Revista Científica British Medical Journal: hidroxicloroquina em pacientes com doença de coronavírus leve a moderada em 2019 – ensaio clínico aberto, randomizado – BMJ 2020 – Os eventos adversos foram maiores nos receptores de hidroxicloroquina do que nos não receptores

“Conclusões: A administração de hidroxicloroquina não resultou em uma probabilidade significativamente maior de conversão negativa do que o padrão de atendimento isolado em pacientes internados no hospital com covid-19 leve a moderada, persistente, principalmente. 

Os eventos adversos foram maiores nos receptores de hidroxicloroquina do que nos não receptores.”

Registro de teste ChiCTR2000029868.

369 doi: https://doi.org/10.1136/bmj.m1849 (Publicado 14 de maio de 2020) Cite-o como: BMJ 2020; 369: m1849

“Conclusions: Administration of hydroxychloroquine did not result in a significantly higher probability of negative conversion than standard of care alone in patients admitted to hospital with mainly persistent mild to moderate covid-19. Adverse events were higher in hydroxychloroquine recipients than in non-recipients.”

 

Fonte:

https://www.bmj.com/content/369/bmj.m1849?fbclid=IwAR154WTweuyathXU5RcO18tWBvxMU6RMDz8-16bk3Qb_rEjzGW8u6lMr8Uc

 

CCDE Acesso livre

Pesquisa

Hidroxicloroquina em pacientes com doença de coronavírus leve a moderada em 2019: ensaio clínico aberto, randomizado

BMJ 2020 ; 369 doi: https://doi.org/10.1136/bmj.m1849

 (Publicado 14 de maio de 2020) Cite-o como: BMJ 2020; 369: m1849

 

  1. Wei Tang, professor associado 2 ,
  2. Zhujun Cao, médico de doenças infecciosas 3 ,
  3. Mingfeng Han, médico do peito 4 ,
  4. Zhengyan Wang, médico do peito 5 ,
  5. Junwen Chen, médico do peito 6 ,
  6. Wenjin Sun, médico de doenças infecciosas 7 ,
  7. Yaojie Wu, médico cardiovascular 8 ,
  8. Wei Xiao, médico do peito 9 ,
  9. Shengyong Liu, médico de doenças infecciosas 10 ,
  10. Erzhen Chen, professor 11 ,
  11. Wei Chen, médico do peito 2 ,
  12. Xiongbiao Wang, médico do peito 12 ,
  13. Jiuyong Yang, médico do peito 13 ,
  14. Jun Lin, médico gastrointestinal 14 ,
  15. Qingxia Zhao, médico de doenças infecciosas 15 ,
  16. Youqin Yan, médico de doenças infecciosas 16 ,
  17. Zhibin Xie, médico do peito 17 ,
  18. Dan Li, médico do peito 18 ,
  19. Yaofeng Yang, médico de peito 19 ,
  20. Leshan Liu, pesquisador associado em estatística 20 ,
  21. Jieming Qu, médico do peito e professor 2 ,
  22. Guang Ning, médico endocrinológico e professor 21 ,
  23. Guochao Shi, médico do peito e professor 2 ,
  24. Qing Xie, professor 

Afiliações de autores

  1. 1 Departamento de Medicina Pulmonar e Intensiva, Hospital Ruijin, Escola de Medicina da Universidade Jiao Tong de Xangai, Xangai, China
  2. 2 Instituto de Doenças Respiratórias, Faculdade de Medicina, Shanghai Jiao Tong University, Shanghai, China
  3. 3 Departamento de Doenças Infecciosas, Hospital Ruijin, Escola de Medicina da Universidade Jiao Tong de Xangai, Shanghai 200025, China
  4. 4 Departamento de Medicina Respiratória, Hospital N ° 2 da Cidade de Fuyang, Fuyang, Anhui, China
  5. 5 Departamento de Medicina Respiratória, Hospital Suizhou, Universidade de Medicina Hubei, Suizhou, Hubei, China
  6. 6 Departamento de Medicina Respiratória e de Terapia Intensiva, Hospital Popular de Xiangyang No 1, Universidade de Medicina de Hubei, Xiangyang, Hubei, China
  7. 7 Departamento de Doenças Infecciosas, Hospital Central de Ezhou, Ezhou, Hubei, China
  8. 8 Departamento de Medicina Cardiovascular, Hospital Popular de Yunmeng, Xiaogan, Hubei, China
  9. 9 Departamento de Medicina Respiratória, Primeiro Hospital Popular da Cidade de Jingzhou, Jingzhou, Hubei, China
  10. 10 Departamento de Doenças Infecciosas, Hospital Xiaogan, afiliado à Universidade de Ciência e Tecnologia Wuhan, Xiaogan, Hubei, China
  11. 11 Departamento de Medicina de Emergência, Hospital Ruijin, Escola de Medicina da Universidade Jiao Tong de Xangai, Xangai, China
  12. 12 Departamento de Medicina Respiratória, Hospital Putuo, Universidade de Medicina Tradicional Chinesa de Xangai, Xangai, China
  13. 13 Departamento de Medicina Respiratória, Hubei Space Hospital de Xiaogan, Xiaogan, Hubei, China
  14. 14 Departamento de Gastroenterologia, Hospital Zhongnan da Universidade de Wuhan, Wuhan, Hubei, China
  15. 15 Departamento de Doenças Infecciosas, Sexto Hospital Popular de Zhengzhou, Zhengzhou, Henan, China
  16. 16 Departamento de Doenças Infecciosas, Hospital Wuhan No 7, Wuhan, Hubei, China
  17. 17 Departamentos de Medicina Respiratória, Hospital Xiaogan, afiliado à Universidade de Ciência e Tecnologia Wuhan, Xiaogan, Hubei, China
  18. 18 Departamento de Medicina Respiratória, Terceiro Hospital Popular de Yichang, Yichang, Hubei, China
  19. 19 Departamento de Medicina Respiratória, Hospital Popular de Xiao Gan, Xiaogan, Província de Hubei, China
  20. 20 Centro de Pesquisa Clínica, Hospital Ruijin, Faculdade de Medicina da Universidade Jiao Tong de Xangai, Xangai, China
  21. 21 Centro Nacional de Pesquisa de Xangai para Doenças Endócrinas e Metabólicas, Laboratório Estatal Chave de Genômica Médica, Instituto de Xangai para Doenças Endócrinas e Metabólicas, Hospital Ruijin, Hospital de Ruijin, Escola de Medicina da Universidade Jiao Tong de Xangai, Xangai, China

Resumo

Objetivo Avaliar a eficácia e a segurança da hidroxicloroquina mais o padrão de atendimento em comparação com o padrão de atendimento isolado em adultos com doença por coronavírus 2019 (covid-19).

 

Projeto Ensaio multicêntrico, aberto, controlado e randomizado.

 

Estabelecimento de 16 centros de tratamento covid-19 designados pelo governo na China, de 11 a 29 de fevereiro de 2020.

 

Participantes 150 pacientes internados no hospital com covid-19 confirmado laboratorialmente foram incluídos na intenção de tratar a análise (75 pacientes designados à hidroxicloroquina mais o padrão de atendimento, 75 apenas o padrão de atendimento).

 

Intervenções A hidroxicloroquina administrada em uma dose inicial de 1200 mg por dia durante três dias, seguida por uma dose de manutenção de 800 mg por dia (duração total do tratamento: duas ou três semanas para pacientes com doença leve a moderada ou grave, respectivamente).

 

Medida do desfecho principal Conversão negativa do coronavírus da síndrome respiratória aguda grave 2 por 28 dias, analisada de acordo com a intenção de tratar o princípio. Os eventos adversos foram analisados ​​na população de segurança em que os receptores de hidroxicloroquina foram participantes que receberam pelo menos uma dose de não-receptores de hidroxicloroquina e hidroxicloroquina foram aqueles gerenciados apenas com o padrão de atendimento.

 

Resultados Dos 150 pacientes, 148 tiveram doença leve a moderada e dois tiveram doença grave. A duração média desde o início dos sintomas até a randomização foi de 16,6 (DP 10,5; intervalo 3-41) dias. Um total de 109 (73%) pacientes (56 cuidados padrão; 53 cuidados padrão mais hidroxicloroquina) tiveram uma conversão negativa bem antes de 28 dias, e os restantes 41 (27%) pacientes (19 cuidados padrão; 22 cuidados padrão mais hidroxicloroquina) foram censurados por não atingirem a conversão negativa do vírus. A probabilidade de conversão negativa em 28 dias no grupo padrão de atendimento mais hidroxicloroquina foi de 85,4% (intervalo de confiança de 95% 73,8% a 93,8%), semelhante à do grupo padrão de atendimento (81,3%, 71,2% a 89,6%) . A diferença entre os grupos foi de 4,1% (intervalo de confiança de 95% – 10,3% a 18,5%). Na população de segurança, eventos adversos foram registrados em 7/80 (9%) dos não receptores de hidroxicloroquina e em 21/70 (30%) dos receptores de hidroxicloroquina. O evento adverso mais comum nos receptores de hidroxicloroquina foi diarréia, relatada em 7/70 (10%) dos pacientes. Dois receptores de hidroxicloroquina relataram eventos adversos graves.

 

Conclusões A administração de hidroxicloroquina não resultou em uma probabilidade significativamente maior de conversão negativa do que o padrão de atendimento isolado em pacientes internados no hospital com covid-19 leve a moderada, persistente, principalmente. Os eventos adversos foram maiores nos receptores de hidroxicloroquina do que nos não receptores.

 

Registro de teste ChiCTR2000029868.

 

Leia o artigo neste link:

https://www.bmj.com/content/369/bmj.m1849?fbclid=IwAR154WTweuyathXU5RcO18tWBvxMU6RMDz8-16bk3Qb_rEjzGW8u6lMr8Uc

 

image2020

 

Efeito da infecção por SARS-CoV-2 – Covid 19 – na função gonadal masculina

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Effect of SARS-CoV-2 infection upon male gonadal function: A single center-based study

Efeito da infecção por SARS-CoV-2 na função gonadal masculina: um estudo baseado em um único centro

This article is a preprint and has not been peer-reviewed [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

Download article:

Effect of SARS-CoV-2 infection upon male gonadal function: A single center-based study

 

Since SARS-CoV-2 infection was first identified in December 2019, it spread rapidly and a global pandemic of COVID-19 has occurred. ACE2, the receptor for entry into the target cells by SARS-CoV-2, was found to abundantly express in testes, including spermatogonia, Leydig and Sertoli cells. However, there is no clinical evidence about whether SARS-CoV-2 infection can affect male gonadal function so far. In this study, we compared the sex-related hormones between 81 reproductive-aged men with SARS-CoV-2 infection and 100 age-matched healthy men, and found that serum luteinizing hormone (LH) was significantly increased, but the ratio of testosterone (T) to LH and the ratio of follicle stimulating hormone (FSH) to LH were dramatically decreased in males with COVID-19. Besides, multivariable regression analysis indicated that c-reactive protein (CRP) level was significantly associated with serum T:LH ratio in COVID-19 patients. This study provides the first direct evidence about the influence of medical condition of COVID-19 on male sex hormones, alerting more attention to gonadal function evaluation among patients recovered from SARS-CoV-2 infection, especially the reproductive-aged men.

(…)

Link da publicação:

Effect of SARS-CoV-2 infection upon male gonadal function: A single center-based study

 

medrxiv_internal_logo

Cães podem identificar infecções hospitalares. Dogs that accurately sniff out superbug infections? The role of animals in hospital infections

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(NaturalNews) In this high-tech world, sometimes it’s better to rely on a low-tech solution or, in this case, no tech.

A new study to be published in the Christmas issue of the British Medical Journal found that dogs can be used to sniff out Clostridium difficile, or C-diff, the element that is responsible for a rising number of hospital infections that are extremely resistant to antibiotics.

F1.medium
The olfactory sense of dogs can be used to identify C-diff infections in stool samples as well as the air surrounding patients in the hospital environment, all with a high degree of accuracy, researchers said.

The journal said current findings support earlier conclusions that dogs are capable of detecting various types of cancer as well, and may have potential for screening hospital wards to help prevent C-diff outbreaks.

The infectious C-diff occurs most commonly in older patients who have recently finished a course of antibiotics in the hospital. But the infections can also begin in the community, especially in nursing homes and other skilled facilities. Symptoms of the infection can range from mild diarrhea to a life-threatening bowel inflammation.

Some questions remain, but early results are promising

Early detection of the infection is important if doctors hope to contain its spread, but diagnostic tests confirming it are slow (and expensive), which can delay treatment for as much as a week.

Researchers said that diarrhea as a result of a C-diff infection has a certain smell, and that dogs – with their superior olfactory capabilities – likely could detect it much better, in comparison with humans. That supposition prompted scientists in the Netherlands to see if dogs could be trained to sniff out C-diff.

Scientists used a two-year-old male Beagle (named Cliff) that had been trained by a professional instructor to spot C-diff in stool samples and in patients who had contracted the infection. Cliff was taught to either lay down or sit when he detected the specific scent.

Following two months of training, Cliff’s detection capability was formally tested on 50 C-diff positive and 50 C-diff negative stool samples, said scientists. He managed to correctly identify all 50 positive samples and 47 of the 50 negative samples.

The results equate to 100 percent sensitivity and 94 percent specificity (sensitivity measures the proportion of positives correctly identified, while specificity measures the proportion of negatives correctly identified).

Cliff was then taken to two hospital wards to conduct further detection tests in a live environment. The dog managed to correctly identify 25 of 30 cases (83 percent sensitivity) and 265 of 270 negative controls (98 percent specificity). Researchers added that the dog was efficient and quick, managing to screen a complete hospital ward for the presence of patients infected with C-diff in fewer than 10 minutes.

Early detection certainly possible

Scientists admitted there were some limitations to the study, such as the unpredictability of using an animal as a diagnostic tool, as well as the possibility that the dog itself could spread infections. Other scientists say other unanswered questions remain.

Still, they note that the study demonstrates that training a dog to detect C-diff infection with a high degree of accuracy, both in samples of stool and in patients who are hospitalized and could contract the infection.

“Early detection could overcome common diagnostic delays (lack of clinical suspicion, delays in sampling stool, and laboratory procedures) and lead to prompt hygienic measures and treatment,” the researchers concluded. “This could have potential for C. difficile infection screening in healthcare facilities and thus contribute to C. difficile infection outbreak control and prevention.”

Sources:

http://www.eurekalert.org/pub_releases/2012-12/bmj-dca121212.php

http://www.bmj.com/content/345/bmj.e7396

http://www.naturalnews.com/037709_fecal_matter_c_diff_infection.html

Learn more: http://www.naturalnews.com/038465_superbug_infections_dogs_sniffing.html#ixzz2GArAc26D

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Mulheres fumantes na pós-menopausa correm risco 16% maior de terem câncer

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28/3/2011 – ZH Caderno Vida

 

O estudo foi realizado com quase 80 mil mulheres americanas durante 10 anos
Dois estudos publicados recentemente mostram claramente os riscos e benefícios do estilo de vida no combate ao câncer, destacando os perigos do tabagismo para mulheres na pós-menopausa e os efeitos protetores dos exercícios no intestino. As mulheres na pós-menopausa que fumam ou costumavam fumar correm um risco até 16% maior de desenvolver câncer de mama do que aquelas que nunca fumaram, destacou um artigo publicado na edição online do British Medical Journal (BMJ).

As mulheres que foram extensivamente expostas ao fumo passivo, tanto na infância quanto na idade adulta, também podem correr mais riscos de desenvolver câncer de mama, acrescentaram. No entanto, esse risco aparente não se aplica a mulheres apenas moderadamente expostas ao fumo passivo.

O estudo foi realizado com quase 80 mil mulheres americanas, entre 50 e 79 anos. Todas foram acompanhadas por 10 anos.

Outra pesquisa separada, publicada pelo British Journal of Cancer, demonstrou que pessoas com estilo de vida mais ativo corriam pelo menos três vezes menos riscos de desenvolver grandes tumores nos intestinos, conhecidos como pólipos, que costumam ser precursores de câncer. A conclusão se baseia em um apanhado de 20 estudos publicados.

— Há muito sabemos que um estilo de vida ativo pode proteger contra o câncer de intestino, mas esse estudo é o primeiro a examinar todas as evidências disponíveis e demonstrar que uma redução dos pólipos intestinais é a explicação mais provável para isso — disse a principal autora do estudo, Kathleen Wolin, da Escola de Medicina da Universidade de Washington, em Saint Louis, no Missouri.

Segundo ela, a prática de exercícios traz muitos benefícios, inclusive o fortalecimento do sistema imunológico, reduzindo a inflamação nos intestinos e ajudando a reduzir os níveis de insulina, todos fatores propensos a influenciar o risco de desenvolvimento de pólipos. Meia hora de exercícios moderados por dia — qualquer um que provoque perda de fôlego suave — e a manutenção de um peso razoável são chaves para reduzir os riscos de câncer de intestino, destacou o Cancer Research UK, que publica o jornal.

O que dizem os estudos

:: As mulheres na pós-menopausa que fumam ou costumavam fumar correm um risco até 16% maior de desenvolver câncer de mama do que aquelas que nunca fumaram

:: Meia hora de exercícios moderados por dia — qualquer um que provoque perda de fôlego suave — e a manutenção de um peso razoável são chaves para reduzir os riscos de câncer de intestino.

 

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Not Just Urban Legend

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Organ trafficking was long considered a myth. But now mounting evidence suggests it is a real and growing problem, even in America.

http://www.newsweek.com/2009/01/09/not-just-urban-legend.html

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Tráfico de órgãos: após 23 anos, acusados de retirar rins de pacientes vivos vão a júri

Açougue Humano: de onde vêm e para onde vão os órgãos transplantados no tráfico humano

Tráfico de órgãos no Brasil: íntegra da entrevista com a antropóloga Nancy Scheper-Hughes

Tráfico de órgãos humanos na Europa

Editorial da Revista Ciência Hoje da SBPC: erros declaratórios da morte encefálica

Tráfico de órgãos é terceiro crime organizado mais lucrativo no mundo, segundo Polícia Federal

Tráfico de órgãos pode movimentar 13 bilhões por ano

Tráfico de órgãos é uma realidade comprovada no Brasil e no exterior

***

By the time her work brought her back to the United States, Nancy Scheper-Hughes had spent more than a decade tracking the illegal sale of human organs across the globe. Posing as a medical doctor in some places and a would-be kidney buyer in others, she had linked gangsters, clergymen and surgeons in a trail that led from South Africa, Brazil and other developing nations all the way back to some of her own country’s best medical facilities. So it was that on an icy February afternoon in 2003, the anthropologist from the University of California, Berkeley, found herself sitting across from a group of transplant surgeons in a small conference room at a big Philadelphia hospital.

By accident or by design, she believed, surgeons in their unit had been transplanting black-market kidneys from residents of the world’s most impoverished slums into the failing bodies of wealthy dialysis patients from Israel, Europe and the United States. According to Scheper-Hughes, the arrangements were being negotiated by an elaborate network of criminals who kept most of the money themselves. For about $150,000 per transplant, these organ brokers would reach across continents to connect buyers and sellers, whom they then guided to “broker-friendly” hospitals here in the United States (places where Scheper-Hughes says surgeons were either complicit in the scheme or willing to turn a blind eye). The brokers themselves often posed as or hired clergy to accompany their clients into the hospital and ensure that the process went smoothly. The organ sellers typically got a few thousand dollars for their troubles, plus the chance to see an American city.

As she made her case, Scheper-Hughes, a diminutive 60-something with splashes of pink in her short, grayish-brown hair, slid a bulky document across the table—nearly 60 pages of interviews she had conducted with buyers, sellers and brokers in virtually every corner of the world. “People all over were telling me that they didn’t have to go to a Third World hospital, but could get the surgery done in New York, Philadelphia or Los Angeles,” she says. “At top hospitals, with top surgeons.” In interview after interview, former transplant patients had cited the Philadelphia hospital as a good place to go for brokered transplants. Two surgeons in the room had also been named repeatedly. Scheper-Hughes had no idea if those surgeons were aware that some of their patients had bought organs illegally. She had requested the meeting so that she could call the transgression to their attention, just in case.

Hospital officials told NEWSWEEK that after meeting with Scheper-Hughes, they conducted an internal review of their transplant program. While they say they found no evidence of wrongdoing on the part of their surgeons, they did tighten some regulations, to ensure better oversight of foreign donors and recipients. “But that afternoon,” Scheper-Hughes says, “they basically threw me out.”

It’s little wonder. The exchange of human organs for cash or any other “valuable consideration” (such as a car or a vacation) is illegal in every country except Iran. Nonetheless, international organ trafficking—mostly of kidneys, but also of half-livers, eyes, skin and blood—is flourishing; the World Health Organization estimates that one fifth of the 70,000 kidneys transplanted worldwide every year come from the black market. Most of that trade can be explained by the simple laws of supply and demand. Increasing life spans, better diagnosis of kidney failure and improved surgeries that can be safely performed on even the riskiest of patients have spurred unprecedented demand for human organs. In America, the number of people in need of a transplant has nearly tripled during the past decade, topping 100,000 for the first time last October. But despite numerous media campaigns urging more people to mark the backs of their driver’s licenses, the number of traditional (deceased) organ donors has barely budged, hovering between 5,000 and 8,000 per year for the last 15 years.

In that decade and a half, a new and brutal calculus has emerged: we now know that a kidney from a living donor will keep you alive twice as long as one taken from a cadaver. And thanks to powerful antirejection drugs, that donor no longer needs to be an immediate family member (welcome news to those who would rather not risk the health of a loved one). In fact, surgeons say that a growing number of organ transplants are occurring between complete strangers. And, they acknowledge, not all those exchanges are altruistic. “Organ selling has become a global problem,” says Frank Delmonico, a surgery professor at Harvard Medical School and adviser to the WHO. “And it’s likely to get much worse unless we confront the challenges of policing it.”

For Scheper-Hughes, the biggest challenge has been convincing people that the problem exists at all. “It used to be a joke that came up at conferences and between surgeons,” she says. “In books and movies, you find these stories of people waking up in bathtubs full of ice with a scar where one of their kidneys used to be. People assumed it was just science fiction.” That assumption has proved difficult to dismantle. In the mid-1980s, rumors that Americans were kidnapping children throughout Central America only to harvest their organs led to brutal attacks on American tourists in the region. When those stories proved false, the State Department classified organ-trafficking reports under “urban legend.” Scheper-Hughes’s evidence, which is largely anecdotal and comes in part from interviews with known criminals, has not convinced department officials otherwise. “It would be impossible to successfully conceal a clandestine organ-trafficking ring,” Todd Leventhal, the department’s countermisinformation officer, wrote in a 2004 report, adding that stories like the ones Scheper-Hughes tells are “irresponsible and totally unsubstantiated.” In recent years, however, the WHO, Human Rights Watch and many transplant surgeons have broken with that view and acknowledged organ trafficking as a real problem.

At first, not even Scheper-Hughes believed the rumors. It was in the mid-1980s, during a study of infant mortality in the shantytowns of northern Brazil, that she initially caught wind of mythical “body snatcher” stories: vans of English-speaking foreigners would circle a village rounding up street kids whose bodies would later be found in trash bins removed of their livers, eyes, kidneys and hearts.

When colleagues in China, Africa and Colombia reported similar rumblings, Scheper-Hughes began poking around. Some stories—especially the ones about kidnapped children, stolen limbs and tourists murdered for organs—were clearly false. But it was also clear that slums throughout the developing world were full of AWOL soldiers, desperate parents and anxious teenage boys willing to part with a kidney or a slice of liver in exchange for cash and a chance to see the world—or at least to buy a car.

Before long, Scheper-Hughes had immersed herself in an underworld of surgeons, criminals and those eager to buy or sell whatever body parts could be spared. In Brazil, Africa and Moldova, newspapers advertised the sale and solicitation of human body parts while brokers trolled the streets with $100 bills, easily recruiting young sellers. In Istanbul, Scheper-Hughes posed as an organ buyer and talked one would-be seller down to $3,000 for his “best kidney.” In some of these countries, as the WHO later quantified, 60 to 70 percent of all transplant surgeries involved the transfer of organs from those countries’ citizens to “transplant tourists” who came from the developed world.

But not all organs flowed from poor countries to rich ones; Americans, for example, were both buyers and sellers in this global market. A Kentucky woman once contacted Scheper-Hughes looking to sell her kidney or part of her liver so that she could buy some desperately needed dentures. And a Brooklyn dialysis patient purchased his kidney from Nick Rosen, an Israeli man who wanted to visit America.

Unlike some organ sellers, who told of dingy basement hospitals with less equipment than a spartan kitchen, Rosen found an organ broker through a local paper in Tel Aviv who arranged to have the transplant done at Mount Sinai Medical Center in New York. An amateur filmmaker, Rosen documented a portion of his odyssey on camera and sent the film to Scheper-Hughes, whose research he had read about online. The video excerpt that NEWSWEEK viewed shows Rosen meeting his broker and buyer in a New York coffee shop where they haggle over price, then entering Mount Sinai and talking with surgeons—one of whom asks him to put the camera away. Finally, after displaying his post-surgery scars for the camera, Rosen is seen rolling across a hotel bed covered in $20 bills; he says he was paid $15,000. (Brokers, on the other hand, typically net around $50,000 per transplant, after travel and other expenses. In America, some insurance plans will cover at least a portion of the donor’s medical expenses.)

The money changed hands outside the hospital’s corridors, and Rosen says that he deliberately misled the Mount Sinai doctors, but that no one there challenged him. “One hospital in Maryland screened us out,” he says. Tom Diflo, a transplant surgeon at New York University’s Langone Medical Center, points out that many would-be donors do not pass the psychological screening, and that attempting to film the event would probably have set off an alarm bell or two. “But the doctors at Mount Sinai were not very curious about me,” Rosen says. “We told them I was a close friend of the guy who I sold my kidney to, and that I was donating altruistically, and that was pretty much the end of it.” Citing privacy laws, Mount Sinai officials declined to comment on the details of Rosen’s case. But spokesperson Ian Michaels says that the hospital’s screening process is rigorous and comprehensive, and assesses each donor’s motivation. “All donors are clearly advised that it is against the law to receive money or gifts for being an organ donor,” he says. “The pretransplant evaluation may not detect premeditated and skillful attempts to subvert and defraud the evaluation process.”

Because many people do donate organs out of kindness, altruism provides an easy cover for those seeking to profit. And U.S. laws can be easy to circumvent, especially for foreign patients who may pay cash and are often gone in the space of a day. Diflo, who has worked in numerous transplant wards over the past two decades, says that while they are in the minority, hospitals that perform illegal transplants certainly exist in the United States. “There are a couple places around that have reputations for doing transplants with paid donors, and then some hospitals that have a ‘don’t ask, don’t tell’ policy,” he says. “It’s definitely happening, but it’s difficult to ferret out.”

Diflo became an outspoken advocate for reform several years ago, when he discovered that, rather than risk dying on the U.S. wait list, many of his wealthier dialysis patients had their transplants done in China. There they could purchase the kidneys of executed prisoners. In India, Lawrence Cohen, another UC Berkeley anthropologist, found that women were being forced by their husbands to sell organs to foreign buyers in order to contribute to the family’s income, or to provide for the dowry of a daughter. But while the WHO estimates that organ-trafficking networks are widespread and growing, it says that reliable data are almost impossible to come by. “Nancy has done truly courageous work, literally risking her life to expose these networks,” says Delmonico. “But anecdotes are impossible to quantify.”

Scheper-Hughes acknowledges that in gathering these anecdotes she has frequently bumped up against the ethical boundaries of her own profession. While UC Berkeley (which funds most of her work) granted special permission for her to go undercover, she still takes heat from colleagues: misrepresenting oneself to research subjects violates a cardinal rule of academic research. “I expect my methods to be met with criticism,” she says. “But being an anthropologist should not mean being a bystander to crimes against the vulnerable.”

While Rosen has fared well since the surgery—he recovered quickly, used the money to travel and stays in touch with his kidney recipient via Facebook—most of the donors Scheper-Hughes and her colleagues have spoken with are not so lucky. Studies show that the health risks posed by donating a kidney are negligible, but those studies were all done in developed countries. “Recovery from surgery is much more difficult when you don’t have clean water or decent food,” says Scheper-Hughes. And research on the long-term effects of organ donation—in any country—is all but nonexistent.

Last may, Scheper-Hughes once again found herself sitting across from a group of transplant surgeons. This time they were not as incredulous. More than 100 of them had come from around the world to Istanbul for a global conference on organ trafficking. Together, they wrote and signed the Declaration of Istanbul, an international agreement vowing to stop the commodification of human organs. But unless their document is followed by action, it will be no match for the thriving organ market. Even as illegal trade is exposed, a roster of Web sites promising to match desperate dialysis patients with altruistic strangers continues to proliferate unchecked. These sites have some surgeons worried. “We have no way to tell if money is changing hands or not,” says Diflo. “People who need transplants end up trying to sell themselves to potential donors, saying, ‘I have a nice family, I go to church,’ etc. Is that really how we want to allocate organs?”

Maybe not. But in the United States, the average wait time for a kidney is expected to increase to 10 years by 2010. Most dialysis patients die in half that time, and the desperate don’t always play by the rules.

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Stop Harvesting Organs after ‘Cardiac Death,’ Say MDs

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Wednesday September 15, 2010

By Patrick B. Craine

CALGARY, Alberta, September 15, 2010 (LifeSiteNews.com) – A group of doctors have called on the medical community to cease harvesting organs from patients whose hearts have stopped pulsating, saying that doctors are misleading families to believe that the patient has died when in fact their loved one is still alive.

The story was featured Wednesday on the cover of Canada’s National Post.

“A longstanding tenet of ethical organ donation [is] that the nonliving donor must be irreversibly dead at the time of donation,” explain the eight paediatric intensive care specialists, writing in Pediatric Critical Care Medicine.

The doctors say that the public’s “underlying assumption” when they agree to donate organs is that “they are giving permission to have their organs removed after they are dead.”

But the authors observe that “death” has been redefined in the last few decades to meet the demand for more organs.  They say organs were originally taken from “cadaveric donors who died in the conventional way, irreversibly losing all electrical and mechanical activity from the heart (circulation) and all brain function, despite medical efforts to save them.”

But “this method of organ procurement created a problem for organ transplantation.” “If the patient died in the conventional way then, at the time of irreversibility, so did most organs.”

The notion of “brain death” was created in 1981 in order to harvest more organs, they say.  Then in 1991 the Pittsburgh Protocol was developed to allow doctors to harvest the organs of adults after a person’s heart has stopped for a certain period.

The Protocol involves removing the person from life support for 30 to 60 minutes.  If the patient’s heart continues to beat after that time, they are returned to the ICU, but if it stops for a prescribed period (around 2 minutes, though ranging from 75 seconds to 10 minutes depending on the jurisdiction), the organs are harvested.

“No efforts are made to assess the patient’s brain function at the time of organ removal,” the authors explain. “The claim is that circulation has irreversibly stopped after 2 mins of observation.”

But this ignores the many reports of the “Lazarus phenomenon,” where a patient’s heart starts again 5 to 10 minutes after CPR is performed.  Such instances suggest that “the heart function and circulation may not be irreversibly stopped in DCD [‘Donation after Cardiac Death’] patients at the time of organ procurement.”

The authors also point out that doctors’ desire to prolong lives through organ transplants can “foster physician and institutional bias” for the cardiac death criteria.

While opposing the notion of “cardiac death”, the authors accept organ harvesting following “brain death”.  Opponents of “brain death” point out that organs can only be harvested when the organ’s functioning continues, meaning that the donor is still showing signs of life.  They say that if the person is truly dead, the unpaired vital organs cannot be transplanted.  In particular, “brain death” has allowed heart transplants, but the heart is only useful if it is still beating in the donor.

Akin to the “Lazarus phenomenon” noted by the authors, there have been numerous instances of patients recovering following a declaration of “brain death”.

The National Post interviewed Dr. Ari Joffe, the sole Canadian author of the controversial document, from Stollery Children’s Hospital in Calgary.  “I think that we’re being less than entirely honest about when the patient is truly dead,” he said. “We’re not trying to deny the parent the choice to donate … The point we’re making is ‘what if they’re almost dead and we’re not sure if they’re dead, and it’s not at the point of irreversibility yet?’”

http://www.lifesitenews.com/ldn/2010/sep/10091510.html

See related LifeSiteNews.com coverage:

Melbourne Doctor: Most Donors Still Alive when Organs are Removed
http://www.lifesitenews.com/ldn/2008/oct/08102105.html

New England Journal of Medicine: ‘Brain Death’ is not Death
http://www.lifesitenews.com/ldn/2008/aug/08081406.html

Doctors Who Almost Dissected Living Patient Confess Ignorance about Actual Moment of Death
http://www.lifesitenews.com/ldn/2008/jun/08061308.html

Doctor Says about “Brain Dead” Man Saved from Organ Harvesting – “Brain Death is Never Really Death”
http://www.lifesitenews.com/ldn/2008/mar/08032709.html

Denver Coroner Rules “Homicide” in Organ-Donor Case
http://www.lifesitenews.com/ldn/2004/oct/04101208.html

Russian Surgeons Removing Organs Saying Patients Almost Dead Anyway
http://www.lifesitenews.com/ldn/2003/sep/03090906.html

Shock: Oxford Neonatologist Says Time Has Come to Consider “Mandatory Organ Donation”
http://www.lifesitenews.com/ldn/2008/oct/08102413.html

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Finis Vitae. Is Brain Death Still Life? Consiglio Nazionale delle Ricerche Italia

Indice

http://web.cnr.it/sitocnr/Iservizi/Pubblicazioni/Catalogopubblicazioni/Catalogo.html?voce=10&id=528

Table of contents
Foreword p.   7
The Heart of the Matter, John Andrew Armour 11
Determining Death: is Brain Death Reliable?, Rainer Beckmann 27
A Brief Summary of Catholic Doctrine Regarding Human Life,
Fabian W. Bruskewitz 45
Death: the Absence of  Life, Paul A. Byrne 63
Genuine Science or False Philosophy?, Roberto de Mattei 85
What is ‘Brain Death’? A British Physician’s View, David W Evans 99
Personal Testimony on the Understanding of Brain Death,
Joseph C. Evers 107
The Apnea Test – a Bedside Lethal ‘Disaster’ to Avoid a Legal
‘Disaster’ in the Operating Room, Cicero Galli Coimbra 113
Brain Death. A United Kingdom Anaesthetist’s View,
David J. Hill 147
The Beginning and the End of Life. Toward Philosophical Consistency,
Michael Potts 161
On ‘Brain Death’ in Brief Philosophical “Arguments” against
Equating it with Actual Death and Responses to “Arguments”
in Favour of such an Equation, Josef Seifert 189
Brain-body Disconnection: Implications for the Theoretical
Basis of  ‘Brain Death’, D. Alan Shewmon 211
Table of contents
Is Brain Death the Death of the Human Being?
On the Current State of Debate, Robert Spaemann 251
A Law of Life, Legality vs. Morality, Wolfgang Waldstein 265
Controversies on Brain Death in Japan and our Seven-Year Experience
after the Enforcement of the Organ Transplantation Law,
Yoshio Watanabe 275
Unpaired Vital Organ Transplantation. Secular Altruism?
Has Killing become a virtue?, Walt Franklin Weaver 285
The Concept of Brain Death and the Death of Man, Ralph Weber

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Mors est finis vitae: not only is death the biological end of life, but it is also the moment when its meaning is disclosed, and with it, also the ultimate purpose of human life. Nevertheless, there has not been on the subject of death the same scientific and cultural debate among public opinion and experts alike, which in recent years, on the other hand, has developed and is still taking place, about the origin of life.

The application of recent scientific and technological developments to medicine have led to new grounds for reflection on death: it is enough here to mention issues such as therapeutic obstinacy, the “biological will”, euthanasia and assisted suicide, requests of interruption of treatment, palliative therapies and above all the removal of organs for transplantation purposes. The ideal scenario for those who perform a certain type of explants, such as those concerning the human heart, would be to be able to do so on a human being who is still alive. Obviously, this does in turn raise serious moral problems which can be solved only provided we “redefine” the entire concept of death.

In fact up until the 60s, Western judicial and medical tradition believed that the acknowledgement of death should be carried out through the confirmation of the definitive cessation of all vital functions: that is breathing, blood circulation and activity of the nervous system. In August 1968, an “Ad Hoe” Committee instituted by Harvard Medical School set forth a new criterion for the ascertainment of death based on entirely neurological evidence: that is on the definitive cessation of all brain activity, under the definition of “irreversible coma” .

Since then the concept of brain death has been incorporated into both legislation and medical practice in most countries in the world. Ever since the 80s, however, doubts and criticisms have been repeatedly raised within the scientific community on the validity of such definition. The criteria introduced by the “Ad Hoc” Committee instituted by Harvard Medical School seem to have lost nowadays both their scientific foundation and initial justification. According to them, in fact, if the encephalon ceases functioning, the body becomes nothing more than a mere collection of organs, forsaken and lacking the coordinating centre which would allow the integration among the various functions of the body itself. However, although on a theoretical level what is known as the concept of “central integration” retains a certain attractiveness and can be made object of many and diverse interpretations from a philosophical point of view, medical day by day practice has throughout the years demonstrated a multiplication of episodes in which the irreversible cessation of all brain functions did not bring about also the cessation of integrated functioning of a human body, even when in intensive care.

Many doubts and questions have also been raised with regards to the neurological criteria to be employed for the ascertainment of death. In order to declare a patient with lethal brain injuries dead is it necessary to consider the functioning of the whole encephalon or does a critical system exist within the encephalon which by ceasing its activity can single – handedly determine the dis – integration of the body and, as a consequence, its death?

In a number of countries among which the United Kingdom, doctors who are called upon to ascertain the death of a brain injured patient, only take into account the functionality of the encephalic trunk alone, and do not employ any instrumental methods of assessment in order to verify their clinical evaluation. On the contrary, in Italy neurological criteria which refers to the functionality of the whole encephalon apply and it is compulsory under the law to perform an electroencephalogram on the patient. Why does such an inconsistency in the nature of neurological criteria applied exist? And furthermore, which set of criteria is the most scientifically appropriate in this case?

Furthermore, other questions can be added to those mentioned above, such as those which derive from medical practice drawing attention to cases of patients who, although answering to the requirements set forth by the neurological criteria concerning the entire encephalon, and therefore declared dead but still linked to the reanimation machines while waiting for organ explantation, still retain endocrine – hypothalamic functions as well as those of neuro-hormonal regulation. Does this mean that those patients were in fact still alive? Should this be the case, it would mean that brain death should be viewed not as the death of a human being, but rather as an irreversible condition, a stage which precedes the authentic death of the individual.

All these, and many other weighty questions of an ethical, juridical and philosophical nature, are investigated in this volume by internationally renowned scholars. A number of these contributions have been presented at the Conference entitled “The Signs of Death” which was promoted by the Pontifical Academy of Sciences and took place in Vatican City on 3-4 February 2005, while others have been written for this publication by European and American doctors, jurists, philosophers.

The significance and the complexity of the subject – matter require an in depth investigation to which we hope also this publication will give a significant contribution.

Roberto de Mattei

Vice-President

National Research Council of Italy

http://web.cnr.it/sitocnr/Iservizi/Pubblicazioni/Catalogopubblicazioni/Catalogo.html?voce=10&pag=689

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