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Bioethics > Ethical Issues about Extension of Life > Flashcards

Ethical Issues about Extension of Life Flashcards

1
Q

is a medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ.

A

organ transplantation

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2
Q

involves surgically replacing a failing organ with a healthy donor organ.

A

organ transplantation

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3
Q

The donor and recipient may be at the same location, or organs may be transported from a donor site to another location.

A

organ transplantation

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4
Q

organs and /or tissues that are transplanted within the same person’s body.

A

autografts

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5
Q
  • Transplants that are recently performed between two subjects of the same species. It can either be from a living or cadaveric source.
A

allografts

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6
Q

allografts can come from what source (2)

A

living
cadaveric

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7
Q

Organs that have been successfully transplanted

A

heart, kidneys, liver, lungs, pancreas, intestines, thymus and uterus.

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8
Q

tissues that are referred as musculoskeletal grafts

A

bones, tendons

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9
Q

tissues including bones and tendons are referred to as

A

musculoskeletal grafts

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10
Q

are the most commonly transplanted organs worldwide

A

kidneys

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11
Q

kidneys are the most commonly transplanted organs worldwide, followed by the

A

liver
heart

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12
Q

are the most commonly transplanted tissues; these outnumber organ transplants by more than tenfold.

A

cornea and musculoskeletal grafts

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13
Q

Organ donors may be (3)

A

living
brain dead
dead via circulatory death

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14
Q

issue may be recovered from donors who die of (2)

A

circulatory death
brain death

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15
Q

Tissue may be recovered from donors who die of circulatory death, as well as of brain death – up to
___ hours past the cessation of heartbeat.

A

24

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16
Q

Unlike organs, most tissues (with the exception of ___) can be preserved and stored for up to five years

A

corneas

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17
Q

Unlike organs, most tissues (with the exception of corneas) can be preserved and stored for up to

A

five years

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18
Q

Unlike organs, most tissues (with the exception of corneas) can be preserved and stored for up to five years, meaning they can be

A

banked

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19
Q

offer a great solution for many patients with organ failure and can improve their lifespan and quality of life

A

transplants

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20
Q

Undergoing an ___transplant can lengthen a person’s life and allow those with a chronic illness to live a normal lifespan.

A

organ

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21
Q

donor organs are often rejected by the host’s (recipient’s) immune system

A

transplanted organs rejection

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22
Q

recognizes that the new tissue is foreign, causing an inflammatory attack on the new tissue which if not stopped results in failure of the transplanted organ.

A

immunesystem

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23
Q

stimulate cytotoxic T cells to attack the transplanted organ while simultaneously inhibiting the action of protective T regulatory cells.

A

inflammatory cytokines

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24
Q

Multiple inflammatory cytokines stimulate ____ _ cells to attack the transplanted organ

A

cytotoxic T cells

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25
Q

Multiple inflammatory cytokines stimulate cytotoxic T cells to attack the transplanted organ while simultaneously inhibiting the action of

A

protective T regulatory cells

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26
Q

help suppress the immune system and protect the transplanted organ

A

conventional treatmentts

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27
Q

help suppress the immune system and protect the transplanted organ
however, they often have severe side effects.

A

conventional treatments

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28
Q

also reduce the amount of T regulatory cells in circulation, preventing the immune system from developing tolerance to the new organ.

A

immunosuppressive drugs

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29
Q

Natural interventions such as ___ and ___ may help lessen the inflammatory immune response and promote more successful transplant tolerance

A

circumin
omega-3 fatty acids

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30
Q

Help Prevent Organ Transplant Rejection

A

conventional medical treatment

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31
Q

Immunosuppressive drugs are under what kind of treatments

A

conventional medical treatment

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32
Q

example of immunosuppresive drugs

A

calcineurin inhibitors (e.g. cyclosporine)

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33
Q

May Be Beneficial for Organ Transplantation

A

natural interventions

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34
Q

a component of the spice turmeric, is a potent anti-inflammatory agent.

A

curcumin

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35
Q

Numerous studies demonstrate ____ability to inhibit inflammatory cytokines involved in transplant rejection. An animal study showed mice that had heart transplants survived significantly longer when treated with an immunosuppressive drug in combination with ___than the drug alone.

A

curcumin

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36
Q

found in fish oil, known for their anti-inflammatory properties, also suppress cytokines involved in transplant rejection.

A

omega-3 fatty acids

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37
Q

Many studies demonstrate their beneficial effects, including a study where kidney transplant patients supplemented with ___oil experienced better recovery of renal function after a rejection episode than control patients.

A

fish

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38
Q

has been shown to inhibit the activity of multiple inflammatory cytokines.

A

resveratrol

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39
Q

Animals who received a genetically incompatible liver transplant had reduced levels of cytotoxic T cells and survived significantly longer when supplemented with

A

resveratrol

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40
Q

is known to modulate the action of several inflammatory cytokines. In combination with vitamin E

A

Quercetin

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41
Q

has been shown in vitroto combat the hepatotoxic effects of cyclosporine, a common immunosuppressive drug.

A

quercetin

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42
Q

also inhibited T-cell proliferation, suggesting it may be effective in reducing transplant rejection.

A

quercetin

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43
Q

found heart transplant patients with the lowest blood levels of the active form of vitamin _ (1,25-dihydroxy vitamin _)were over 8 times as likely to die one year post transplant than those with the highest levels.

A

vitamin D

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44
Q

active form of vitamin D

A

1,25-dihydroxy vitamin D

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45
Q

seed extract has been shown to alter the ratio favorably and modulate immune response.

A

Grape

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46
Q

Higher ___ levels have been shown to be associated with increased mortality after transplantation.

A

homocysteine

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47
Q

. Several natural interventions can lower homocysteine levels, including

A

B complex vitamins
N-acetylcysteine

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48
Q

B complex vitamins

A

B6
B12
folate

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49
Q

such as those found in green andblack tea, cocoa, and pomegranate, have cardioprotective effects that may be beneficial after organ transplantation.

A

polyphenolsp

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50
Q

polyphenols is found in

A

green andblack tea, cocoa, and pomegranate

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51
Q

Steps in the process are as follows

1st step

A

Identification of the Potential Donor by the Hospital

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52
Q

Medical professionals at a hospital identify a potential candidate for donation. The nature of the injury leads a physician to determine the patient is brain dead or a potential donation after circulatory death (DCD) candidate.

what step

A

identification of potential donor by the hospital

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53
Q

2nd step in determining organ transplantation

A

evaluation of donor eligibility

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54
Q

Information is provided on the patient’s medical status and the recovery coordinator evaluates the patient. The evaluation includes a medical and social history and physical examination of the patient. This determines whether or not the patient is a suitable candidate for donation.

what step

A

evaluation of donor eligibioity

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55
Q

3rd step in organ transplantation

A

Authorization for Organ Recovery

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56
Q

If the patient is a candidate for organ and/or tissue donation, at an appropriate time the legal next-of-kin is approached with the opportunity of donation. If a donor designation or individual authorization by the decedent cannot be identified, the family must give their consent in order for the donation process to proceed. If the family consents, the legal next-of-kin signs a donor consent form.

what step

A

authorization for organization recovery

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57
Q

4th step in donor transplantation

A

medical maintenance of the patient

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58
Q

Once family consent or donor designation has been provided, the clinical coordinator, in concert with the hospital staff, maintains the patient medically. In some cases physician support is requested on a consultation basis.

what step

A

medical maintenance of the patient

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59
Q

5th step in organ transplantation

A
  1. Matching Organs to Potential Recipients
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60
Q

Information on the organs available for donation, the donor’s blood type and body size is provided to clinical coordinator. The computer then matches the donated organs to potential recipients. Recipient selection is based on blood type, body size, medical urgency and length of time on the waiting list. The heart, liver and lungs are matched by blood type and body size. In matching the pancreas and kidneys, genetic tissue type is also considered

what step

A

matching organs to potential recipients

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61
Q

6th step in organ transplantation

A
  1. Offering Organs Regionally, Then Nationally
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62
Q

A computerized list of waiting patients in the matching blood group is provided to the coordinator who seeks to match organs with recipients in the donation service area. If a match cannot be made for a specific organ within this area, the organ is offered on a regional basis, then nationally, if necessary.

what step

A

offering organs regionally; then nationally

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63
Q

7th step of organ transplantation

A
  1. Placing Organs and Coordinating Recovery
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64
Q

When a recipient match has been found, the coordinator calls the transplant center for the patient who matches the donated organ(s). The patient’s transplant surgeon is responsible for making the decision whether to accept the organ. If the surgeon declines the organ for that patient, the coordinator contacts the transplant surgeon of the next patient on the list. This process continues for each organ until all of the organs have been appropriately matched with recipients. The coordinator then arranges for the operating room (for the recovery of the organs) and the arrival and departure times of the transplant surgery teams.

what step

A

placing organs and coordinating recovery

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65
Q

8th step of organ transplantation

A

Surgical Recovery of Organs

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66
Q

When the surgical team arrives, the donor is taken to the operating room where the organs and tissues are recovered through a dignified surgical procedure. In accordance with law, physicians recovering the organs do not participate in the donor’s care prior to the determination of brain death.

what step in organ transplantation

A
  1. Surgical Recovery of Organs
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67
Q

9th step in organ transplantation

A
  1. Preparing Recipients for Surgery
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68
Q

Once the recipients have been identified, they are called by their transplant surgeons for the final pre-operative preparations while the organ recovery process is occurring at the donor hospital. Upon the organs’ arrival at the transplant hospital, the recipients are taken to surgery and the transplants are performed

what step

A

preparing recipients for surgery

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69
Q

10th step of organ transplantation

A

. Distribution of Organs

70
Q

The coordinator takes a sample of the lymph node tissue to a laboratory for tissue typing and subsequent matching with recipients. Other organs are taken directly to the recipients by the surgical recovery teams.

what step

A

distribution of organs

71
Q

raises a number of bioethical Issues
including the definition of death,
when and how consent should be given for an organ to be transplanted,
payment for organs for transplantation.

A

transplantation

72
Q

a term sometimes used when you go to another country and pay for an organ transplant

A

transplantation tourism

73
Q

the trading of human organs, tissues, or other body products, usually for transplantation.

A

organ trafficking

74
Q

guiding principle for organ transplantation by WHO (4)

A

Autonomy
Beneficence
3. Non-maleficence
Justice

75
Q

Cells, tissues and organs may be removed from the bodies of deceased person for the for the purpose of transplantation if:

 (a) any consent required by law is obtained, and

 (b) there is no reason to beleive that the deceased person objected to such removal.

what principle

A

autonomy

76
Q

Cells, tissues and organs may be removed from the bodies of deceased person for the for the purpose of transplantation if:

A

any consent required by law is obtained, and

there is no reason to beleive that the deceased person objected to such removal.

77
Q

Physician determining that a potential donor has died should not directly involved in cell, tissue or organ removal from the donor or subsequent transplantation procedure; nor should they be responsible for the care of any intended recipient of such cells, tissues and organs.

what principle

A

beneficence

78
Q

Cells, tissues and organs should only be donated freely without monetary payment or reward of monetary value. The prohibition on sale or purchase of cells, tissues and organs does not preclude reimbursing reasonable and verifiable expenses incurred by the donor, including loss of income, or paying the cost of recovering, processing, preserving and supplying human cells, tissues and organs for transplantation.

what principle

A

beneficence

79
Q

Minors and legally incompetent people no cells, tissues or organs should be removed from the body of a living minor for the purpose of transplantation other than narrow exceptions allowed under national law. Specific measures should be in place to protect the minor and, wherever possible the minor assent should be obtained before donation.

what principle

A

non-maleficence

80
Q

Physicians and other health professionals should not engage in transplantation procedures, and health insurers and other payers should not cover such procedures, if the cells, tissues and organs concerned have been obtained through exploitation or coercion of, or payment to, the donor or the next of kin of a deceased donor.

what principle

A

non-maleficence

81
Q

The allocation of organs, cells and tissues should be guided by clinical criteria and ethical norms, and financial or other considerations. Allocation rules, defined by appropriately constituted committees, should be equitable, externally justified and transparent.

what principle

A

justice

82
Q

ethical issues for debate on organ transplantation

A

Is human body a commodity? How should decisions be made about who receive scarce organs?

Who should pay for transplants?

Should one person receive several organs or several persons receive one?

Should one person have second transplant when the first one fails or should a different person be given a first chance at a new organ?

Should organs be donated to those persons who have abused their bodies by drinking and smoking or only those whose organs are damaged by disease? Should state law maker be involved in transplantation?

83
Q

medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ

A

organ transplantation

84
Q

 Occurs because the recipient’s organ has failed or has been damaged through illness or injury

A

organ transplantation

85
Q

 Transfer of a whole or partial organ from one body to another

A

organ transplantation

86
Q

– a transplant of tissue from one to oneself (e.g. skin grafts, vein extraction, storing blood in advance surgery)

A

autograft

87
Q

example of autograft (3)

A

skin grafts
vein extraction
storing blood in advance for surgery

88
Q

transplanted organ or tissue from a genetically non-identical member of the same species

A

allograft

89
Q

 Most human tissue and organ transplant fall under this

A

allograft

90
Q

a subset of allograft in which organs or tissues are transplanted from a donor to a genetically identical recipient (identical twin)

A

isograft

91
Q

 Anatomically identical to allografts, closer to autografts in terms of recipient’s immune response

A

isograft

92
Q

isograft is anatomically identical to what

A

allografts

93
Q

isograft is closer to ___ in terms of recipient’s immune response

A

autografts

94
Q

 Transplantation in which organs or tissues are transplanted from a donor to genetically identical recipient such as an identical twin

A

isografts

95
Q

isografts are also known as

A

isotransplans

96
Q

transplants that are always accepted

A

isografts

97
Q

replacement of an individual’s defective organ with an organ harvested from another organ from another species

A

xenograft

98
Q

source of organ for human use (2)

A

primates
pigs

99
Q

genetic similarities to humans

A

primates

100
Q

large availability

A

pigs

101
Q

transplantation of living tissues, cells, and organs from one species to another

A

xenotransplantation

102
Q

 Genetically alter an animal organ with human genes to trick patient’s immune system into accepting it

A

xenotransplantation

103
Q

– is an organ transplanted from one species to another

A

xenograft

104
Q

refer to same species transplant

A

allotransplantation

105
Q

disease transmission

A

xenozoonosis

106
Q

sources for organ transplantation (4)

A

mandated choice
presumed consent
incentives
prisoners

107
Q

voluntary donation

which source of organs?

A

mandated choice

108
Q

a person is presumed to have consnted to organ donation in case of their accidental death

what kind of source

A

presumed content

109
Q

1st step for organ transplantation

A

identification of potential donor by hospital

110
Q

medical professional at a hospital identify a potential candidate for donation

what step for organ transplantation

A

identification of potential donor by the hospital

111
Q

the nature of injury leads a physician to determine the patient (2)

A

brain dead
circulatory death candidate (DCD)

112
Q

DCD means

A

donation after circulatory death

113
Q

information is provided on the patient’s medical status

what step for organ transplantation

A

evaluation of donor eligibility

114
Q

2nd step for organ transplantation

A

evaluation of donor eligibility

115
Q

the recovery coordinator evaluates the patient. This determines whether or not the patient is suitable candidate for donation

what step for organ transplantation

A

evaluation of donor eligibility

116
Q

recovery coordinator evaluates the following on whether the patient is suitable for donation (3)

A

medical history
social history
physical examination of patient

117
Q

if a patient is a candidate for organ and/or tissue donation, at an appropriate time the legal next-of-kin is approached with the opportunity of donation

what step for organ transplantation

A

authorization for organ recovery

118
Q

if a donor designation or individual authorization by the decedent cannot be identified, the family must give their consent in order for the donation process to proceed

what step for organ transplantation

A

authorization for organ recovery

119
Q

if the family consents, the legal next-of-kin signs a donor consent form

what step for organ transplantation

A

authorization for organ recovery

120
Q

once family consent or donor designation has been provided, the clinical coordinator in concert with the hospital staff, maintains the patient medically

what step for organ transplantation

A

medical maintenance of the patient

121
Q

in some cases, physician support is requested on a consultation basis

what step for organ transplantation

A

medical maintenance of the patient

122
Q

what information on the organs available for donation are known to be provided to the clinical coordinator

A

donor’s blood type
body size

123
Q

after information on the organs available for donation are provided to the clinical coordinator, the computer then matches the donated organs to potential recipients

what step for organ transplantation

A

matching organs to potential recipients

124
Q

recipient selection is based on ($)

A

blood type
body size
medical urgency
length of time on waiting list

125
Q

used for matching heart, liver, and lungs

A

body type and body size

126
Q

body type and body size were used to match

A

heart, liver, and lungs

127
Q

in matching pancreas and kidneys, what is typed

A

genetic tissue type

128
Q

genetic tissue type is used to match what organs (2)

A

pancreas
kidneys

129
Q

a computerized list of waiting patients in the matching blood group is provided to the coordinator who seeks to match organs with recipients in the donation service area

what step for organ transplantation

A

offering organs regionally, then nationally

130
Q

if match cannot be made for a specific organ in the area, the organ is offered on a regional basis, then nationally, if necessary

what step for organ transplantation

A

offering organs regionally, then nationally

131
Q

when a recipient match has been found, the coordinator calls the transplant center for the patient whom atches the donated organ(s)

what step for organ transplantation

A

placing organs and coordinating recovery

132
Q

the patient’s transplant surgeon is responsible for making the decision whether to accept the organ

what step for organ transplantation

A

placing organs and coordinating recovery

133
Q

if the surgeon declines the organ for that patient, the coordinator contacts the transplant surgeon of the next patient on the list

what step for organ transplantation

A

placing organs and coordinating recovery

134
Q

this process continues for each organ until all of the organs have been appropriately matched with recipients

what step for organ transplantation

A

placing organs and coordinating recovery

135
Q

the coordinator then arranges for the operating room (for the recovery of organs) and the arrival and departure times of transplant surgery teams

what step for organ transplantation

A

placing organs and coordinating recovery

136
Q

when the surgical team arrives, the donor is taken to the operating room where the organs and tissues are recovered through a dignified surgical procedure

what step for organ transplantation

A

surgical recovery of organs

137
Q

in accordance with law, physicians recovering the organs do not participate in the donor’s care prior to the determination of brain death

what step for organ transplantation

A

surgical recovery of organs

138
Q

once the recipients have been identified, they are called by their transplant surgeons for the final pre-operative preparations while the organ recovery process is occurring at the donor hospital

what step for organ transplantation

A

preparing recipients for surgery

139
Q

upon the organs’ arrival at the transplant hospital, the recipients are taken to surgery and the transplants are performed

what step for organ transplantation

A

preparing recipients for surgery

140
Q

the coordinator takes a sample of the lymph node tissue to a laboratory for tissue typing and subsequent matching with recipients

what step for organ transplantation

A

distribution of organs

141
Q

other organs are taken directly to the recipients by the surgical recovery teams

what step for organ transplantation

A

distribution of organs

142
Q

puts unfair pressure on economically disadvantaged people, wealthy people have unfair access

A

buying and selling of organs

143
Q

compromises the donor and recipient safety

A

buying and selling of organs

144
Q

due to limited resource, distributive justice is observed

A

organ allocation

145
Q

distributive justice includes

A

how to fairly divide resources
equal access
maximum benefits

146
Q

everyone should have to able access it equally

length of time

age of recipient

what part of distributive jsutice

A

equal access

147
Q

reasons for equal access (3)

A

exclude individual worth from equation
exclude medical worthiness (smoking)
exclude social worthiness (prisoners)

148
Q

maximize the number of successful transplants

medical need

probability of success

A

maximum benefit

149
Q

reason for maximum benefit

A

limited resource should avoid waste

second transplant

factor in medical outcome

150
Q

cells, tissues, organs may be removed from the bodies of deceased person for the purpose of transplantation

what WHO guiding principle

A

autonomy

151
Q

cells, tissues, organs may be removed from the bodies of deceased person for the purpose of transplantation (2)

A

any consent required by law is obtained

there is no reason to believe that the deceased person objected to such removal

152
Q

physician determining that a potential donor has died should not directly involved in cell, tissue, or organ removal from the donor or subsequent transplantation procedure

what WHO guiding principle

A

beneficence

153
Q

Physician should not be responsible for the care of any intended recipient of such cells, tissues, and organs

what WHO guiding principle

A

beneficence

154
Q

in general, living donors should be genetically, legally or emotionally related to their recipients

what WHO guiding principle

A

Autonomy, non-maleficence, justice

155
Q

has informed, voluntary consent and professional follow up is ensured and organized

what WHO guiding principle

A

autonomy, non-maleficence, justice

156
Q

no cells, tissues, or organs should be removed from the body of a living minor for the purpose of transplantation other than narrow exceptions allowed under national law

what WHO guiding principle

A

non-maleficence

157
Q

specific measures should be in place to protect the minor, and wherever possible the minor assent should be obtained before donation

what WHO guiding principle

A

non maleficence

158
Q

cells, tissues, and organs should only be donated freely without monetary payment or reward of monetary value

what WHO guiding principle

A

beneficence

159
Q

the prohibition on sale or purchase of cells, tissues, and organs does not preclude reimbursing reasonable and verifiable expenses incurred by the donor, including loss of income or paying the cost of recovering, processing, preserving, and supplying human cells, tissues, and organs for transplantation

what WHO guiding principle

A

beneficence

160
Q

capable persons must be allowed to accept or refuse recommended medical interventions

what WHO guiding principle

A

autonomy

161
Q

medical practitioners should act in the best interests of the patient

what WHO guiding principle

A

beneficence

162
Q

physicians and other health professionals should not engage in transplantation procedures, and health insurers and other payers should not cover such procedures, if the cells, tissues, and organs concerned has been obtained through exploitation or coercion of , or payment to, the donor or the next of kin of a deceased donor

what WHO guiding principle

A

nonmaleficence

163
Q

the allocation of organs, cells, tissues should be guided by clinical criteria and ethical norms, and financial or other considerations

A

justice

164
Q

defined by appropriately constituted committees, should be equitable, externally justified, and transparent

A

allocation rules

165
Q

What applications of principles of bioethics

in choosing this, students are maximizing the life span for the most number of people. This related to the principle of Maximize benefits and minimize harm

A

Save the youngest

166
Q

What applications of principles of bioethics

option values fairness, relates to principle Justice

A

draw straws (or any randomization techniques)

167
Q

What applications of principles of bioethics

this option considers the special needs of vulnerable population. It relates to the principle Respect for persons

A

save the weakest

168
Q

What applications of principles of bioethics

saving someone who may be able to save others benefits a larger number of people. This relates to the principle Maximizing benefits and minimizing harms

A

Save the most useful

169
Q

What applications of principles of bioethics

honiring the dignity of human beings includes acknowledging their relationships. This relates the principle “respect for persons”, this approach also relates to Care, an additional principle which can be used alongside the other principles mentioned

A

respect relationship

170
Q

ethical issues for debate

A

Is human body a commodity?
How should decisions be made about who receive scarce organs?
Who should pay for transplants?
Should one person receive several organs or several persons receive one?
Should one person have second transplant when the first one fails or should a different person be given a first chance at a new organ?
Should organs be donated to those persons who have abused their bodies by drinking and smoking or only those whose organs are damaged by disease?
Should state law maker be involved in transplantation?

Bioethics (8 decks)

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