Academic literature on the topic 'Donation and transplantation'

Previous research has established that organ procurement professionals who talk with families about donation have strong personal preferences concerning the donation of specific organs and tissues. This study examines possible reasons for such preferences and compares them with those of hospital personnel who talk with families about donation. The findings suggest that preferences among procurement personnel closely resemble those of hospital personnel, but procurement professionals' reasons reflect a slightly higher rate of self-interest. Aversions among procurement personnel differ from those of hospital personnel. Procurement personnel have fewer aversions to donating eyes and skin and more aversions to bone, and their aversions are more likely to reflect professional experience with particular donations. The findings suggest the need for changes both in the way donation options are offered to families and the way hospital and procurement personnel are educated.

Donor-recipient ABO and/or HLA incompatibility used to lead to donor decline. Development of alternative transplantation programs enabled transplantation of incompatible couples. How did that influence couple characteristics? Between 2000 and 2014, 1232 living donor transplantations have been performed. In conventional and ABO-incompatible transplantation the willing donor becomes an actual donor for the intended recipient. In kidney-exchange and domino-donation the donor donates indirectly to the intended recipient. The relationship between the donor and intended recipient was studied. There were 935 conventional and 297 alternative program transplantations. There were 66 ABO-incompatible, 68 domino-paired, 62 kidney-exchange, and 104 altruistic donor transplantations. Waiting list recipients (n=101) were excluded as they did not bring a living donor. 1131 couples remained of whom 196 participated in alternative programs.Genetically unrelateddonors (486) were primarily partners.Genetically relateddonors (645) were siblings, parents, children, and others. Compared to genetically related couples, almost three times as many genetically unrelated couples were incompatible and participated in alternative programs (P<0.001). 62% of couples were genetically related in the conventional donation program versus 32% in alternative programs (P<0.001). Patient and graft survival were not significantly different between recipient programs. Alternative donation programs increase the number of transplantations by enabling genetically unrelated donors to donate.

Aim: Although number of patients requiring organ and tissue transplantation is gradually increasing over time, number of organ donations is not sufficient to meet such requirement. This is due to gap in the knowledge regarding organ transplantation as well as individual or religious thoughts. Since some people avoid from organ donation because of their religious beliefs, religious officials play an important role in guiding such people by providing accurate information. In this study, it was aimed to determine perspectives on organ donation among religious officials. Methods: This descriptive study was conducted on 141 religious officials working in Yozgat province. A data sheet including sociodemographic characteristics such as age, gender, education level and a 20-item questionnaire about opinions on organ donation and transplantation were used for data collection. Results: Of participants, 62.4% reported that they have knowledge about organ donation; 54.6% reported that they learned from visual media; 64.5% reported that they do not know how to donate organ; and 72.3% reported that they wish to have knowledge about organ donation. Only 2.9% of participants were donors. Conclusion: Although level of knowledge was moderate in religious officials who have important role in organ donation, organ donation rate was comparable with general population. Keywords: Organ donation, organ transplantation, religious officials

Organ donation rate in India is very low when compared to many developed countries which contribute to the deaths due to organ failures every year. Kerala, one of the southern states in India with best health statistics in the country, has a deceased organ donation programme and has an organ donation rate higher than national average. However, there is a significant decline in number of donations in recent years.

Objectives: The aim of this study was to assess the knowledge, attitude and motivation toward stem cell donation among Saudi population in Riyadh, Saudi Arabia. Methods: This is a cross-sectional study that was conducted at different malls in Riyadh. Selection of malls was done randomly according to the geographical distribution of Riyadh, in which sample size was calculated and distributed equally. The participants were asked to complete a questionnaire that addressed their knowledge, attitude and motivation toward stem cell transplantation and donation. Results: Results of this study showed that population knowledge about stem cell transplantation and donation is considered to be low. Only (37.8%) has enough information about stem cell transplantation and donation. There is a positive correlation between level of education and participant’s knowledge regarding stem cell transplantation and donation. The study revealed that 39.3% of participants have willingness for stem cell donation. Conclusion: It has been found that two third of population expressed lack of knowledge about stem cell transplantation and donation. Also, only 40% of participants showed willingness for donation, and the most common reason for not donating stem cell was the lack of information about stem cell and the value of donation While, increasing level of education was associated with better understanding of stem cell donation and its role in therapy and saving lives. Therefore, suitable campaign, advertising and counseling program for population is recommended to increase level of knowledge and motivation toward stem cell donation.

Aim. To carry out monitoring of the organization and development of organ donation and transplantation in the Russian Federation according to 2014. Materials and methods. Questioning of heads of all the centers of transplantation is carried out. The comparative analysis of the obtained data in dynamics of years, between certain regions of the Russian Federation, the transplantation centers, and also with data of the international registers is made. Results. According to the Register in 2014 in the Russian Federation functioned 36 centers of kidney transplantation, 14 centers of liver transplantation and 9 centers of heart transplantation. The waiting list of kidney transplantation in 2014 included 4636 potential recipients that makes 16% of total number of the patients 29 000 receiving dialysis. The rate of donor activity in 2014 made 3.2 per million population (pmp). Efficiency of donor programs in 2014 continued to increase: the share of effective donors after brain death in 2014 increased to 77.2%, the share of multiorgan explantation made 50.5%, average number of organs received from one effective donor made 2.6. In 2014 the rate of kidney transplantation made 7.0 pmp, the rate of liver transplantation made 2.1 pmp and the rate of heart transplantation made 1.1 pmp. In the Russian Federation the number of transplantations of liver and heart continues to increase. The significant contribution to development of the organ donation and transplantation brings the Moscow region in which 11 centers of transplantation function and nearly a half from all kidney transplantations and more than 65% of all liver and heart transplantations are carried out. Conclusion. In theRussian Federation the potential for further development of the transplantology remains. In particular, at the expense of increase in the efficiency of regional donation programs, introduction of technologies, expansion of the practices of multiorgan donation and transplantations of extrarenal organs, interregional transplant coordination. Preservation of volumes of public funding for transplantological medical care and federal financing of donation programs in regions are of great importance.

Aim. To carry out monitoring of the organization and tendencies in the development of organ donation and transplantation in the Russian Federation in 2016. Materials and methods. Questioning of the heads of all the centers of transplantation is carried out. The comparative analysis of the obtained data in dynamics of the years, between certain regions of the Russian Federation and transplantation centers is done. Results. According to the register 35 centers of kidney transplantation, 22 centers of liver transplantation and 11 centers of heart transplantation were functioning in the Russian Federation in 2016. The waiting list of kidney transplantation in 2016 included 4818 potential recipients that make 14% of total number of the patients (35 000) receiving dialysis. The rate of donor activity in 2016 made 3.3 p. m. p. Efficiency of donor programs in 2016 continued to increase: the share of multiorgan retrieval made 64.1%, average number of organs received from one effective donor made 2.7. In 2016 the rate of kidney transplantation made 7.4 p. m. p., the rate of liver transplantation made 2.6 p. m. p.; the rate of heart transplantation made 1.5 p. m. p. In 2016 the number of transplantations in the Russian Federation increased by 14.8% in comparison with 2015 having overcome the level of 1700 organs transplantation. The Moscow region still remains to be the core of stability and development of the organ donation and transplantation in the country where 10 centers of transplantation function and half of all kidney transplantations and more than 70% of all liver and heart transplantations are carried out. Conclusion. The results of 2016 were positively affected by the introduction of targeted financial support of medical activity, related to organ donation, from federal budget resources. Among unresolved problems which constrain the development there are collision of legal regulation of licensing of medical activities for organ donation and transplantation, lack of the state order for the organization of transplantological medical care in each region, lack of responsibility of the heads of the regions and medical organizations for the organization of organ donation. Positive tendencies of the development of organ donation and transplantation in Russia call for further monitoring, strengthening and building.

In 1995 the Italian Institute of Health began assembling information regarding organ donors, recipients, and transplants. Data on more than 3000 transplants were collected and recorded to date. In addition to characteristics of donors and donating hospitals, this article describes donation activity and organ procurement in Italy from 1992 to 1996. Despite the encouraging results, the donation situation in Italy remains a challenge due to the nonhomogeneous distribution of organ donation throughout the country. It is hoped that an increase in the rate of organ donation and procurement in some regions will enable Italy to reach the European mean.

Although recent research has established a relationship between donation rates and the consent process for organ and tissue donation, little attention has been given to the content of the donation discussion. Recent studies suggest that families want more information to aid them in making the decision to consent. To address the family's needs, the interviewer should introduce the subject appropriately, respond fully to the family's questions, and provide the following information: the options of donating particular organs or tissues, the potential benefits of donation, the right not to donate, the effects on the funeral, the lack of cost of donation to the family, a description of the procurement procedures, and what will happen if the donated organs cannot be used for transplant.

Background: Organ donation is defined as an act of giving one or more organs, without compensation, for transplantation to another person. For many of the end stage organ diseases, organ transplantation is the most preferred treatment. The need for organ transplantation is higher than the availability. For the transplantation program to be successful awareness regarding organ donation is needed and people must have a positive attitude towards donating organs. The present study was undertaken to assess the attitude of general population towards organ donation residing in a rural community of Ernakulam District. Materials and methods: A descriptive analytical survey was conducted to assess the attitude of general population towards organ donation. A 5 point likert scale was used to assess the attitude towards organ donation. 100 subjects were selected using convenient sampling technique. The collected data was analysed by using descriptive and inferential statistics. Results: The results of the study revealed that among 100 subjects, 81% of general population were having positive attitude, 19% were having neutral attitude and none of the subjects were having negative attitude towards organ donation. Even though majority of subjects were having positive attitude towards organ donation only 34% subjects were willing for organ donation. There was a significant association between the attitude of general population towards organ donation with demographic variables like religion and history of organ transplantation among family members/ relatives/ friends at P<0.05 level of significance. Conclusion: The study revealed that majority of the participants were having positive attitude towards organ donation.

Solid organ transplantation is a rare health intervention that saves lives, improves quality of life and, where there is an alternative such as dialysis, is cost-effective. However, organ transplantation is a complex intervention that is limited by the number of organ donors, and requires life-long immunosuppression of the recipient. Infections are a common complication of organ transplantation, and a major cause of death for transplant recipients. Donor-derived infections, while rare, are of particular concern for transplant clinicians, as a potentially avoidable consequence of transplantation. Donation practice must balance the risks of infection transmission with the risks of overly restrictive donation policies that could limit this life-saving intervention. Post-transplant, clinicians must remain vigilant for new recipient infections, whether donor-derived, reactivating or arising anew. In this thesis, I generate novel data regarding aspects of infections affecting solid organ donation and transplantation where current practice can be improved, focusing in particular on blood-borne viruses and preventable post-transplant infections. Theme 1: Assessment of potential organ donors for blood-borne virus transmission risk All potential solid organ donors are rigorously screened for their suitability to donate. One reason potential donors may be declined is where there is perceived to be an increased risk of transmission of infectious diseases, including blood-borne viruses (BBV) such as hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV). Unexpected BBV transmissions have indeed led to devastating recipient outcomes. However, testing and treatment for these conditions have evolved substantially in recent years and decades. Nucleic acid testing (NAT) is now both rapidly available and highly sensitive for infection. Implementation of NAT reduces serological window periods to smaller eclipse periods. Meanwhile, HCV has become curable in the vast majority of cases, HBV can be prevented with vaccination, or effectively suppressed, and even HIV now has effective suppressive treatments. Given these developments, a reassessment of suitability of potential organ donors with BBV, or risk factors for their acquisition, is warranted. The first aim of this thesis was to understand whether transplant clinicians can correctly interpret hepatitis serology and then consistently judge potential donor transmission risk and donation suitability. This is explored in Chapter 2 through an anonymous, self-completed, cross-sectional survey distributed electronically to Australian and New Zealand clinicians involved in kidney transplantation (2014-2015). We compared respondents’ interpretation of clinical scenarios with paired donor and recipient hepatitis B and C serology to recommendations in clinical practice guidelines. We then used logistic regression modelling to investigate characteristics associated with decisions on transplant suitability in scenarios with poor (<50%) guideline concordance. The 110 survey respondents in our sample had demographic characteristics representative of the target workforce. While donor and recipient hepatitis statuses were largely well understood, transplant suitability responses varied among respondents. For an HBV surface antigen (HBsAg) positive donor and vaccinated recipient, 44% of respondents suggested the donor was unsuitable for transplant (guideline concordant) but 35% suggested the donor was suitable with prophylaxis (guideline divergent). In four scenarios with transplant suitability guideline concordance of <50%, acute transplant care involvement predicted guideline concordant responses (OR [odds ratio] 1.69, p=0.04). Guideline concordant responses were chosen less by hepatologists, intensive care doctors (OR 0.23, 0.35 respectively, p=0.01), and New Zealanders (guideline concordant responses OR 0.17, p<0.01; alternative responses OR 4.31, p<0.01). Hence, we conclude that despite broadly consistent interpretations of hepatitis serology by respondents, resulting transplant suitability decisions vary, and often diverge from guidelines. Having established variability between clinicians, this thesis next aimed to describe current practice regarding potential donors with increased risk for BBV transmission in Chapter 3. Specifically, we aimed to describe the size and characteristics of this group, whether they proceeded to donate, and reasons not donating. To do this, we conducted a cohort study of all potential organ donors referred in New South Wales, Australia between 2010 and 2018. Baseline risk potential donors were compared to potential donors with increased BBV transmission risk, due to a personal history of HIV, HCV or HBV and/or behavioural risk factors. We found 624/5749 potential donors (10.9%) perceived to have increased BBV transmission risk. This included 298/5749 (5.2%) with HCV (including HBV co-infections) and 239/5749 (4.2%) with increased risk behaviours (no known BBV). Potential donors with HCV and those with increased risk behaviours were younger and had fewer comorbidities than baseline risk potential donors (p<0.001). Many potential donors (82 with HCV, 38 with risk behaviours) were declined for donation purely due to perceived BBV transmission risk. Most were excluded prior to BBV testing. When potential donors with HCV did donate, they donated fewer organs than baseline risk donors (median 1 versus 3, p<0.01), especially kidneys (OR 0.08, p<0.001) and lungs (OR 0.11, p=0.006). In summary, many potential donors were not accepted due to perceived increased BBV transmission risk, without viral testing, and despite otherwise favourable characteristics. This suggests the potential for transplantation rates to be substantially increased if more potential donors with HCV and/or increased risk behaviours were accepted. Taken together, the findings of variable donor suitability decision-making, and the rejection of otherwise high-quality potential donors without viral testing, suggest there may have been missed opportunities to donate from some potential donors with positive serology or increased risk behaviours. Supporting clinicians to identify such previously rejected potential donors with an acceptable risk profile, and using these organs for transplantation, may have the potential to significantly increase donation rates. Theme 2: Estimating the actual risks of BBV transmission To support change in clinical practice, estimates of the risks posed by increased risk donors are helpful. Blood-borne virus rates vary internationally, and no data from the Australian context was available. We synthesised existing literature to produce Australian estimates of the actual risk posed by potential donors with increased risk behaviours for BBV only (Chapter 4). We conducted a systematic review and meta-analysis of cohorts reporting incidence and prevalence of HIV, HCV and HBV among increased risk groups in Australia. The residual risks of window period infections were estimated in the setting of negative serology and NAT. Residual risk of HIV was found to be highest among men who have sex with men at 4.8 per 10,000 persons testing negative with serology (95% CI: 2.7-6.9), and 1.5 per 10,000 persons with additional negative NAT (95% CI: 0.9-2.2). Residual risk of HCV was highest among injecting drug users (IDU) with a residual risk of 289 per 10,000 persons (95% CI: 191-385) with negative serology, and 20.9 per 10,000 persons (95% CI: 13.8-28.0) with additional negative NAT. Residual risk for HBV was highest in IDU with 98.6 window period infections per 10,000 with negative serology (95% CI: 36.4-212.7) and 49.4/10,000 with additional negative NAT (95% CI: 18.2-106.9). We concluded that the absolute risks of window period infection are low among Australian groups with increased risk but negative viral testing. These findings inform shared decision-making by clinicians and recipients and have the potential to increase organ donation rates from increased risk donors where risks are considered tolerable. To understand the magnitude of transmission risks from donors with positive hepatitis serology, we next examined a cohort of linked donors and recipients (Chapter 5). The aims of this work included describing the rates of transmission and non-transmission of BBV from donors with BBV to recipients, and identifying any previously unrecognized transmissions from donors perceived to pose a baseline transmission risk. To do this, we linked transplant registries with administrative health data for all solid organ donor-recipient pairs in New South Wales, Australia, 2000-2015. All new recipient notifications of HBV, HCV or HIV after transplant were identified. Proven/probable donor-transmissions within 12 months of transplant were classified according to a published US algorithm. Of 2,120 organ donors, there were 72 with a viral infection (9/72 active, 63/72 past). These 72 donors donated to 173 recipients, of whom 24/173 already had the same infection as their donor, and 149/173 did not and so were at risk of donor-transmission. Among those at risk: 3/149 recipients had proven/probable viral transmissions (1 HCV, 2 HBV); none were unrecognised by donation services. There were no deaths from transmissions. There were no donor-transmissions from donors without known BBV. Our findings confirm the safety of organ donation in an Australian cohort, with no unrecognised viral transmissions and most donors with viral infections not transmitting the virus. The results support targeted increases in donation from donors with viral infections. Data-linkage can enhance current biovigilance systems. The local evidence of transmission risks generated in Chapters 4 and 5 provide much-needed data to tackle the evidence and practice gap established in Chapters 2 and 3. This allows the implementation of changes in clinical donation and transplantation practice which could safely increase donation rates. Theme 3: Recipient infections after transplantation Another finding from the research in Chapter 5 was the identification of a substantial number of new BBV infections that were unrelated to donor transmission risk. Beyond the 3 identified proven/probable transmissions reported above, an additional 68 recipients had new virus notifications, of whom 2/68 died due to HBV infection. The infections in these 68 recipients may have been undetected late transmission, reactivating HBV, or de novo infections. Substantial preventative measures are available for these conditions including vaccination and avoiding risk-exposures. Stimulated by this concern about preventable non-transmitted infection, Chapter 6 of this thesis aims to understand the burden of notifiable infections post-transplant, which often have known preventive strategies. To do this, we conducted a cohort study of all solid organ recipients transplanted in New South Wales, Australia, 2000-2015. We used data-linkage to connect transplant registers to hospital admissions, notifiable diseases database, and the death register. We then calculated standardised incidence ratios (SIR) relative to general population notification rates, accounting for age, sex, and calendar year, and identified infection-related hospitalisations and deaths. Among 4,858 solid organ recipients followed for 39,183 person-years, there were 792 notifications. Influenza was the most common infection (532 cases, incidence 1358/100,000 person-years, 95%CI:1247-1478), with the highest prevalence within 3 months post-transplant. The second most common was salmonellosis (46 cases, incidence 117/100,000 person-years, 95%CI:87-156), followed by pertussis (38 cases, incidence 97/100,000 person-years, 95%CI:71-133). Influenza and invasive pneumococcal disease (IPD) in transplant recipients showed significant excess cases compared with the general population (influenza SIR 8.5, 95%CI:7.8-9.2, IPD SIR 9.8, 95%CI:6.9-13.9), with high hospitalisation rates (47% influenza cases, 68% IPD cases) and some mortality (four influenza and one IPD deaths). By 10 years post-transplant, cumulative incidence of any vaccine-preventable disease was similar for most transplanted organs at 12%, except for lung recipients, where it was nearly 30%. Gastrointestinal diseases, tuberculosis and legionellosis had excess cases among transplant recipients, although there were few sexually transmitted infections and vector-borne diseases. Improved vaccination programs, health education, and pre-transplant donor and recipient screening have the potential to reduce preventable infections among transplant recipients. Conclusion: This thesis explores some ways in which infectious diseases impact organ donation and transplantation, and identifies areas where clinical practice could be improved. Transplant clinicians need more support to interpret hepatitis transmission risk as they have variable interpretations of suitability. Many potential donors have increased risks for BBV transmission, with otherwise favourable characteristics, and did not donate. Actual transmission risks from both Australian donors with BBV and potential donors with increased risk behaviours are, in absolute terms, low. A reconsideration of risk profiles for potential donors with increased BBV transmission risk could materially increase organ donation rates in Australia. In addition, organ transplant recipients have significant post-transplant infections, including both BBV and other notifiable infections such as vaccine-preventable and gastrointestinal infections. Important infections post-transplant could be prevented by improved vaccination uptake and optimised strategies, donor and recipient screening for latent infection, and donor recipient education.

On December 3rd, 1967, Dr Christian Barnard performed the world's first human heart transplant. This medical milestone propelled the technique of organ transplantation into the public arena, and simultaneously created a need for human organs that has never been met. The disparity between the numbers of organs needed for transplantation and the numbers of organ donated has generated substantial research. Most of this research has focused on individual characteristics and behaviours in an attempt to understand the individual's decision to donate. In contrast, the research in this thesis emanates from the position that we must first investigate how organ donation and transplantation is socially understood. The theory of social representations (Moscovici, 1984) proclaims an interdependence between the individual and the social, and their inseparability in the construction of social knowledge. Conceptualised thus, organ donation and transplantation moves from being understood in terms of an individual decision to a socially derived way of understanding a medical practice. Thus, the focus of the research presented in this thesis is a holistic conceptualisation of organ donation and transplantation as socially constructed knowledge. Three studies were conducted, each addressing this issue from a different methodological perspective. The first study, which was exploratory in nature, investigated whether there was a representation pertaining to organ donation and organ transplantation, and traced the development of the representation through the printed media. Drawing from research into the structural properties of a representation (Abric, 1993, 1996), and the notions of themata, anchoring and objectification (Moscovici, 1984, 1993), the findings from this study set the direction and design of the two studies that followed. The main finding from this study was the suggestion that what was initially considered to be two representations was better understood as one representational field organised around conflicting images of organ donation and transplantation as a Gift of Life and the Mechanistic removal and replacement of body parts. The findings, however, from the first study suggested a stasis to the representational field that did not accommodate the dynamism implied. Thus, the second study extended the findings of the first study and investigated the representational field through discourse from focus group discussions. The theoretical position here conceptualised consensus as consensual reality (Rose et al., 1995), and investigated the suggestion that the core of the representation is hierarchically arranged into normative and functional dimensions (Guimelli, 1998). The findings from this second study evidenced the contradictory nature of discourse around the issue of organ donation and transplantation. These were discussed in light of Billig' s (1988) rhetorical position of the role of argumentation in social thinking. The co-existence of contradiction was suggested through the differential elicitation of the normative and functional dimensions of the core (Guimelli, 1998). The final study extended the findings of both earlier studies through a delineation of the core and peripheral elements within the representational field so as to specifically investigate the dynamic co-existence of contradiction within the one representational field. The study employed a mail-out questionnaire embedded with 8 experimental conditions. This manipulated two tasks, scenario and rating scale and word association, in order to investigate the elicitation of the representation in accordance with context. This study developed the notion of themata (Markova, 2000), the role of contradiction in a representation (Wagner et al., 2000), reflexive and non-reflexive thought, and an understanding of consensus as consensual reality (Rose et al., 1995). The major conclusion of the thesis is that an investigation of the issue of organ donation and transplantation within the theoretical framework of social representations theory (Moscovici, 1984) reveals a contradictory representational field organised around the dialectical notions of Life and Death, emanating as two, seemingly contradictory, images of organ donation and transplantation as a Gift of Life and the Mechanistic removal and replacement of body parts. Moreover, the co-existence of this contradictory representational field is maintained through the differential elicitation of the normative and functional dimension of the representation in accordance with social context. An integration of the findings within the theoretical tenets of social representations theory is given, addressing the interdependence between the representational process and what is being represented. The practical implications of these findings as they relate to the societal issue of organ donation and transplantation are also discussed.

Since the 1950’s procuring organs for cadaveric transplantation has been based around a “gift of life” discourse, institutionalised through the carrying of donor cards/driving licence or registration on the NHS Organ Donor Register. Yet regardless of whether and how the deceased recorded their wishes to donate, their next-of-kin are always whether organs can be removed. Little is known about the reasons families give for refusing or agreeing to an organ donation request. In order to identify the circumstances in which an organ donation request is more likely to be accepted or refused by the family of a brain stem dead individual, semi-structured interviews were carried out in various areas of Scotland in order to ascertain donor and non-donor relatives’ beliefs, attitudes and experiences. The findings suggest that wider cultural beliefs embedded in society about the value of gifting, death and the body are brought to the specific context of an organ donation request. It is the interactions between these values and other factors, such as familial and hospital support and dynamics and the perceived value of the outcome from donation affects whether families will donate or not. The findings of such an investigation will have obvious policy implications for those interested in increasing the present UK organ procurement rate and can also inform debates about the merits of introducing alternative systems. However, a study of organ donation and transplantation can also provide the sociologist with a unique insight into several engaging areas of sociological interest: modern gift practices (including altruism and social exchange theory), the way meanings are constructed onto dead bodies by different groups, of how and when death is defined, and finally, can lead insight into an intricate relationship about how individuals’ view the relationship between personal, social and corporeal identity.

This thesis examines the position of children who donate regenerative tissue to potentially save the life of another. The great good that can come about through their participation is at the cost of the donor child undergoing physically invasive and unnecessary medical procedures. The non-therapeutic element of a child’s involvement brings about legal and ethical issues that are the subject of this thesis. The central aim of this thesis is to determine if Australian child donors are treated appropriately and are sufficiently protected in acting as tissue donors, and whether a new regulatory response is needed for their benefit. The research engages with the ethical literature and legal analysis, and complements these theoretical perspectives with a qualitative analysis of interviews with medical professionals who are experienced in dealing with child donors. This research demonstrates that domestic regulation – in the form of law and professional guidelines – has had little influence on how donor children are treated in clinical practice. Until recently, the practical safeguards offered to protect donor children from physical and psychological harm also varied between hospitals and were often limited in nature. However, there has been a recent trend towards improved, standardised care for Australian donor children due, primarily, to a desire to conform to international accreditation standards. Two conclusions are reached: first, donor children have, to date, not been sufficiently protected – either theoretically in law or practically through consistent national treatment; and, second, existing domestic regulation has failed to effectively regulate this area. I recommend implementing a new domestic regulatory response to benefit Australian donor children. There is a need to provide donor children with more attention, to listen to them more and for them to be consistently treated around the country. To achieve this, engagement with the medical profession is essential.

Organ transplantation, as an extremely demanding, but impоrtant medical intervention, has always provided significant scope for opposing different legal and ethical principles. That scope is being expanded by considering the possibility that a sensitive category of persons, such as minors, may appear in the role of donor. While transplantation of organs from living minors is prohibited for the above reasons, cadaveric transplantation of organs from deceased children is legal in the law of the Republic of Serbia. This paper analyzes precisely such legally regulated organ donation, which implies the possibility of the appearance of a deceased minor as a donor. While, on the one hand, there is a growing need to take organs from children in order to transplant them and preserve the life of another child of appropriate age, such a decision has a significant emotional impact, above all, on the parents of the child. Keeping in mind that parents appear as the only authorized holders of the right to decide on the transplantation of an organ of a deceased minor, it is necessary to analyze the legal nature of the rights they have on the body and organs of the child. Also, it is necessary to point out the importance of more precise legal regulation of the conditions under which such transplantation can be performed, as well as the necessity of ensuring the autonomy of the will of the minor in terms of organ donation, which he could achieve for life.

Organ transplantation, as an extremely demanding, but impоrtant medical intervention, has always provided significant scope for opposing different legal and ethical principles. That scope is being expanded by considering the possibility that a sensitive category of persons, such as minors, may appear in the role of donor. While transplantation of organs from living minors is prohibited for the above reasons, cadaveric transplantation of organs from deceased children is legal in the law of the Republic of Serbia. This paper analyzes precisely such legally regulated organ donation, which implies the possibility of the appearance of a deceased minor as a donor. While, on the one hand, there is a growing need to take organs from children in order to transplant them and preserve the life of another child of appropriate age, such a decision has a significant emotional impact, above all, on the parents of the child. Keeping in mind that parents appear as the only authorized holders of the right to decide on the transplantation of an organ of a deceased minor, it is necessary to analyze the legal nature of the rights they have on the body and organs of the child. Also, it is necessary to point out the importance of more precise legal regulation of the conditions under which such transplantation can be performed, as well as the necessity of ensuring the autonomy of the will of the minor in terms of organ donation, which he could achieve for life.

Blood, bone marrow and organ donation is a major issue that concerns all of us. Even though 18 is the age of eligibility to become a donor, awareness should be raised earlier through education. To this end, and given that this issue is marred by prejudice and misconceptions, we developed an educational pack, aimed at senior high school students, which may be delivered in the context of a biology or sociology course. The proposed teaching intervention follows a three-fold approach: (1) First, students are educated on monoclonal antibodies and relevant biotechnology tools and their role in organ transplantation via a board game, (2) Second, we promote empathy using a free writing exercise that employs art prompts and audiovisual material, (3) Third, we assign students with research projects that involve building questionnaires, collecting and analyzing data and producing a science poster to be posted on the school website. Importantly, the aim of this proposed intervention is to educate and to raise awareness while students build on their research, technology and writing skills.