Over the last few years, policies have been introduced in the UK which aim to improve organ transplantation rates by changing the way that potential organ donors are treated before death. Patients incapacitated due to catastrophic brain injury may now undergo ante-mortem donor optimisation procedures to facilitate deceased organ donation. As I identify in this thesis, the most significant ethical and legal problem with these policies is that they are not based on what the patient would have chosen for themselves in the specific circumstances. The policies identify and treat patients meeting certain clinical criteria as a group rather than the individuals, with their own viewpoints, that the law on best interests requires. They equate registration on the Organ Donation Register with ante-mortem donor optimisation procedures being in their best interests, despite registrants having neither been informed about nor given consent to ante-mortem interventions. The overarching claim I make in this thesis is that a system of specific advance consent is needed to provide a clear and unequivocal legal justification for ante-mortem donor optimisation procedures. The ethical foundation for this claim is autonomy, and this is the central theme running through all six chapters. I argue that autonomy should be incorporated into donor optimisation policy to promote the dignity and integrity of potential organ donors and to safeguard trust in the organ donation programme. I argue that a system of specific advance consent is needed as part of the duty of care owed to registrants on the Organ Donor Register and to facilitate the determination of the best interests of the potential organ donor. I argue that the state has not established the necessity of the current policy of non-consensual donor optimisation procedures and that they are under an ethical and legal obligation to introduce an autonomy-based framework for ante-mortem interventions to facilitate organ donation.

Au moment où le législateur s’apprête à ouvrir l’assistance médicale à la procréation aux couples de femmes, cette étude a pour objet de porter un regard critique sur l’analyse doctrinale du Titre VII du Livre premier du Code civil. Alors que la plupart des auteurs considèrent que le droit français est incohérent en ce qu’il recourt aux mêmes modes d’établissement de la filiation que l’enfant soit ou non lié biologiquement à ceux qui sont juridiquement reconnus comme ses parents, cette thèse propose de réenvisager le fondement de la filiation à partir d’une analyse causale de la parenté. Ce changement de perspective permet d’éclairer sous un jour nouveau les conditions d’accès à l’assistance médicale à la procréation ainsi que les enjeux tenant à leur éventuelle modification. Il permet aussi et surtout de réévaluer la cohérence du droit de la filiation et sa capacité à appréhender ces nouvelles figures de la parenté. / As the legislator gets ready to open medically assisted procreation to women couples, the purpose of this study is to take a critical look at the doctrinal analysis of the Title VII of the First Book of the French Civil Code. Most of the authors consider that French law is incoherent as it uses the same modes of establishment of filiation whether a child is biologically related to those who are recognized as his parents or not. This thesis proposes to reconsider the basis of filiation, using a causal analysis of parenthood. This change of perspective allows to cast a new light on the eligibility criteria to medically assisted procreation as well as on the stakes of their potential modification. It also leads to reevaluate the coherence of the law of filiation and its capacity to comprehend the new figures of parenthood.

Cette thèse de psychopathologie psychanalytique est une réflexion théorico-clinique sur l'expérience d'une assistance médicale à la procréation (AMP), et plus particulièrement sur l’état psychologique des femmes infertiles en parcours de fécondation in vitro (FIV) et de don d'ovocytes. Cette recherche a pour but d'évaluer la psychopathologie de ces femmes et les éventuels remaniements psychiques qu'impose ce mode de procréation. L’hypothèse générale de cette étude soutient l’idée qu’il existe des particularités dans le fonctionnement psychique des femmes infertiles qui diffèrent selon que les femmes ont recours à une FIV ou à un don d’ovocytes. La méthodologie repose sur la base d'entretiens semi-directifs, de questionnaires et de tests projectifs (Rorschach et TAT) et l'analyse du matériel recueilli s'appuie sur la théorie psychanalytique. Les résultats montrent que ces femmes souffrent d’une blessure psychique qui est à mettre en lien avec le vécu d’une castration réelle de leur féminité dans sa valence maternelle châtrée. Les femmes infertiles se trouvent sous l’emprise de l’objet primaire et leur fonctionnement mental se caractérise par une pensée opératoire défensive. De plus, le recours à une FIV ou à un don d’ovocytes suscite des aménagements psychiques, notamment en termes de représentations maternelles, qui apparaissent spécifiques au type d’AMP. Enfin, l’AMP amène les couples à érotiser les interventions médicales conduisant notamment à un remaniement des théories sexuelles infantiles et à une reconstruction des fantasmes originaires. / This thesis psychoanalytic psychopathology is a reflection on the theoretical and clinical experience of medical assistance to procreation (MAP), and more particularly on the psychological status of infertile women in course of in vitro fertilization (IVF) and oocyte donation. This research aims to assess the psychopathology of these women and the possible psychological changes imposed by this mode of procreation. The general hypothesis of this study is as follows: there are specific aspects in the psychic functioning of infertile women, these characteristics differ between women using IVF or oocyte donation. The methodology is based on semi-directive interviews, questionnaires and projective tests (Rorschach and TAT) and analysis of collected material is based on psychoanalytic theory. The results show that these women suffer psychological injury that is to be linked with the experience of a real castration of their femininity in its valence maternal castrated. Infertile women are under the mastery of the primary object and mental functioning is characterized by a defensive operational thought. In addition, the use of IVF or oocyte donation leads to psychic adjustments, particularly in terms of maternal representations that appear specific to the type of MAP. Finally, MAP brings couples to eroticize medical interventions leading a redesign of infantile sexual theories and a reconstruction of primal fantasies.

The voluntary blood donation issue is topical in the Czech Republic since the number of blood donors has not yet reached the number of donors existing in the neighboring countries. Because of this fact the Czech Blood Cross together with transfusion services centers in the Czech Republic and in cooperation with various organizations, e.g. Czech Radio, do their best to obtain new voluntary blood donors via blood donation campaigns. Language of these campaigns is mainly of persuasive character. As such, it is often viewed as a means of white propaganda which stems from factual information and whose aim is to persuade the consumer of the message about the legitimacy of its ideology. White propaganda also helps to build trust which is lately used. In other words, the consumer of the message becomes blood donor. The thesis analyzes persuasive linguistic means of propaganda present in online discourse of the selected campaigns. On the basis of learned facts, the thesis also tries to characterize this discourse type; moreover, it makes suggestions for designing a new blood donation campaign.

In this study we studied how holistic mission should be accomplished. May we speak about social and evangelical mandates? This search is done through the examination of a Christian relief organisation, the Hungarian Baptist Aid. Our main research question was: Is the work of this service holistic? Although we concluded in the light of David Bosch's mission interpretation that their mission is not yet holistic, the model of Hungarian Baptist Aid is encouraging how we could multiply our resources that are placed in God's hand. How we can see a commission that seemed impossible can become possible, and how we can find our way in God's mission. / Christian Spirituality, Curch History and Missiology / M. Th. (Missiology)

This study aimed at exploring and describing the perceptions of relatives of patients with chronic renal failure regarding kidney donation. The number of patients suffering from chronic renal failure awaiting kidney transplantation is on the increase, while the treatment they get in the interim is not cost effective. The researcher used qualitative descriptive and exploratory research using the Potter and Perry’s Health Belief Model. She applied purposive sampling and used semi structured interviews to collect data from 45 participants who were all relatives of patients coming for haemodialysis at a selected hospital in KwaZulu-Natal. Data analysis identified participants’ perceptions regarding chronic renal failure and kidney donation. Findings of the study revealed that most relatives were fully aware of kidney donation, but fear and lack of knowledge regarding kidney transplantation were the main barriers to them offering themselves for kidney donation. The researcher recommends that the Renal Transplant Multidisciplinary Committee should ensure the public is informed about kidney donation and more intensive education should be given to the relatives of patients suffering from chronic renal failure at an early stage in the illness to give them more time to come to terms with the concept of kidney donation. / Health Studies / M.A. (Health Studies)

LIMA, M. M. P. Avaliação da Política Nacional de Transplantes no Ceará: atuação da Central Estadual e das Comissões Intra-Hospitalares. 2011. 120f. Dissertação (Mestrado em Avaliação de Políticas Públicas) – Universidade Federal do Ceará, Pro - Reitoria de Pesquisa e Pós-Graduação, Programa de Pós-Graduação em Avaliação de Políticas Públicas, Fortaleza, 2011. / Submitted by Ana Paula Paula (mappufce@gmail.com) on 2012-03-21T19:19:48Z No. of bitstreams: 1 2011_Di_ MonicaMPLIMA.pdf: 1422237 bytes, checksum: 6e0ef28dacd03092b4f154837d396356 (MD5) / Approved for entry into archive by Maria Josineide Góis(josineide@ufc.br) on 2012-03-22T13:26:27Z (GMT) No. of bitstreams: 1 2011_Di_ MonicaMPLIMA.pdf: 1422237 bytes, checksum: 6e0ef28dacd03092b4f154837d396356 (MD5) / Made available in DSpace on 2012-03-22T13:26:27Z (GMT). No. of bitstreams: 1 2011_Di_ MonicaMPLIMA.pdf: 1422237 bytes, checksum: 6e0ef28dacd03092b4f154837d396356 (MD5) Previous issue date: 2011 / In recent decades, the transplants have had a profound impact on the care of end-stage patients with several kinds of diseases. In Brazil, public policies regarding people who need transplants require thorough assessments. This research aimed to evaluate the performance of the Organ Notification, Harvesting and Distribution Center of the State of Ceará (CNCDO) and Intra-hospital Commission on Organ and Tissue Donation for Transplant (CIHDOTTs) from Fortaleza, instances considered decisive in the operationalization of the National Transplant Policy in the State of Ceará. The research was conducted by using secondary and primary data, both quantitative and qualitative, developed from July 2010 to February 2011. The president of CNCDO was interviewed. It was applied a form to be filled out by 12 coordinators of CIHDOTTs and structured observations were accomplished in three CIHDOTTs. The following results had been highlighted: CIHDOTTs with reduced teams and nurse predominance; CNCDO overloaded and performing activities which belong to the CIHDOTTs; CIHDOTTs working essentially in an active search for potential donors; the family members refusal is largely responsible for the non-confirmation of a significant number of donations; it was identified fragility in campaign, qualification and joint planning actions between CNCDO and CIHDOTTs; CNCDO and CIHDOTTs resent greater support from health professionals and hospital managers and also the lack of equipment and appropriate physical space; the great expenditure of energy of CNCDO and CIHDOTTs result in an insignificant number of effective donations; there are difficulties in the process of identifying likely potential donor, delay in the diagnosis of brain death and in the beginning of the hemodynamic maintenance of the possible donor. The indication that greater results are obtained from the campaigns which favor the regional language confirms the initial assumption that educational initiatives, due to their immediate impact on the population, has the potential to leverage the transplant process. We conclude that human, structural and technological factors pose serious obstacles to the implementation of the National Transplant Policy in the State of Ceará, with little significant impact on the sole waiting list in the country. We suggest actions on several fronts: to redirect the dissemination campaigns towards approaches which are more culturally related to the region and closer to people; to offer more frequent courses to raise awareness and to improve the skills of health professionals; to develop strategies to raise awareness of professionals and managers regarding the noble task of CNCDO and CIHDOTTs; to employ more professionals and train them to perform the detection and diagnosis of brain death faster and to ensure the accomplishment of the hemodynamic maintenance efficiently / Nas décadas recentes, os transplantes tiveram um profundo impacto no cuidado dos pacientes em estágio final de diversos tipos de doenças. No Brasil, as políticas públicas relacionadas com as pessoas que necessitam de transplante carecem de avaliações aprofundadas para desenvolvimento e aplicação de políticas públicas. A presente pesquisa teve como objetivo avaliar a atuação da Central de Notificação de Transplantes do Estado do Ceará (CNCDO) e das Comissões Intra-Hospitalares de Doação de Órgãos e Tecidos para Transplantes (CIHDOTTs) de Fortaleza, instâncias consideradas decisivas na operacionalização da Política Nacional de Transplantes no território do Ceará. A pesquisa foi realizada utilizando dados secundários e primários, tanto quantitativos quanto qualitativos, sendo desenvolvida no período de julho de 2010 a fevereiro de 2011. Foi realizada entrevista com a presidente da CNCDO, aplicado um formulário com 12 coordenadoras das CIHDOTTs e realizadas observações estruturadas em três CIHDOTTs. Destacam-se entre os resultados: CNCDO sobrecarregada e realizando atividades da alçada das CIHDOTTs; CIHDOTTs com equipes reduzidas e predomínio de enfermeiras, atuando essencialmente na busca ativa de potenciais doadores; a recusa dos familiares sendo a grande responsável pela não confirmação de significativo número de doações; identificadas fragilidades nas ações de campanha, qualificação e planejamento conjunto da CNCDO com as CIHDOTTs; ambas ressentem-se de maior apoio dos profissionais de saúde e dos gestores dos hospitais e também da falta de equipamentos e espaço físico apropriado; o grande dispêndio de energia da CNCDO e das CIHDOTTs resulta em números ínfimos de efetivas doações; há dificuldades no processo de identificação de provável potencial doador, demora no diagnóstico de morte encefálica e em iniciar a manutenção hemodinâmica do possível doador. A indicação de que são maiores os resultados obtidos com as campanhas que privilegiam a linguagem regional confirma o pressuposto inicial de que ações educativas, por impactarem imediatamente na população, têm potencial para alavancar o processo de transplante. Concluímos que fatores humanos, estruturais e tecnológicos representam sérios entraves à execução da Política Nacional de Transplante no Estado do Ceará, com impacto pouco significativo na fila de espera, que é única para o País. Indicamos ações em diversas frentes: redirecionar as campanhas de divulgação para abordagens mais identificadas com a cultura regional e mais próxima às pessoas; cursos mais frequentes para maior sensibilização e qualificação dos profissionais de saúde; desenvolvimento de estratégias para maior sensibilização dos profissionais e gestores quanto às nobres tarefas da CNCDO e das CIHDOTTs; maior número de profissionais e capacitação mais frequente deles para que realizem a detecção e diagnóstico de morte encefálica de forma precoce e mais agilmente e que assegurem a realização da manutenção hemodinâmica de quantos potenciais doadores sejam identificados.

According to Scripture God created human beings "in our image, after our likeness". The likeness used to be conceived in terms of the rational nature human beings possess. Modern thought has come to conceive of the likeness rather in terms of being person, who receives her identity in relationships from others and at the same time mediates the others´ identity to them. The author presents the historical development of the concept of person as well as selected contemporary approaches, which she evaluates in light of the personal life of the Triune God as it is witnessed in Scripture and incessantly communicated in the liturgy of the church. She also presents ways of conceiving of created personhood she has attained in this light. Created persons are created in order to receive divine self-communication and to be able to participate in it, which they can in dependence on the one, who is the true revelator of God, as participation in his revelatory activity. By accepting their dependence, they become capable of acting freely through themselves and fulfill the task entrusted to them by creation.

Submitted by Ana Carla Almeida (ana.almeida@ucsal.br) on 2016-12-01T11:45:01Z No. of bitstreams: 1 FERREIRA, PCS-2016.pdf: 1856390 bytes, checksum: 668236db461cf5f5936d9fb25930846a (MD5) / Approved for entry into archive by Rosemary Magalhães (rosemary.magalhaes@ucsal.br) on 2017-01-16T12:24:57Z (GMT) No. of bitstreams: 1 FERREIRA, PCS-2016.pdf: 1856390 bytes, checksum: 668236db461cf5f5936d9fb25930846a (MD5) / Made available in DSpace on 2017-01-16T12:24:57Z (GMT). No. of bitstreams: 1 FERREIRA, PCS-2016.pdf: 1856390 bytes, checksum: 668236db461cf5f5936d9fb25930846a (MD5) Previous issue date: 2016-06-30 / O presente trabalho visa discutir o conflito entre o anonimato do doador de sêmen e o direito à identidade genética na técnica de reprodução assistida heteróloga. Aborda-se a busca dos casais inférteis pelo sonho de ter filhos, sendo necessária, algumas vezes, a utilização de material genético alheio aos deles. Discutem-se os princípios da Bioética e do Biodireito que permeiam os avanços da Biotecnologia, no intuito de preservar a humanidade de forma digna. No Brasil, defende-se o anonimato do doador de sêmen, tendo em vista que não há legislação específica, apenas resoluções do Conselho Federal de Medicina, gerando reflexões éticas e jurídicas. Há uma discrepância entre o contrato do doador de sêmen, que deve ser obrigatoriamente gratuito, e o contrato de recepção de sêmen, que é oneroso e lucrativo para as clínicas de reprodução humana assistida, pois prestam serviços médicos utilizando material genético gratuitamente obtido. Outrossim, não se confundem o direito à identidade genética com o direito de reconhecimento de paternidade. O princípio da afetividade norteia o Direito de Família, não sendo o pai biológico, de fato, o pai afetivo do indivíduo. O direito à ascendência genética está atrelado aos direitos de personalidade do ser humano, cuja existência deve ser digna, seja no aspecto físico ou emocional/psíquico. Percebe-se, então, que há uma carência de legislação para garantir o direito apenas à identidade genética, o que não incidiria em obrigações afetivas, alimentares ou/e sucessórias para o doador de sêmen. / This paper discusses the conflict between the anonymity of the sperm donor and the right to genetic identity in heterologous reproductive assisted technology. Deals with the search for the dream of infertile couples to have children, requiring sometimes the use of genetic material foreign to them. The principles of Bioethics and Biolaw discussing that pervade the advances in Biotechnology, in order to preserve humanity dignity. In Brazil, defends anonymity of semen donor, given that there is no specific legislation, only resolutions of the Federal Council of Medicine, generating ethical and legal considerations. There is a discrepancy between the semen donor contract, which must necessarily be free, and semen reception agreement, which is expensive and profitable for the assisted human reproduction clinics, as providing medical services by using genetic material obtained for free. Also, do not confuse the right to genetic identity with the right to paternity recognition. The principle of affectivity guides the Family Law, not being the biological father, in fact, the emotional individual's father. The right to genetic ancestry is linked to the personality rights of the human being, whose existence should be worthy, is the physical aspect or emotional / mental. It is clear, then, that there is a lack of legislation to ensure the right genetic identity, which would focus not on affective bonds, food and / or succession to the semen donor.

A doação de plaquetas por aférese é um procedimento automatizado que permite a obtenção deste hemocomponente em grande quantidade e com ato grau de pureza; deste processo obtém-se um subproduto chamado Câmara de Leucorredução (CLR) que é descartado ao final da doação. São permitidas até 24 doações/ano; porém as possíveis consequências de doações frequentes para esses doadores são pouco investigadas. Assim, foram identificados e quantificados os leucócitos de doadores de plaquetas frequentes e de 1ª vez. Também foi avaliada a viabilidade do uso das células mononucleares da CLR para pesquisas. Observou-se mais células na CLR que no sangue e que a frequência das populações é similar. O estado de ativação e a capacidade funcional (proliferação e produção de citocinas) foram similares entre CLR e sangue, assim como a taxa de apoptose espontânea. Entre doadores frequentes e de primeira vez não houve diferença no número de leucócitos, sugerindo que doações recorrentes não alteraram as populações leucocitárias. / Plateletpheresis is an automatized procedure to obtain high purity platelet for transfusions. From this procedure its possible to obtain a byproduct: The Leukoreduction system chamber (LRSC), which is discarded at the end of donation process. This type of donation allows 24 donation/year, but the consequences of frequent donations are poorly investigated. Therefore, we identified and quantified leukocytes of frequent and first time platelet donor. Also, was evaluated the viability, for research, of mononuclear cells recovery from LRSC. The total number of mononuclear cells was higher in LRSC than in peripheral blood samples, but the frequencies were similar in all the samples. Activation state and functional capacity (measured by cell proliferation and cytokine production) were similar in both, blood and LRSC mononuclear cells, as well as spontaneous apoptosis. Among frequent (6 or more donations in 1 year) and first time donor, there was no difference in the leukocyte total number, suggesting that frequent donation do not modify these cells.