http://cjasn.asnjournals.org Clinical Journal of the American Society of Nephrology RSS feed -- recent Ethics articles 1555-905X Clinical Journal of the American Society of Nephrology 1555-9041 http://cjasn.asnjournals.org/icons/banner/title.gif http://cjasn.asnjournals.org http://cjasn.asnjournals.org/cgi/content/short/2/2/300?rss=1 Many families deny organ recovery from recently deceased relatives. As a result, valuable organs and some of the lives they could save are lost. Several plans designed to rectify this tragic situation have been proposed, including organ sales. We suggest another approach that we believe to be superior and that is rarely discussed: routine recovery of all transplantable cadaveric organs without consent. Here we show that this plan is ethically acceptable, more equitable than our current opting-in approach, consistent with other mandatory social programs, and life-saving. Based on these considerations, we believe that it is time to eliminate entirely the consent requirement for recovery of transplantable cadaveric organs.

]]> 2007-02-27 info:doi/10.2215/CJN.03260906 American Society of Nephrology 2 2 303 2007-03-01 300 Ethics http://cjasn.asnjournals.org/cgi/content/short/2/1/107?rss=1 Because the dialysis patient population is increasingly composed of older patients with high symptom burden, shortened life expectancy, and multiple comorbid conditions, nephrologists often engage in end-of-life decision-making with their patients. In the 1990s, reported practices of nephrologists’ end-of-life decision-making showed much variability. In part as a reaction to that variability, the Renal Physicians Association (RPA) and the American Society of Nephrology (ASN) developed a clinical practice guideline on end-of-life decision-making. To determine whether nephrologists’ attitudes and reported practices had changed over time, survey responses from 296 nephrologists completing an online survey in 2005 were compared with 318 nephrologists who completed a similar mailed survey in 1990. In 2005, less variability was noted in reported practices to withhold dialysis from a permanently unconscious patient (90% would withhold in 2005 versus 83% who would withhold in 1990, P < 0.001) and to stop dialysis in a severely demented patient (53% in 2005 would stop versus 39% in 1990, P < 0.00001). In 2005, significantly more dialysis units were reported to have written policies on cardiopulmonary resuscitation (86% in 2005 versus 31% in 1990, P < 0.0001) and withdrawal of dialysis (30% in 2005 versus 15% in 1990, P < 0.0002); nephrologists were also more likely to honor a dialysis patient’s do-not-resuscitate order (83% in 2005 versus 66%, P < 0.0002) and to consider consulting a Network ethics committee (52% in 2005 versus 39%, P < 0.001). Nephrologists’ reported practices in end-of-life care have changed significantly over the 15 years separating the two surveys, suggesting that the development of the clinical practice guideline was worthwhile.

]]> 2006-12-29 info:doi/10.2215/CJN.03080906 American Society of Nephrology 1 2 111 2007-01-01 107 Ethics