelord Sustainability, Sustainability reports, Signalling theory, Stakeholder theory, Business emissions, Equality, Corruption, Donation, Business Research, GRI, CSR, CSR history, Voluntary disclosure och Legitimacy theory. Frågeställningar Hur har företags hållbarhetsredovisning påverkats av förändringen i GRI:s ramverk, mätt i antal sidor samt branschtillhörighet mellan åren 1998-2019? Hur har begrepp inom miljö, socialt och ekonomiskt ansvar förändrats i företags hållbarhetsredovisningar mellan åren 1998–2019? Syfte Syftet med studien är att undersöka hur svenska företag i branscherna fordon, energi samt skog- och pappersproduktion har påverkat sin hållbarhetsredovisning utifrån miljö, socialt och ekonomiskt perspektiv, mellan åren 1998–2019. Metod Studiens tillvägagångssätt är kvantitativ metod med innehållsanalys som var tänkt att bestå av totalt 75 stycken hållbarhetsrapporter men endast 62 stycken kunde användas. Dessa 62 rapporter kommer från 25 olika företag som tillhör energi, skogs- och pappersproduktion och bilbranschen. Studien använde sig av hållbarhetsredovisningar från 1998–2019. Resultatet kodades därefter i ett kodningsschema. Slutsats Den slutsats som kan uppsatsen visar är att en ökning av antal hållbarhetsrapporter har ökat i alla tre branscher. Även de flesta orden påvisar en ökning under 1998–2019.

Chaque année, plusieurs milliers de patients aux prises avec une maladie chronique terminale s’ajoutent à la liste d’attente pour une transplantation d’organe, espérant ainsi prolonger leur espérance de vie. Le plus souvent, le don d’organes survient suite au décès neurologique d’un donneur, une condition qui n’est pas sans conséquence sur la qualité des organes. Les traitements pharmacologiques visant à rétablir l’homéostasie et à protéger les organes à transplanter ont été majoritairement étudiés dans des études observationnelles, au début des années 80. Depuis, très peu d’essais randomisés ont évalué l’impact d’interventions chez des donneurs sur des issues cliniques chez des receveurs. Conséquemment, le bénéfice net des traitements pharmacologiques utilisés de routine chez les donneurs d’organes après décès neurologique demeure inconnu et la rationnelle physiopathologique supportant leur utilisation est questionnable. Cette thèse a pour visée de recenser les évidences supportant les traitements pharmacologiques employés pour la stabilité hémodynamique des donneurs d’organes après décès neurologique et de décrire le niveau d’évidence supportant leur usage. Nous visons également à identifier des cibles de recherche potentielles basées sur de nouvelles observations pathophysiologiques. Pour atteindre ces objectifs, nous avons dressé un large portrait de la prise en charge actuelle des donneurs après décès neurologique, ceci menant ensuite à l’exploration des perceptions des médecins intensivistes canadiens en regard de ces interventions. Nous avons également exploré la présentation clinique cardiaque des donneurs et nous avons identifié des barrières à la recherche clinique dans le domaine. Notre thèse a mené à 4 articles scientifiques. D’abord, nous avons démontré à l’aide d’une revue systématique des lignes directrices internationales sur la prise en charge des donneurs après décès neurologique que les recommandations actuelles sont incohérentes et que leur faible qualité méthodologique reflète la lenteur de l’émergence de la recherche dans le domaine. Ensuite, nous avons effectué un sondage national auprès de médecins des soins intensifs ayant de l’expérience dans la prise en charge des donneurs. Nous avons ainsi démontré que les perceptions de pratiques sont très variables au pays et avons attribué ces divergences d’opinions au manque de données probantes, et à la possible inexpérience relative des médecins face aux rares cas de don d’organes sur une unité de soins intensifs. Notre troisième article a démontré que la dysfonction ventriculaire droite est fréquente après un décès neurologique, bien que la littérature actuelle ne mette l’emphase que sur la dysfonction ventriculaire gauche et ses conséquences. Nous émettons l’hypothèse que la description actuelle des conséquences hémodynamique du décès neurologique est incomplète et qu’une meilleure compréhension des mécanismes sous-jacents à la dysfonction ventriculaire droite permettrait d’identifier de nouvelles cibles thérapeutiques. Finalement, en s’appuyant sur nos observations, nous questionnons l’efficacité et la pertinence d’interventions pharmacologiques administrées de routine chez les donneurs telles que l’hormonothérapie de remplacement. Nous avons donc effectué un essai randomisé pilote visant à évaluer la faisabilité d’une étude multicentrique déterminante comparant la levothyroxine au placebo chez des donneurs potentiels. Cette étude pilote a démontré qu’une étude d’envergure était nécessaire afin d’évaluer le bénéfice de l’intervention et a permis d’identifier des barrières à la recherche spécifiques au domaine. Nous proposons que des activités de transfert de connaissances sur le niveau d’évidence supportant les interventions pharmacologiques actuelles soient implantées en préparation d’un essai randomisé contrôlé multicentrique. Cette thèse a permis de mettre en lumière la validité questionnable du traitement pharmacologique pour la prise en charge de l’instabilité hémodynamique des donneurs d’organes tel qu’il est utilisé présentement. Nous avons fait ressortir que le traitement actuel est historiquement basé sur des données de faible évidence. Nous suggérons que l’avenir de la recherche interventionnelle chez les donneurs d’organes repose sur la capacité des cliniciens et des chercheurs à reconnaitre les zones d’incertitude dans les connaissances actuelle et à accepter des changements dans leur pratique. / Every year, thousands of chronically ill patients are added to the transplant list, in the hope of an organ transplant that could save their life. Most frequently, organ donation occurs following neurological death of a donor, a clinical pathological condition that can jeopardize the quality and stability of organs. The body of literature on the hemodynamic consequences of neurological death and their treatment exist since the early 80’s. Since then, very few randomized trials have been performed on the neurologically deceased donor population. As a consequence, the benefit of routine pharmacological therapies for the hemodynamic management of neurologically deceased donors on recipients’ outcomes is still uncertain, and the pathological theory underlying their use remains questionable. Consequently, this thesis aims at describing the actual body of evidence supporting the pharmacological treatment for the hemodynamic management of neurologically deceased donors and the theoretical rationale for their use. We also aimed at adding to the actual knowledge of brain death physiological hemodynamic consequences. To achieve this goal, we drew a broad portrait of the actual management of hemodynamic instability in organ donors, leading to the exploration of perceptions on these interventions. We then explored physiological consequences of neurological death at the heart level and evaluated the feasibility of conducting a multicentre trial on a pharmacological intervention in donors. Our thesis let to four research articles. First, we demonstrated through a systematic review of international guidelines for the management of neurologically deceased donors that the existing recommendations are inconsistent and that their poor methodological quality reflects the slow emergence of clinical research in the field. Then, in a national survey of intensive care physicians with experience in organ donor clinical management, we identified varying perceptions of practices in the country. We attributed this difference in opinions to the paucity of research in the field and to the possible relative inexperience of some physicians when managing deceased donors, a relatively rare condition in the intensive care unit. Our third article suggested that right ventricular dysfunction is frequent after neurological death, although existing literature focus mainly on the occurrence and consequences of left ventricular dysfunction. We postulate that the actual description of hemodynamic consequences of neurological death is incomplete and that a better understanding of the mechanisms underlying right ventricular dysfunction would permit to identify new therapeutic targets. Finally, based on our previous conclusions, we questioned the relevance and efficacy of levothyroxine routine administration in donors and designed a pilot randomized controlled trial to evaluate the feasibility of a multicenter definitive trial. This pilot trial permitted to identify important barriers to interventional research including neurologically deceased donors. We propose that knowledge translation activities on the actual level of evidence supporting routine interventions be implemented in the preparation of a future randomized trial. This thesis permits to question the validity of the actual pharmacological management of neurologically deceased donors highlighting the paucity of high-evidence literature in the field and the penetrance of historical interventions and concepts. We suggest that the future of research in the field lies on the ability to recognize areas of uncertainties and the acceptance of practice change.

Orientador: Patricia Borba Marchetto / Resumo: A bioética envolve questões que acontecem em um mundo multidisciplinar, interdisciplinar ou transdisciplinar, o que pode sugerir uma grande lacuna do direito, favorecendo ou até promovendo violações contra a humanidade, como também aos sistemas internacionais de direitos humanos e aos direitos fundamentais, estes inseridos no cenário constitucional brasileiro. Neste caso, a ciência e a tecnologia invadem o mundo do Direito, limitadas pelos institutos do direito à vida e da dignidade da pessoa humana, os quais são premissas constitucionais de formação do Estado para a construção e o fortalecimento do ordenamento jurídico composto por regras nacionais e por fontes internacionais, cenário permeado por questões éticas e morais que trazem interpretação tanto ao Direito quanto à Bioética e suas peculiaridades. A relevância do tema deve ser observada não somente pelo viés dos interesses econômicos que envolvem as pesquisas científicas ou a manutenção dos sistemas de saúde pública, mas, principalmente, para obtenção de respostas aos dilemas que envolvem a ciência e a saúde e suas sensíveis e possíveis violações aos princípios mencionados. Através de um caso concreto, ainda em trânsito no sistema de justiça brasileiro, abordando o direito de uma paciente submetida à lista de espera por um transplante de medula, a pesquisa se desenvolve no sentido de discutir a relação entre direitos humanos, bioética, preservação da vida, evolução científica e seus desafios modernos e, especialmente, ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Bioethics involves issues that happens in a multidisciplinary, interdisciplinary or transdisciplinary world, which can suggest a wide gap of the Law studies, favoring or even promoting violations against humanity, but also to international systems of human and fundamental rights, these inserted into Brazilian constitutional scenario. In this case, the science and technology invades the world of law, limited by the institutes of the right to life and human dignity, which are constitutional premises of formation of the State for the construction and strengthening of the legal system composed of national rules and international fonts, scenery permeated by ethical and moral issues that bring interpretation both to the Law regarding Bioethics and its peculiarities. The relevance of the theme should be observed not only by the bias of economic interests that involve scientific research or the maintenance of public health systems, but mainly for obtaining answers to dilemmas that involve science and health and his sensitive and possible violations to the principles mentioned. Through a concrete case, still in transit in the Brazilian justice system, addressing the right of a patient subject to the waiting list for a bone marrow transplant, the research develops in order to discuss the relationship between human rights, bioethics, preservation of life, scientific progress and its modern challenges and, especially, to reach an analysis as to the application of national legislation con... (Complete abstract click electronic access below) / Mestre

Human infertility is not a new phenomenon, but it is as old as humanity itself. Currently in most developed countries, the number of couples who have a problem with childbearing is growing. This is due, among other things, to the lifestyle associated with career development and postponement of parenthood. While in the past infertile couples usually had only two options to deal with their sterility - childlessness and a substitute life program, or adopting a child. Today, infertile couples have a third option and this is the treatment of infertility using assisted reproduction methods. This year, exactly forty years have elapsed since the birth of the first child by means of extracorporeal fertilization. Already then the assisted reproduction was considered a method that is ethically problematic. Numerous specialists, such as physicians, biologists, lawyers, philosophers, theologians, and others, have been involved in the quest for ethical issues. Not only there has been no solution to some problems during the whole lifetime of assisted reproduction on which most experts and the general public would agree, but with the gradual development of this treatment method new problems have arisen. Today's stage of development of artificial insemination techniques and procedures together with modern...