Hubert Doucet

Are ‘anonymous’ and ‘non-directed’ prerequisites for living altruistic donation? The views of transplant physicians from France and Québec

It can be argued that living altruistic donors should remain anonymous and should not express preferences in the selection of organ recipients. This study aimed to describe the views of transplant physicians in France and Québec regarding these issues. A total of 27 French and 19 Québec renal transplant physicians took part in individual, semi-directed interviews. Almost all of the physicians agreed that anonymity is mandatory in living altruistic donation (LAD). Regarding the issue of directed donation, most of the French physicians (78%) were opposed to any form of the practice, compared to only a third of their Québec colleagues (32%). We found that these positions were embedded in their respective cultural, legal and social contexts. These results afford a better understanding of these complex issues in two different cultural contexts, and will be useful in the development of international guidelines for LAD.

Survey highlights the need for specific interventions to reduce frequent conflicts between healthcare professionals providing paediatric end-of-life care

This study explored how paediatric healthcare professionals experienced and coped with end‐of‐life conflicts and identified how to improve coping strategies.

Élargissement du cercle de donneurs vivants et création des comités d’experts. Des transplanteurs français et la loi de bioéthique

Resume Objectifs En 2004, la legislation francaise entourant le prelevement d’organes sur une personne vivante fut revisee. La nouvelle legislation a elargi le cercle des donneurs vivants potentiels et a cree les comites d’experts. Le but de cette etude est de recueillir l’opinion de medecins transplanteurs sur ces modifications legislatives. Methodes Des entretiens semi-diriges ont ete effectues avec 27 transplanteurs francais (nephrologues et urologues). La question des modifications legislatives a ete abordee avec 26 de ces transplanteurs. Le contenu de ces entretiens a ete soumis a une analyse de contenu et thematique telle que celle decrite par Miles et Huberman [1]. Resultats 15 des 26 transplanteurs rencontres se sont dits favorables a l’elargissement du cercle de donneurs vivants potentiels car il autorisait le don entre conjoints et permettait aux membres de la famille elargie d’etre donneur vivant. Dix transplanteurs ont exprime des reserves face a cet elargissement et un seul transplanteur s’est dit en defaveur. Douze transplanteurs se sont exprimes sur la question des comites d’experts. Sur ce nombre, cinq se sont dits favorables alors que les sept autres transplanteurs ont exprime une ambivalence face a ce comite. Discussion Cette etude a permis de mettre en lumiere les opinions de transplanteurs francais face a l’elargissement du cercle de donneurs vivants et la creation de comites d’experts tels qu’ils sont definis dans la revision de la loi de bioethique de 2004. Ces resultats pourront contribuer a la reflexion lors de la prochaine revision des lois de bioethique prevue en 2009.

Anthropological Challenges Raised by Neuroscience: Some Ethical Reflections

The Nobel Laureate Illya Prigogine compares the recent breakthroughs in human biology to the major changes that occurred when the Neolithic period succeeded the Paleolithic, 12,000 years ago. Although there is disagreement about the meaning of these changes, most opposing views recognize that a “major transformation” took place. Some interpret the recent breakthroughs in neuroscience as the first step toward “our posthuman future” whereas others see the consequences of these achievements as the end of humankind. Genomics and neuroscience are the main fields that, at this point, give rise to such a debate, some authors stating that neuroscience raises even greater anthropological and ethical challenges than does genomics. This article focuses on neuroscience. Its main object is to critically assess these diverging opinions on the impact of neuroscience and to determine whether both sides are not telling us something important about ourselves and how neuroscience could enlighten healthcare ethics. I acknowledge the help of Dr. Nancy Burbidge and Dr. Beatrice Godard in the preparation of this manuscript.

How is organ transplantation depicted in internal medicine and transplantation journals

BackgroundIn their book Spare Parts, published in 1992, Fox and Swazey criticized various aspects of organ transplantation, including the routinization of the procedure, ignorance regarding its inherent uncertainties, and the ethos of transplant professionals. Using this work as a frame of reference, we analyzed articles on organ transplantation published in internal medicine and transplantation journals between 1995 and 2008 to see whether Fox and Swazey’s critiques of organ transplantation were still relevant.MethodsUsing the PubMed database, we retrieved 1,120 articles from the top ten internal medicine journals and 4,644 articles from the two main transplantation journals (Transplantation and American Journal of Transplantation). Out of the internal medicine journal articles, we analyzed those in which organ transplantation was the main topic (349 articles). A total of 349 articles were randomly selected from the transplantation journals for content analysis.ResultsIn our sample, organ transplantation was described in positive terms and was presented as a routine treatment. Few articles addressed ethical issues, patients’ experiences and uncertainties related to organ transplantation. The internal medicine journals reported on more ethical issues than the transplantation journals. The most important ethical issues discussed were related to the justice principle: organ allocation, differential access to transplantation, and the organ shortage.ConclusionOur study provides insight into representations of organ transplantation in the transplant and general medical communities, as reflected in medical journals. The various portrayals of organ transplantation in our sample of articles suggest that Fox and Swazey’s critiques of the procedure are still relevant.

Use of personalized medicine in the selection of patients for renal transplantation: views of Quebec transplant physicians and referring nephrologists

AIM To explore the views of physicians on the use of personalized medicine tools to develop a new method for selecting potential recipients of a renal allograft. METHODS A total of 22 semidirected interviews, using clinical case studies. RESULTS According to the participants, this method has several possible applications within renal transplantation (individualizing immunosuppressive therapy, help with decision making, and possibly with the selection of patients). It could be more effective than the method presently used. The method must be validated scientifically, and must also involve clinical judgment. CONCLUSION The use of personalized medicine within transplantation must be in the best interests of the patient. An ethical reflection is necessary in order to focus on the possibility of patients being excluded, as well as on the resolution of the equity/efficacy dilemma. Empirical research has shown itself to be essential for ascertaining the views of the clinicians who will be working with the tools provided by personalized medicine.

European Analysis of the Various Procedures Existing to Interrupt a Clinical Research Protocol Thanks to a French Example of Gene Therapy

Publisher Summary A study was conducted to examine whether the decision to interrupt a protocol, deeply dependent on the benefice/risk ratio, especially in the gene therapy field of research where biologists and physicians, were directly related. This study helped to identify various criteria pointed out by the researchers. So, when an unexpected and serious event happened, about two-thirds of the population declared being in favor of the interruption of the protocol. A serious and expected event is defined by the death of a patient or a highly allergic reaction. When multiple, less serious events occur, about 53% of the population is also in favor of an interruption of a protocol, but the correlation between these incidents and the protocol has to be clearly demonstrated. The benefice/risk ratio has to be evaluated before each decision. A codification of the criteria, helping in the evaluation of the benefice/risk ratio could be developed in the future in gene therapy, whose goal is the long-term modification of a gene correcting a nonfunctional molecule. So, when a physician decides to include a person to a protocol or to interrupt a protocol, he needs to keep in mind the possible benefit that other patient could have if the protocol continues. About 90% of the population is in favor of the creation of a multidisciplinary independent European and transnational committee involved and specialized in the regulation of gene therapy. Abstract The decision to interrupt a protocol is deeply dependent on the benefice/risk ratio, especially in the gene therapy field of research where biologists and physicians are directly related. Through the 350 gene therapy researchers selected, because they have presented a research poster during the XIth annual congress of the European Society of Gene Therapy in Edinburgh (November 2003), 62 answered our online anonymous questionnaire. Some important possible axis of regulation criteria and processes were underlined. The online version of this questionnaire is still available on our website: http://sergent.jacques.free.fr . Questioned about three main research axis (criteria suggested, legitimate and proper process to regulate research and the necessity of a moratorium on somatic gene therapy), the gene therapy community has demonstrated the importance of a proper regulation. Suggesting the Jesse Gelsinger case (1999) and the Bubble kids of Necker (2002), they have also demonstrated their wish to see a regulation process involving a committee, particularly because of their transnational and multidisciplinarity qualities. The possible interactions with not only the patients but also the associations of patients were also pointed out. A regulation mediated by the national ministries was the unique process that encountered more than 50% of approval. The necessity to have a European regulation through a committee has been demonstrated. In fact, about 75% of the researchers encourage a European regulation and approve the extension of a decision taken in one European country to the European community, if this decision is scientifically demonstrated for a multi-country shared protocol. Nevertheless, only 50% of the population approve the creation of a European law, which cannot be adapted to each individual decision. The inter-activity, which exists in a committee, is the characteristic mentioned by the population, determinant in a possible European regulation. The unawareness of the actual charters and declarations with interest in gene therapy has also been shown by this study, especially by the directors of laboratories or studies.