Başkent Üniversitesi Makaleler
Permanent URI for this collectionhttps://hdl.handle.net/11727/13096
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Item Strategies for Reducing the Renal Transplant Waiting List: A Review(Başkent Üniversitesi, 2009-09) Shrestha, Badri ManRenal transplant is the optimum form of therapy for most patients with end-stage renal failure, because that treatment results in a significant improvement in the patient’s quality of life and is cost-effective. The exponential increase in the number of patients on the renal transplant waiting list globally has become a serious problem fueled by an increase in the number of patients with end-stage renal disease, the shortage of organs for transplant, and the failure of transplanted kidneys for various reasons. Strategies are being used by transplant professionals to retard the progression of chronic kidney disease, increase organ donation, reduce the acute rejection rate, and prevent transplant losses. This paper provides an up-to-date review of the interventional strategies used to reduce the ever-increasing renal transplant waiting list.Item Do We Need To Maximize the Knowledge and Attitude Level of Physicians and Nurses Toward Organ Donation and Transplant?(Başkent Üniversitesi, 2008-12) Bener, Abdulbari; Al-Maslamani, Yousuf; El-Shoubaki, HatemObjectives: We sought to assess the knowledge level, attitudes, and personal views of physicians and nurses toward organ donation and transplant. Materials and Methods: This is a cross-sectional survey, carried out from November 2007 to June 2008 in the intensive care units and accident and emergency departments of the hospitals of the Hamad Medical Corporation. A representative sample of 685 health care professionals working in the hospitals was approached; 521 agreed to participate in the study (76.1%). Face-to-face interviews were based on a questionnaire that included sociodemographic information, knowledge level, and personal views toward organ donation and transplant. Results: Of the 521 participants, there were 268 physicians (51.4%) and 253 nurses (48.6%). The knowledge level of nurses was significantly lower for most of the questions related to organ donation, compared with physicians. Mean ± standard deviation for the score reflecting knowledge level was higher for physicians (4.9 ± 1.9) than it was for nurses (4.4 ± 2.0). The majority of the nurses believed, more than physicians, that brain-dead persons are eligible for organ donation (71.5% vs 63.1%), and that certain organs can be donated while the person is living, including kidneys, lobes of livers, and lungs (71.5% vs 62.3%). Many physicians (72.4%) and nurses (74.7%) did not know that brain death can be described as death. Most physicians and nurses supported organ donation (91.8% vs 79.8%), although a lower proportion of physicians and nurses were willing to donate a kidney to a family member in need (64.6% vs 68.0%). More than physicians (23.9%), nurses (61.3%) agreed that they lacked sufficient information about organ donation. Conclusions: Although the physicians and nurses had an acceptable level of knowledge about organ donation, the mean knowledge score for physicians showed significantly better understanding of the criteria for organ donation and procurement.Item Implications of ICU Stay After Brain Death: The Saudi Experience(Başkent Üniversitesi, 2006-12) Al-Attar, Besher; Shaheen, Faissal; Salam, Mohammed Abdul; Al-Sayyari, Abdullah; Babiker, Abdulqayoum; Zakaria, Haroun; Babiker, Ahmed; Saclayan, LeviObjective: The interval from brain death (BD) to organ harvesting is critical to the success of transplantation. We evaluated the time from BD onset to harvesting and analyzed sources of delay. Materials and Methods: This retrospective study was conducted from January 1999 to December 2003. Time intervals analyzed to determine the causes of delay were: time of admission to the intensive care unit (ICU), to the report to the Saudi Center for Organ Transplantation (SCOT), to the documentation of BD, to organ retrieval and/or cardiocirculatory cessation without organ retrieval. Results: During the 5-year analysis, 1834 people were reported to the SCOT. Of those, more than 1511 (80%) were reported during their first week of treatment in the ICU, and BD was documented in 1099 (59.9%). The mean interval from ICU admission to organ retrieval or cardiac arrest was 10.3 days and that from admission to the report to the SCOT was 5.6 days. In the consensual group, the mean interval from the documentation of BD until harvesting was 2 days, and that from documentation until cardiocirculatory cessation without organ retrieval in the nonconsensual group was 5 days. All subjects demonstrated a significant decrease in systolic blood pressure and a significant increase in plasma sodium and serum creatinine levels. The body temperature, serum plasma levels of sodium, and kidney function (measured by the serum creatinine level) of potential donors were compared, and patients with hypothermia, hypernatremia, or renal failure had a shorter stay in the ICU. Conclusions: Fewer than 30% of the patients could be maintained on mechanical support for more than 1 week after the declaration BD. It is crucial that we increase hospital-staff awareness about the importance of organ donation and transplantation, improve the identification of BD candidates, and enable the early reporting and documentation of BD.Item Organ Donations from Deceased Persons in the Saudi Arabian Population(Başkent Üniversitesi, 2005-06) Al Shehri, Saleh; Shaheen, Faissal A. M.; Al-Khader, Abdulla A.Methods: We examined next-of-kin records of Saudi brain dead persons who had been approached for consent for donation during 1998. These same next of kin were approached in 2004 and asked to fill out a questionnaire examining demographics, awareness, and emotions regarding their decision to donate a family member’s organ(s). In addition, data related to the deceased persons also were recorded. Results: During 1998, 41 Saudi next of kin had been approached for permission to obtain organs from their deceased relatives. Of these, 16 consented and 25 did not. We obtained responses from all the consenters (group 1) and from 16 of the nonconsenters (group 2). The consenters were more educated; had positive feelings about donation and still do; and had keener knowledge regarding organ donation, religious standpoints about donation, and the results of transplantation. Conclusions: The results demonstrate that consent for donation depends on prior knowledge and awareness of the various aspects of organ donation. Public education methods used to encourage organ donation need review. We found no differences in economic status or age between consenters and nonconsenters. The relationship between the deceased person and the next of kin does not appear to play a role in determining consent or refusal. On the other hand, consent was less likely when death was caused by a motor vehicle accident than it when other factors led to death.Item Important Social Factors that Affect Organ Transplantation in Islamic Countries(Başkent Üniversitesi, 2003-12) AAAl-Khader; Shaheen, F A M.; Al-Jondeby, M S.Social attitudes and beliefs have direct and strong impact on people’s acceptance of organ donation and brain death, and therefore affect the entire practice of organ transplantation. The views differ from one society to another, and they at least partially explain regional variations in the world with respect to success of organ transplantation. Social attitudes and ethics in Islamic countries are closely intertwined with Islamic tradition, teachings and heritage. These positions are strongly adhered to in many Islamic countries, and by Moslems who live in countries that are not predominantly Islamic. We feel that transplant physicians and transplant coordinators should be aware of these factors when dealing with potential donors and recipients. Decision-making can be facilitated if these issues are considered prior to consulting with a donor’s family and if an appropriate compassionate explanation of need for transplantation and basis of brain death diagnosis is provided based on a knowledge of underlying social constraints. Such steps can make the donation process smoother for both health care workers and the family.Item Organ Bağışı ve Naklinde Etik, Dinsel ve Yasal Yaklaşımlar(Başkent Üniversitesi, 2004-06) A. Ç. DontluOrgan bağışı ve transplantasyon sayısı arttıkça yapılan transplantasyon sonuçlarının başarısı da artmıştır. Buna paralel olarak etik , dini ve yasal problemler de gündeme gelmiş ve yasal naklinin sosyal ve legal boyutları tartışılmaya başlanmıştır. Neredeyse tüm tıbbi tedaviler içinde en çok soru sorulan alan transplantasyondur. Dünyada ve ülkemizde, etik ,dini inanış ve kurallar göz önüne alınarak kanuni düzenlemeler yapılmıştır. Böylece organ bağışı ve naklindeki önemli bir artış olmuştur. Buna rağmen organ bekleyen hasta sayısı her gün katlanarak artmaktadır. Bu nedenle canlı ve beyin ölümü gelişmiş kadavradan başka organ kaynakları da yaratmak yolunda çalışmalar yapılması zorunlu hale gelmiştir. Kalbi atmayan kadavra kullanımı bir çıkış yolu olsa da; Xenotransplantasyon ile ilgili çalışmalar da ümit vaad etmektedir. Kalbi atmayan kadavra donörlerin daha sık ve verimli kullanılması ve Xenotransplantasyona ait etik ,dinsel ve yasal kurallar belirlenmeli ve bu yolla da organ ve doku bağışı ile transplantasyon artışı sağlanmalıdır. Bu yazıda organ bağışı ve naklini etkileyen etik, dinsel ve yasal yaklaşımlar irdelenmiştir Ethical, Religious And Legal Aspects of Organ Donation and Transplantation As numbers of organ donations and transplantations have increased, so has the proportion of successful outcomes. In parallel with the expansion of transplantation, ethical, religious and legal issues have arisen. Today, the social and legal dimensions of organ transplantation are under debate. It is fair to state that no medical treatment attempted to date has given rise to as many ethical questions as transplantation. In Turkey and throughout the world, laws are enacted according to people’s ethical and religious beliefs and rules. However, the number of patients with end-stage organ disease who are waiting for transplants is increasing rapidly. There is a need to find organ sources other than living donors and brain-dead cadaveric donors, and research in new areas is essential. Use of non-heart-beating donors is one solution, but xenotransplantation also appears promising. The ethical, religious, and legal aspects of both these areas of transplantation need to be examined in order to increase organ and tissue donation and transplantation. This review discusses the ethical, religious and legal aspects of organ donation and transplantation in general.