Esta pesquisa teve por objetivos conhecer a percepção de enfermeiros sobre conflitos éticos no processo de doação de órgãos e tecidos para transplante, como são tomadas as decisões e o que é levado em consideração para a tomada de decisão frente a conflitos éticos. Foi realizado um estudo exploratório, descritivo e de abordagem qualitativa, sendo utilizada a análise de conteúdo proposta por Bardin. Foram realizadas onze entrevistas com enfermeiros que prestaram assistência a potenciais doadores na prática profissional, há pelo menos um ano, lotados nas seguintes unidades: UTI adulto e pediátrica, Pronto socorro, Centro cirúrgico, Unidades de internação e na Comissão Intra Hospitalar de Doação de Órgãos e Tecidos para Transplante. Após a análise emergiram cinco categorias: 1. Dificuldade em aceitar a morte encefálica; 2. Não aceitação da equipe multiprofissional de desconectar o ventilador mecânico do paciente em morte encefálica não doador de órgãos; 3. Dificuldades da equipe multiprofissional durante o processo de doação de órgãos; 4. Situações que podem interferir no processo de doação de órgãos e 5. Tomada de decisão frente a conflitos éticos no processo de doação de órgãos. Os resultados mostraram que os enfermeiros identificam conflitos éticos no processo de doação de órgãos, gerados por diversos fatores como: a dificuldade em aceitar a morte encefálica como morte do individuo, a resistência em aceitar a suspensão do suporte terapêutico no paciente em morte encefálica, a falta de conhecimento e comprometimento durante o processo de doação, o descaso e assistência inadequada ao potencial doador de órgãos, a dificuldade com a alocação de recursos humanos e materiais incluindo a liberação de leitos de UTI para o potencial doador; as crenças religiosas e as falhas de comunicação. Além disso, para tomar decisão frente aos conflitos éticos, eles levam em conta o princípio da beneficência, o dever legal e, principalmente, o diálogo com os colegas. Assim, ficou evidenciado que o processo de doação de órgãos está permeado por conflitos éticos, demonstrando uma necessidade de reflexão e discussão sobre o tema, incluindo as situações geradoras e as tomadas de decisão frente aos conflitos éticos / This research aimed to know the perception of nurses on ethical conflicts in the process of donating organs and tissue for transplantation, as decisions are made and what is taken into account in decision-making in the face of ethical conflicts. We conducted an exploratory, descriptive and qualitative approach, using the content analysis proposed by Bardin. Eleven interviews were conducted with nurses who provided assistance to potential donors in professional practice for at least one year, allocated in the following units: adult and pediatric ICU, First Aid, surgical center, inpatient units and the Commission Intra Hospital Organ Donation and Tissues for Transplantation. After analyzing five categories: 1. Difficulty accepting brain death, 2. Non-acceptance of the multidisciplinary team to disconnect the ventilator patient\'s brain-dead organ donor is not 3. Difficulties of the multidisciplinary team during the process of organ donation 4. Situations that may affect the process of organ donation and 5. Decision making in the face of ethical conflicts in the process of organ donation. The results showed that nurses identify ethical conflicts in the process of organ donation, generated by several factors: the difficulty in accepting brain death as death of the individual, the resistance to accept the suspension of therapeutic support in brain death, the lack of knowledge and commitment during the donation process, neglect and inadequate care of the potential organ donor, the difficulty with the allocation of human and material resources including the release of ICU beds for the potential donor, religious beliefs and failures communication. Moreover, to make decisions in the ethical conflicts, they take into account the principle of beneficence, the legal duty, and especially the dialogue with colleagues. Thus, it became evident that the process of organ donation is permeated by ethical conflicts, demonstrating a need for reflection and discussion on the topic, including generating situations and decision making in the face of ethical conflicts

As transfusões sanguíneas constituem-se uma ferramenta indispensável na prática médica atual, sendo a captação e retenção de doadores uma preocupação de todo serviço hemoterápico, assim como a segurança dos doadores e receptores. Neste sentido, a educação prévia à doação de sangue exerce papel fundamental, sendo etapa obrigatória no processo de doação. Um doador bem orientado significa menor risco transfusional e maior probabilidade de retorno. Este trabalho descreve a elaboração e aplicação de um vídeo contendo informações necessárias à conscientização prévia à doação de sangue. Após o levantamento das necessidades de conteúdo, através da legislação, literatura e de grupo focal com doadores, produziu-se um vídeo que foi apresentado previamente à doação. Foram incluídos 500 doadores no grupo conscientizado com o vídeo e 500 no grupo controle, conscientizados com palestras, conforme rotina do serviço, sendo 25% de primeira vez e 75% de retorno. Após a doação, os doadores responderam a um questionário para avaliação dos conhecimentos adquiridos e os grupos foram comparados entre si. Responderam ao questionário 118 e 121 doadores de primeira vez e 375 e 345 de retorno, nos grupo do vídeo e controle, respectivamente. A distribuição dos doadores entre os grupos foi homogênea, não variando em relação a faixas etárias, gênero, escolaridade, número de comparecimentos e motivação para a doação. Quanto à nota obtida no questionário, foi significativamente superior para o grupo do vídeo em relação ao controle, marcadamente ente os doadores de primeira vez. Dentre as faixas etárias analisadas, foi inferior para a faixa etária maior de 50 anos. Os doadores de primeira vez tiveram notas inferiores em relação aos de retorno. A apresentação do vídeo não interferiu nas taxas de inaptidão clínica à doação, de situação de risco para doenças transmissíveis, de reações vasovagais, nem nos resultados sorológicos, sendo semelhantes ao grupo controle. A satisfação geral com o atendimento, medida através de instrumento padrão do serviço, foi superior no grupo do vídeo em relação ao grupo controle. Conclui-se que a ferramenta audiovisual é adequada à informação e educação dos doadores de sangue antes da efetivação da mesma, sendo de especial interesse para os doadores de primeira vez, gerando maior satisfação com o atendimento. / Blood Transfusions are an essential tool in the current medical practice, in which the capture and retention of donors is a concern of every hemotherapy service, as well as the safety of both, the donors and the receptors. Therefore, prior education to blood donation has a fundamental role for being a compulsory stage in the donation process. A well-targeted donor means less transfusion risk and more probability of return. This work describes the development and implementation of a video containing information necessary for prior awareness regarding to blood donation. After collecting data about the need of content, through the legislation, literature and focus group with donors, it was produced a video which was presented before the donation. There were 500 donors included in the group aware of the video and 500 in the control group, conscious with speeches, according to the service routine, being 25% of first time and 75% of regular donors. After the donation, the donors answered a questionnaire to evaluate the knowledge gained and the groups compared with each other. Donors from video and control group answered the questionnaire: 118 and 121 of the first time donors, and 375 and 345 regular donors, respectively. The distribution of donors among the groups was homogeneous, not varying according to age, gender, schooling, number of attendances and motivation for donation. Regarding the score of the questionnaire, it was significantly higher in the video group compared to the control group, especially for first time donors. It was lower for people over 50 years old related to the other ages, and for first time donors, related to the regular ones. The video presentation did not interfer in rates such as clinical deferral to donation, the situation of risk for communicable diseases, vasovagal reactions, not even in serological results, being similar to the control group. The general satisfaction with the attendance, which was measured through a service standard instrument, was higher in the video group compared to the control group. In conclusion, the audiovisual tool is suitable to the information and education of the blood donors before the completion of it, being of a special interest to all first time donors, generating greater satisfaction with the attendance.

Bakgrund: Behovet av organ är större än antalet utförda transplantationer i Sverige. Att som anhörig få beskedet o m ett plötsligt dödsfall kan vara en utlösande faktor till att hamna i kris. Hur hanterar de anhöriga att ta beslut om organdonation och vilka är deras erfarenheter och upplevelser av situationen på en intensivvårdsavdelning. Syfte: Att beskriva anhörigas erfarenheter av att ta beslut om organdonation på en intensivvårdsavdelning. Metod: En systematisk litteraturstudie genomfördes, resultatet grundas på 17 vetenskapliga artiklar varav tolv kvalitativa respektive tre kvantitativa samt två med mixad metod. Resultat: I resultatet framkom olika aspekter på anhörigas erfarenheter om att ta beslut om en organdonation. Resultatet sammanfattades i sju kategorier; viljan om donation, organdonationsprocessen kan skapa lidande, kommunikation och information, kunskap om anhöriges vilja, relationen med vårdpersonal, från fråga till beslut, från beslut till donation, samt efter donation. Slutsats: Litteraturstudien resulterade i en djupare insikt i anhörigas erfarenheter och kunskaper om faktorer som påverkar hens beslut om organdonation. Att som anhörig behöva ta beslut om organdonation i en kris kan generera lidande samt att hitta en mening genom organdonationen. / Background: The need for organs is greater than the number of transplants performed in Sweden. Familiarizing a relative with a sudden death can be a trigger for ending a crisis. How do relatives deal with organ donation decisions and what are their experiences of the situation on an intensive care unit. Purpose: To describe relatives' experiences in deciding on organ donation in an intensive care unit. Method: A systematic literature study was conducted, the result is based on a total of 17 scientific articles, of which twelve qualitative and three quantitative as well as two by mixed method. Result: The results revealed different aspects of the relatives' experience of deciding on organ donation. The result was summarized in seven categories; The desire for donation, the organ donation process can create suffering, communication and information, knowledge of the family's will, the relationship with healthcare professionals, from question to decision, from decision to donation, and after donation. Conclusion: The literature study resulted in a deeper insight into the relatives' experiences and knowledge of factors that influence decisions on organ donation. Being able to decide on organ donation in a crisis as a relative can cause suffering and find an opinion through organ donation.

The donation of organs and tissues for transplantation is being used to treat a wide range of diseases. The structure of the Brazilian transplant system is based on the search for potential donors and in this context, the Commissions Intra-hospital Donation of Organs and Tissues for Transplantation (CIHDOTT) play an important role in obtaining organs through active search potential donors. Among the members of CIHDOTT, is the nurse who has great importance in the donation process and organ transplantation. This study aimed to know the nurse's role as a member of Intra-hospital Committee on Organ Donation and Transplantation fabrics - CIHDOTT. This is a qualitative research, exploratory and descriptive. Was performed with nurses working in CIHDOTT five hospitals in Porto Alegre, the state capital of Rio Grande do Sul, Brazil. Data were collected through semi-structured interview, during the first half of 2014. The data were analyzed based on thematic content analysis framework proposed by Minayo. The results highlight four categories related to the role of the nurse in CIHDOTT: The insertion of nurses in CIHDOTT; Nurses work in CIHDOTT: Facilities and difficulties faced by nurses in the course of work in CIHDOTT. The work of nurses with relatives, particularly with respect to the reception and bond and the centrality of nurses who work in CIHDOTT. We conclude that the CIHDOTT nurse is fundamental, and is seen as crucial for a donation program and successful transplant. Is a professional to perform their role, appropriates technological, logistical and human resources in order to develop mainly the activities of coordination / management CIHDOTT, and direct and indirect assistance throughout the donation and transplantation process actions and attitudes aimed at the donor, to the care team and family. / A doação de órgãos e tecidos para transplante está sendo utilizada para o tratamento de uma ampla gama de afecções. A estrutura do sistema brasileiro de transplante fundamenta-se na procura por potenciais doadores e, neste contexto, as Comissões Intra-hospitalares de Doação de Órgãos e Tecidos para Transplantes (CIHDOTT) desempenham um papel importante na obtenção de órgãos por meio da busca ativa de potenciais doadores. Entre os integrantes da CIHDOTT, encontra-se o enfermeiro, que tem suma importância no processo de doação e transplante de órgãos. O presente estudo teve como objetivo geral conhecer o papel do enfermeiro como membro de Comissão Intra-hospitalar de Doação de Órgãos e Tecidos para Transplantes CIHDOTT. Trata-se de uma pesquisa de abordagem qualitativa, de caráter exploratório e descritivo. Foi realizada com enfermeiros atuantes em CIHDOTT de cinco hospitais em Porto Alegre, capital do Estado do Rio Grande do Sul, Brasil. Os dados foram coletados por meio de entrevista semiestruturada, durante o período primeiro semestre de 2014. Os dados foram analisados com base no referencial de análise de conteúdo temático proposto por Minayo. Dos resultados emergiram quatro categorias, relacionadas ao papel do enfermeiro em CIHDOTT: A inserção do enfermeiro em CIHDOTT; O trabalho do enfermeiro em CIHDOTT: Facilidades e dificuldades, enfrentadas pelo enfermeiro no decorrer do trabalho na CIHDOTT. A atuação do enfermeiro junto aos familiares, particularmente no que tange ao acolhimento e vinculo e a centralidade do enfermeiro atuante em CIHDOTT. Conclui-se que o enfermeiro de CIHDOTT é fundamental, e é tido como elemento crucial para um programa de doação e transplante de sucesso. É um profissional que para desempenhar seu papel, apropria-se de meios tecnológicos, logísticos e humanos no intuito de desenvolver, principalmente, as atividades de coordenação/gestão em CIHDOTT, além de assistência direta e indireta durante todo o processo de doação e transplante com ações e atitudes voltadas para o doador, para a equipe assistencial e para a família.

This thesis deals with legal and ethical aspects of assisted reproduction. The aim of the thesis is to analyse the current legal regulation of assisted reproduction in the Czech Republic, in comparison with the legal system of selected countries. Further aim is to expose the legal regulation's deficits and suggest possible solutions de lege ferenda, particularly with regard to scientific developments and ethical attitudes of the current society. The thesis is divided into six chapters, including the introduction and conclusion. The introductory chapter outlines the issue of assisted reproduction and denotes individual areas on which the thesis will focus. The first chapter deals with the various methods of assisted reproduction and with the term of infertility from the perspective of medical and historical perspective. The second chapter focuses on the legal regulation of individual areas of assisted reproduction in the Czech Republic. Among others, these areas consist of the constitutional protection of the human embryo, the determination of parenthood, the issue of surrogacy, gamete donation and disposition of embryos. The third chapter deals with a comparison of legal framework in selected states. As a representative of the Anglo-American system was chosen United Kingdom of Great Britain and...

Les partages des articles 1075 et suivants du Code civil permettent à un disposant de réaliser par anticipation le partage de sa succession entre ses héritiers présomptifs. Cette faculté, durant les deux siècles qui ont suivi la codification, était réservée aux seuls ascendants au profit de leurs descendants et ce n’est que par la loi du 23 juin 2006 qu’elle a été étendue en dehors de la ligne directe descendante. Cette ouverture résulte d’une évolution progressive de cet acte, réalisée tout au long du XXe siècle pour répondre aux blocages nés des interprétations divergentesdéveloppées au cours du XIXe siècle. Le caractère hybride des partages d’ascendants qui se trouvent au confluent des successions et des libéralités est une donnée établie. Tout comme une médaille est constituée d’un avers et d’un revers, les partages d’ascendants sont constitués d’un élément répartiteur et d’un élément attributif. La réunion indissociable de ces deux éléments confère aux partages des articles 1075 et suivants leur identité. Or, pour indissociables et constitutifs qu’ils soient, les deux côtés ne sont jamais perçus simultanément. Tout l’intérêt d’une approche historique des articles 1075 et suivants consiste à mettre en lumière la façon dont la médaille s’est retournée : comment l’élément attributif s’est développé jusqu’à devenir l’avers, la face principale. / The estate distribution established by the articles 1075 s. of the civil code enables a disposer to anticipate the distribution of his inheritance between the heirs apparent. During the next two centuries which followed the codification, this ability was reserved to the only ascendants in favor of their descendants. The law of the 23rd June 2006 had the effect that it was no longer limited to the direct descending line. This opening was the result of a progressive evolution of the act, which was established all along the twentieth century in order to respond to the blockings arising from the different interpretations developed during the nineteenth century. The hybridity of the ascendants’ estate distribution, situated at the confluence of inheritance and liberalities, is an established fact. As well as a medal has an obverse and reverse side, the ascendants’ estate distribution consists of a distributive element and an attributive element. The inseparable union of these two elements gives the estate distribution established by the article 1075 s. its identity. As inseparable and constituent the obverse and reverse side might be, they are yet never perceived simultaneously, even though the reverse side is generally described by its relation with the obverse: It is the opposite of the one presented as the principal, it is the supporting side of the second listing. All the interest in a historical approach to the articles 1075 s. consist of bringing to light the way the distributive element evolved into becoming the obverse of our institution leading to a notable change of the nature of these estate distributions which nevertheless remain dual acts.

Organ donation is traditionally based on the notion of making a gift based on altruism. An important aspect of ‘altruistic gifting’ is commitment to a solidaristic approach to meeting transplant needs. In line with this, people are encouraged to donate their organs at death to a common pool for collective provision, or donate a live organ to another freely. Given a chronic organ shortage, proposals have been made to change this system to increase donation. Proposals include introducing some organ market or payment in the form of a reward to incentivise live or deceased donation. However, these proposals have been opposed because of the grip of ‘altruistic gift’ as the only ethically acceptable way to procure and distribute organs. To support the ethical acceptability of other systems, ‘altruistic gift’ has been subject to various criticisms. One criticism is the moral relevance of altruism: people may donate on other motives other than altruism; or, altruism is not the motive that underpins most deceased organ donations. Another criticism is the moral value of altruism: even if deceased organ donations are in general altruistic, altruism does not express communal virtues like generosity that support solidarity. A third criticism is the value of the concept of altruism when understood in the pure sense: ‘pure altruism’ fashions an unnecessary or false dichotomy – gift versus sale – in the way people can ethically relate and help each other. Consistent with or following this criticism, it has been argued that use of a financial reward to incentivise donation can be compatible with preserving donation as altruistic albeit in a ‘non-pure’ sense. ‘Altruism’ and reward can co-exist as motives for donation. This thesis concerns itself centrally with the third criticism. It argues that the concept of altruism delineates a distinctive moral ‘perspective’ of a common humanity that engenders a devotion to others’ interests. Accordingly, as I argue, ‘non-pure’ definitions of altruism are misleading as to how a financial reward can be compatible with altruism. From this, the thesis argues that introduction of a financial reward for organ donation would not preserve donation as altruistic. Based on an understanding of altruism as also a motive for ‘creative’ relationships, the thesis counters criticisms of its relevance and value to deceased organ donation under a gift model. As part of its legal analysis, the thesis considers the antithesis of ‘altruistic gift’: the idea of organs as property which places individual control on their disposition at its moral centre. It has been argued that organs should be owned as property so that individuals can sell them, or transmit them to relatives so that relatives can claim payment from donation. To provoke thought on whether organs should be owned as private property like any other, the thesis proposes an inheritance regime for organs with family as default successor.

A travers notre pratique de pédopsychiatre confronté au vécu de familles interpellées par la question du don de gamètes ou d'organes, il nous a semblé que nombre d'apories traversant les phénomènes de la donation et de l'anonymat n'étaient pas pris en compte par la médecine.Si le don et l'anonymat traversent toute la médecine au point que celle-ci les a hissé au rang de principes, ils ne font pas l'objet d'un enseignement ou d'une réflexion approfondie. La philosophie et la littérature apportent aussi certaines réponses possibles . Le don est un présent sans la présence, portant en lui une part d'abandon, sans raison, à quelqu'un qui ne demande rien, puisque justement il ne saurait pas qu'on lui a donné. L'anonymat permet de s'effacer, pour pouvoir rencontrer l'Autre, au plus prés. Ceci commence dès l'origine, pour permettre au sujet d'approcher dans l'errance et le doute une rencontre avec l'inconnu et le dehors, loin d'une altérité qui ne serait que radicale. Enfin, la question du don d'organes, du don de gamètes, de l'anonymat obligent à repenser simultanément la question de la relation et celle de l'identité. Le donneur et le receveur se rencontrent, l'un est obligatoirement plongé dans le temps de l'autre : comment construire une sphère propre et une sphère de l'autre, une intersubjectivité qui rendrait possible la communication entre matériaux d'origine différente ? Comment reconnaître ego et alter, comme des ipséités ? Les concepts d'identité narrative, d'histoires empêtrées, permettent de dépasser la question de l'anonymat. L'anonymat protégerait alors l'identité. Et mieux, permet alors à la reconnaissance, toute éthique, d'advenir. / Through our practice of child psychiatry and confronted with the lived of families concerned with the question of gametes or organs donation, it seems that numerous aporia related to donation and anonymity experiences have not been considered by medicine. If donation and anonymity have been central to medicine to the point that they have become principles, they have never been subjects of education or profound reflection. Philosophy and literature also bring some possible answers. Donation is a present without the presence, carrying with itself some abandonment, without reason, to someone who doesn't ask for anything, precisely because he would not know that he was given something. Anonymity gives an opportunity to fade away, just to be able to meet the other, closer. This obliteration starts from the very beginning. It aims at any founding trace, in order, paradoxically to allow the subject to approach in wandering and doubt a possible encounter with the unknown and the outside, far from an otherness that be only would be radical.Finally, the issue of organ donation, of gamete donation, of anonymity, forces us to rethink simultaneously the question of relationship and identity. The donor and recipient, meet and are necessarily immersed in the other's time: how to build a sphere for oneself and a sphere for the other, an intersubjectivity which would enable the communication between materials of different origin? How to recognize ego and alter, as ipseities? Concepts of narrative identity, entangled stories allow to pass over the question of anonymity. Anonymity would then protect identity. And better still, would allow for an ethical recognition to happen.

Recent advances in assisted reproductive technologies have resulted in an increasing number of children born by gamete donation. Children conceived by egg donation lack a genetic link with their mother whereas children conceived by donor insemination lack a genetic link with their father. In families in which parents do not disclose their use of donated gametes, the child is unaware that their mother or their father in not their genetic parent. The aim of this thesis was to assess the impact of non-disclosure, and of the absence of a genetic link between parent and child, on family functioning and child adjustment. Data were obtained from a representative sample of 36 donor insemination, 32 egg donation and 54 natural conception families when the target child was 7 years old. Standardised interview, questionnaire and observational data were obtained from mothers, fathers, children and the child?s teacher. Few differences in family functioning were found between disclosing and non-disclosing gamete donation families. Likewise, few differences emerged between gamete donation families and natural conception families. The families were found to be functioning well irrespective of whether the parents had disclosed and of whether the child lacked a genetic link with a parent. However, comparisons between donor insemination and egg donation families showed that disclosure status and family type interacted in complex ways. Contrary to predictions, disclosure was not always associated with favourable outcomes. Children in disclosing donor insemination families were rated by teachers as having fewer behavioural problems. However, observational ratings showed lower levels of positive mother-child interaction in disclosing egg donation families. The process of disclosure was also explored. In all but one disclosing family, parents had started to talk to their child about their donor conception by age 4, with disclosure typically initiated and maintained by the mother. Despite mothers? concerns, children did not appear distressed by information about their donor conception. However, interviews with the children themselves suggested that most had little understanding of their donor conception at age 7.

Withdrawal of life support therapy involves controlled removal of life support modalities including artificial respiration and circulation with intent to provide a comfortable death. Withdrawal of life support therapy is necessary prior to procedures such as organ donation after cardio-circulatory death, but remains poorly explored in current literature. To enhance the current evidence, we conducted a thorough structured review, an observational study, and a qualitative comparison of components comprising withdrawal of life support therapy in both donor and non-donor patient groups. At all stages, we considered how results impacted donation after cardio-circulatory death. Withdrawal of life support therapy processes vary between countries, hospitals, practitioners, and patients. Variability in practice impacts care and outcomes for both donor and non-donor patients. Improved definitions and consensus about the process of withdrawal of life support therapy may improve patient care, success of organ donation after cardio-circulatory death, and uptake of donation protocols.