Clinicians and egg donors have signalled their support for a rise in the amount of compensation paid to women who donate eggs to infertile women in the United Kingdom, as the Human Fertilisation and Embryology Authority prepares to launch a public consultation on the subject.
Farrell and Brazier set out the arguments for obtaining specific informed consent for allogeneic blood transfusion.1 They do not deal with allogeneic blood products, but I think their article can be assumed to cover this too. This subject is controversial, and the question of how to seek and record consent has been the subject of a recent consultation by the Department of Health’s Advisory Committee on the Safety of Blood, Tissues and Organs. A question Farrell and Brazier avoid is who should be responsible for gaining informed consent? Should it be those who provide the blood (the transfusion service, probably most informed about the risks) or those who prescribe it (probably least informed)? This is of crucial importance in the debate and has considerable resource implications.
Within transfusion medicine, the question of whether separate informed consent should be obtained from patients for blood transfusion has provoked considerable debate. There has long been support for such an approach in the United States.1 A BMJ editorial in 1997 made it clear that reform was on the professional agenda in the United Kingdom, despite the established position that obtaining general consent for medical treatment included consent for blood transfusion.2 At the time, however, professional consensus proved elusive because of concerns over a range of practical problems, including who should be responsible for obtaining such consent and in what circumstances it should be obtained.3 The issue has now been brought to the fore again, highlighted by the recent stakeholder consultation launched by the UK government’s independent Advisory Committee on the Safety of Blood, Tissue and Organs.
OTTAWA — A Supreme Court ruling placing much of Canada's burgeoning fertility industry under provincial control leaves an enormous gap in the regulation of artificial procreation and exposes women who use the technologies and the children born from them to potential harm, critics say. A sharply divided court struck down key federal powers to regulate assisted human reproduction Wednesday, concluding that several parts of a new law fall under provincial jurisdiction over health care. The ruling effectively stops a federal move toward national standards and guts Assisted Human Reproduction Canada — an embattled federal agency that was struck four years ago to monitor how assisted procreation is carried out at more than two dozen fertility clinics across the country.
Most women who travel from the United Kingdom to other countries for infertility treatment do so because of the long wait and shortage of donor gametes at home, show the results of a survey of “fertility tourists” from the UK. Of 51 women interviewed for the ongoing research project, more than 70% needed donor treatment, most of them with donor eggs or embryos but some with donated sperm, the principal investigator, Lorraine Culley, told a conference in London.
Britain’s Orthodox Jews have been plunged into the centre of an angry debate over medical ethics after the Chief Rabbi ruled that Jews should not carry organ donor cards in their current form. London’s Beth Din, which is headed by Lord Jonathan Sacks and is one of Britain’s most influential Orthodox Jewish courts, caused consternation among medical professionals earlier this month when it ruled that national organ donor cards were not permissible under halakha (Jewish law). The decision has now sparked anger from within the Orthodox Jewish community with one prominent Jewish rabbi accusing the London Beth Din of “sentencing people to death”.
Compensation paid to egg and sperm donors in the United Kingdom could be increased to include a payment for inconvenience, in a bid to tackle an acute shortage of donated gametes. The Human Fertilisation and Embryology Authority (HFEA), which regulates infertility treatment, raises the possibility in a review of its policies on egg and sperm donation launched on 17 January. European law bans payment for donated gametes but allows donors to be compensated for expenses, loss of earnings, and inconvenience. Current HFEA rules allow egg donors to be reimbursed for loss of earnings and expenses, such as travel costs, up to a maximum of £250 (€300; $400). But nothing can be claimed for the physical inconvenience that gamete donors experience, even though egg donation is invasive and sperm donation time consuming.
The number of organ donors and transplantations fell last year in Spain, the country that leads the ranking in both and whose transplantations model was recently adopted by the EU. The decline—which signals a break in the increase seen in recent years—was caused largely by a sharp reduction in deaths from traffic incidents. Improved management of cerebral infarctions and a small increase in the refusal rate to donate organs among families whose relative has died have also contributed to the fall. The reluctance to donate is particularly widespread among the immigrant population. The number of organ donors in Spain dropped from 34.4 per million inhabitants in 2009 to 32 million in 2010, while the total number of registered donors fell from 1606 in 2009 and 1502 in 2010, reports the Spanish National Transplant Organisation. This reduction is the largest seen in the past 20 years.
The United Kingdom’s chief rabbi, Jonathan Sacks, has issued an edict that carrying donor cards is unacceptable and that the current organ donor system is incompatible with Jewish law. The ruling comes after years of debate among rabbinical authorities over the definition of death and when an organ may be removed for transplant purposes. The new statement from the chief rabbi and his rabbinical court, the London Beth Din, says that organs may be removed for transplantation only at the point of cardiorespiratory failure, rather than at brain stem death. The latest figures for 2010 show that 66% of donations came from donors after brain death and 34% from donors after cardiovascular death, NHS Blood and Transplant said.
The number of patients in Israel who die while waiting for a transplant rose last year, and the number of transplantations fell by 20%, the annual report of the Ministry of Health’s National Transplant and Organ Donation Centre has said. As a result the shortage of organs has become more acute. Rafi Biar, chairman of the centre’s steering committee and director of the Rambam Medical Centre in Haifa, said that the main cause of the decrease is a new law that changed the protocol for defining “brain death” after discussions with the Chief Rabbinate. According to Jewish law death can be determined only after cardiopulmonary failure, and until recently the Chief Rabbinate had prohibited organ donation, as it did not recognise brain stem death. However, in 2008 the Israeli parliament passed a law that defines “brain respiratory” death as an indication of death for all legal purposes and also outlined the procedure that should be carried out to ensure that death had occurred.
Cash incentives and the payment of funeral expenses are two ideas being put forward to encourage people to donate human organs and tissue. The Nuffield Council on Bioethics is asking the public if it is ethical to use financial incentives to increase donations of organs, eggs and sperm. Paying for most types of organs and tissue is illegal in the UK. The public consultation will last 12 weeks and the council's findings will be published in autumn 2011.
We provide our bodies or parts of our bodies for medical research or for the treatment of others in a number of ways and for a variety of reasons. However, there is a shortage of bodily material for many of these purposes in the UK. What should be done about it? The Council has set up a Working Party, chaired by Professor Dame Marilyn Strathern, to explore the ethical issues raised by the provision of bodily material for medical treatment and research. Questions to be considered include: * what motivates people to provide bodily material and what inducements or incentives are appropriate? * what constitutes valid consent? * what future ownership or control people should have over donated materials? * are there ethical limits on how we try to meet demand?
US scientists have created working liver grafts in the lab, and say the research could one day allow the growth of livers for transplant. There is a shortage of liver donors, but so far it has been difficult to grow replacement organs. In the work, published in Nature Medicine, a team from Massachusetts General Hospital, created successful grafts using rat cells. A UK expert said it was "a big step in the right direction".
Ask a couple struggling to conceive what they would want most in life and "a child" is the obvious answer. They want something money can't buy, even with all the money in the world. For a couple needing egg or sperm donation this reality might change. Money could buy at least the chance of a child if donors were to be paid, if that's one of the outcomes of the Human Fertilisation and Embryology Authority (HFEA) donation review. Various issues are being reviewed in the HFEA public consultation, but payment of egg and sperm donors is high on the agenda.
Since 1991, sperm donors in the UK have had the legal right to withdraw consent for the use of their sperm in fertility treatment. This has the potential to adversely affect patients. It may mean that previous recipients of a donor’s sperm cannot have further children who are full biological siblings to an existing child, and that embryos created from the donor’s sperm and a patient’s eggs must be destroyed. We have informally investigated withdrawal of consent by sperm donors donating after 1 April 2005, when lifelong anonymity for gamete donors ended.
For the 18th year in a row, Spain leads the world in the number of deceased organ donors per million people -- 34.3. This is a commonly used benchmark of the effectiveness of a donor system and other countries lag far behind. The average for the European Union is 18.1 and in the US it is 26.3. In the UK, the figure is 14.7 and in Australia 12.1 donors per million. The Spanish are particularly proud of their record, which was achieved despite a steady decrease in the number of traffic deaths, a major source of organs. What is the secret of the Spanish system? Dedication and teamwork.In 1989 the government set up a national network of transplant coordinators. They work in all hospitals and closely monitor emergency wards to be aware of potential donors. When they learn of a death, they tactfully try to persuade relatives to allow the person's organs to be harvested. Only about 15% of families refuse consent nowadays, a huge drop from 40% before the system was set up.
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