Denial Of Consent Research Articles

Vanessa Springora et le fossoyage des mythes de la séduction « à la française »

Le Consentement by Vanessa Springora took the French literary world by storm in 2020. In the wake of the #metoo movement, the memoir’s impact has much to do with its ability to uncover the concealing power the persona of the seductive, “civilized,” French man; relatedly, it demystifies a notion of romantic and sexual consent that is problematic in its association of female amorous and sexual desire with the guilt and violence of a destructive and romantic passion. This essay first proposes to historically and culturally situate the twofold deconstruction that Springora achieves within a genealogy, not of love, but of the “French” occultation of violence and sexual abuse. It offers historical distance by putting Le Consentement in dialogue with the cultural context of the First World War, which the essay frames as a rupture that marked a significant change in gender relations in modern France and produced longstanding myths shaped in response to traumatic sexual violence. Second, the article focuses on how Vanessa Springora deconstructs gender domination as conveyed by fairy tales and literature to show that the denial of consent is not romantic.

Coloniality and/as Development in Kashmir: Econonationalism

This article identifies the colonial imperative of ‘we must develop them, with or without their consent’, which is used by the Indian state in order to dominate Kashmiri Muslims, and argues that this notion of development combines patriarchal silencing of the subjugated as well as a gendered fantasy of liberating oppressed Kashmiri women and minorities. While the colonial nature of Indian rule over Kashmir has been a long-term phenomenon, the focus in this article will primarily be on a specific political transformation imposed by the Indian state since August 2019, when even the pretence of autonomy and recognition was given up, and all phenomena constituting coloniality became conspicuous and acute. Adopting a feminist lens, I highlight nine features of contemporary Indian coloniality in Kashmir: denial of consent, paternalism, violence, enforced silencing, lack of accountability, arbitrariness, divide and rule, humiliation and a specious idea of development. I further argue that such a notion of coloniality as development is better understood as ‘econonationalism’ (akin to homonationalism and femonationalism), where the supposed liberatory ideas are rhetorically deployed to mask a dehumanising subjugation.

‘Pass it on’ - New Organ Donation Law in England May 2020

Editorial Commentary
 From 2020, a new legislation comes into force in the UK providing legal status to the concept of presumed consent, extending this from Wales. In essence, consent for organ donation will be assumed unless the donor had actively opted-out. For Black Asian and minority ethnic communities, there is a widening gap between the availability of donors and those that are waiting on transplant lists. A particular stumbling block seems to be the denial of consent by next-of-kin, which appears to be disproportionately high. Exploration of the reasons behind such withholding of consent appears to be lack of information, myths, a lack of cultural sensitivity more than any religious decree [1-2]. Hence, this article will explore in-depth the current scenario, the causes behind these disproportionate representation and leadership that community leaders need to take to improve the access to this life-saving treatment option.
 1 Chakravorty, I. (2020). The Gift of Life: Social & Cultural Perspectives on Organ Donation. SUSHRUTA Journal of Health Policy & Opinions, 13(1), 10-12. https://doi.org/10.38192/13.1.2
 2 Krishnan, N., & Modi, K. (2020). Organ Donation Law & Its Impact on BAME Communities. SUSHRUTA Journal of Health Policy & Opinions, 13(1), 13-15. https://doi.org/10.38192/13.1.4

Substance Abuse among Male Youth Students: A Cross-Sectional Study in Chiraigaon Block of District Varanasi

India lies on the cusp of a demographic transition. It is essential to all-round development of the youths of India. Recent times have witnessed an increase in substance use among younger population. In India forty percent of men use tobacco in some form and One-fifth of young men aged 15–24 consume alcohol. It is estimated that 7.6 million people worldwide died of substance abuse related causes. To find out the association of socio-demographic variables on the problem of substance abuse among male youth students a cross-sectional school based study was conducted from March 2013 to July 2015. By multistage random sampling 570 male youth students aged 15 to 24 years belonged to class 9th to graduates of all the schools and colleges of Chiraigaon Community Development Block was selected. Out of them 27 and 3 students were excluded from study due to unreliability of information and denial of consent. Finally 540 students were interviewed and thus obtained data was entered and analyzed by SPSS. Substance users were more in 20–24 yrs of age group belonging to general caste and having higher level of education. In upper class substance users was less as compared to non-users. Likelihood of Substance use was high among those whose fathers were skilled worker (35.7%) or doing some business (18.8%) and having extremes of education.

Donor Conversion and Procurement Failure: The Fate of Our Potential Organ Donors

Donor availability remains the primary limiting factor for organ transplantation today. The purpose of this study was to examine the causes of procurement failure amongst potential organ donors. After Institutional Review Board approval, all surgical intensive care unit (SICU) patients admitted to the LAC+USC Medical Center from 01/2006 to 12/2008 who became potential organ donors were identified. Demographics, clinical data, and procurement data were abstracted. In non-donors, the causes of procurement failure were documented. During the 3-year study period, a total of 254 patients were evaluated for organ donation. Mean age was 44.8±18.7 years; 191 (75.2%) were male, 136 (53.5%) were Hispanic, and 148 (58.3%) were trauma patients. Of the 254 patients, 116 (45.7%) were not eligible for donation: 34 had multi-system organ failure, 24 did not progress to brain death and had support withdrawn, 18 had uncontrolled sepsis, 15 had malignancy, 6 had human immunodeficiency virus or hepatitis B or C, and 19 patients had other contraindications to organ donation. Of the remaining 138 eligible patients, 83 (60.2%) did not donate: 56 because the family denied consent, 9 by their own choice. In six, next of kin could not be located, five died because of hemodynamic instability before organ procurement was possible, four had organs that could not be placed, and three had their organs declined by the organ procurement organization. The overall consent rate was 57.5% (n=67). From the 55 donors, 255 organs were procured (yield 4.6 organs/donor). Of all patients screened for organ donation, only a fifth actually donated. Denial of consent was the major potentially preventable cause of procurement failure, whereas hemodynamic instability accounted for only a small percentage of donor losses. With such low conversion rates, the preventable causes of procurement failure warrant further study.

A Colloquium on the Congress “A Gift for Life. Considerations on Organ Donation”

Alessandro Nanni Costa, J. M. Simon i Castellvi, Antonio G. Spagnolo, Nunziata Comoretto, Jean Laffitte, Hakan Gabel, Francis L. Delmonico, Ferdinand Muehlbacher, Walter Schaupp, Alexandra K. Glazier, Valter D. Garcia, Mario Abbud-Filho, Jose O. Medina-Pestana, Mariangela Gritta Grainer, Pier Paolo Donadio, Anna Guermani, Riccardo Bosco, Francesco Giordano, Blanca Martinez Lopez de Arroyabe, Marco Brunetti, Marti Manyalich, Gloria Paez, Ricardo Valero, Rafael Matesanz, Elisabeth Coll, Beatriz Dominguez-Gil, Beatriz Mahillo, Eduardo Martin Escobar, Gregorio Garrido, and Felix Cantarovich

Excessive fluid accumulation during stem cell mobilization: a novel prognostic factor of first-year survival after stem cell transplantation in AL amyloidosis patients

AbstractHigh-dose melphalan followed by stem cell transplantation (HDM-SCT) has become the treatment of choice for patients with immunoglobulin light chain amyloidosis (AL). Unfortunately, treatment mortality can be excessive in certain subpopulations. We have noted that patients who gained more than 2% body weight during mobilization had a poorer outcome following HDM-SCT. Excluding 2 patients for lack of weight record and denial of consent, 126 patients between July 1997 and June 2003 were retrospectively studied. Weight increased more than 2.0% during mobilization in 51.6% of the patients. Patients who accumulated more than 2.0% tended to have more proteinuria, more organs involved, lower serum albumin, more diuretic use, and dosage adjustment during mobilization. First-year mortality was significantly higher in those with more than 2% weight gain (33.9% versus 9.8%, P = .002). Multivariate analysis showed weight gain, glomerular filtration rate, and septal thickness to be independent predictors of first-year mortality. The increase in mortality was noted even after the excess weight was diuresed prior to conditioning. The impact on mortality dissipated after the first year. Weight gain during mobilization appears to be a new marker of adverse outcome following HDM-SCT. Better prognostication may improve the treatment mortality rate of these patients.

Cadaveric organ donation: encouraging the study of motivation.

Approximately 6,000 patients per year, or 16 per day, with end-stage organ failure die because of the lack of available organs. Each year only 35% to 50% of potential donors consent to donation (1). During the last 20 years, vigorous educational campaigns, both voluntary and legislative, designed to increase organ donation have failed to increase donation rates significantly. The need for organs has grown nearly five times faster than the number of cadaveric donors: the annually compounded rate (1990–2000) of increase in number of patients on waiting lists has averaged 14.1% a year, whereas the rate of increase of donors has averaged 2.9% a year (2). The American Medical Association (AMA) has been concerned about this problem for many years and has developed several policies addressing it in the past decade (3). AMA policy has supported certain forms of financial incentives for cadaveric organ donation since 1993 (Policy E-2.15, AMA Policy Database), but they have never been implemented because federal law prohibits them. AMA policy specifically prohibits payment to living donors (4). Most initiatives to increase organ donation have focused on what motivates or hinders the decision to donate. Programs to improve organ donation rates have been aimed at public and professional groups. These have included widespread educational campaigns aimed at motivating individuals to become donors. They also have included mandated choice legislation, the establishment of the Organ Procurement and Transplantation Network (OPTN), donor card programs, donor registries, and the creation of specialized organ donation teams within hospitals that discuss organ donation with families and patients. Despite these efforts, cadaveric donation rates have remained nearly stable during the past decade. This report encourages the medical and scientific communities to reexamine the motivation for cadaveric organ donation. Building on the work of the Council on Ethical and Judicial Affairs (CEJA) in 1993, which led to Opinion E-2.15, “Financial Incentives for Organ Donation,” this report identifies reasons why ethical objections to financial incentives, for cadaveric organ donation only, should be reexamined. In particular, this report considers the need to study the impact of financial incentives through limited research trials. Such studies would help measure the effect of incentives not only on donation rates but also on public perception of the transplant enterprise and of the meaning of organ donation. For the purposes of this report, donation and procurement of organs are considered completely independent from the allocation of organs. The report neither suggests nor supports any change in the current system of organ distribution, as developed and administered by the United Network for Organ Sharing (UNOS). Even if financial incentives were found to have a positive impact on cadaveric organ donation rates, allocation algorithms developed by the OPTN would continue to govern organ distribution and transplant recipients would continue to be selected according to ethically appropriate criteria related to medical need rather than ability to pay. Physicians have an obligation to hold their patients’ interests paramount and to support access for all patients to medical care (Principles VIII and IX) (5). To discharge these obligations, physicians should participate in efforts to increase organ donation, including education of their patients and the general public regarding the importance of organ donation and promotion of voluntary donation of organs. Beyond educational programs, however, physicians should support innovative approaches to encourage organ donation. Such efforts include encouragement and, if appropriate, participation in the conduct of ethically designed research studies of donor motivation. A potential impetus for cadaveric organ donation that has not been adequately explored (because of federal prohibition) is financial incentives. Such incentives are not intrinsically unethical; AMA policy has supported them since 1993. Whether a particular incentive is ethical or not depends upon the balance of benefits and harms that result, and these are currently unknown because they have never been investigated.

Investigations on the cornea donation at the Martin-Luther-University Halle-Wittenberg

We analysed the number of the potential cornea donors of the Martin-Luther-University, Halle-Wittenberg over a four-years period, 1995 to 1998 in relationships to the number of the actual donors. We retrospectively reviewed the data of 2545 patients who died at the hospitals of the Martin-Luther-University, Halle-Wittenberg over a four-years period, from January 1995 to December 1998. The medical records of the patients were inspected and contraindications for cornea donation examined. The patients who were younger than 12 months were omitted in our analysis. The patients with at least one contraindication were excluded as potential cornea donors. Additionally we registered the actual cornea donors of the hospitals of the Martin-Luther-University, Halle-Wittenberg between 1995 to 1998. The mean age of the died patients was 60 years. Because of contraindications 597 patients (23.5 %) were excluded from the cornea donation. An acute sepsis with 25.1 % as well as leukemias and lymphomas with 24.8 % matched about half of the exclusion criteria. In the period of investigation we counted 1948 potential cornea donors. In the hospitals of the Martin-Luther-University, Halle-Wittenberg only 57 (2.9 % of potential donors) actual cornea donors have been registered. The possible leading causes for the large discrepancy between the number of the potential and actual donors are: (1) the imperfect identification of potential donors, (2) the donor family have not been asked and (3) the denial of consent by the potential donors family.

Nonprocurement of transplantable organs in a tertiary care hospital: a focus on sociological causes.

The purpose of this study was to investigate prospectively the medical and organizational causes of nonprocurement of transplantable organs and to provide explicit information on the determining factors of family response to donation request. Medical causes investigated were age, human immunodeficiency virus, human T-cell lymphoma virus and hepatitis C virus status, documented malignancy, and chronic cardiac or renal failure. Organizational aspects investigated were cause and place of death and number of referrals. Sociological aspects were investigated by semidirective interviews with the families of the deceased. A total of 105 brain-dead patients and 42 families were included. Of the 105 patients, 9 were not eligible for donation because of medical reasons; cardiac arrest occurred before organ procurement in 6 cases. Denial of consent from the coroner occurred in 7 cases. Consent was requested from the families in 82 cases, obtained in 53 cases, and denied in 29 cases. Consent to donation was associated with openness of the process, information about brain death and transplantation, previously stated will of the deceased, favorable attitude of the deceased toward the medical profession, and a generally altruistic attitude of the deceased. Denial of donation was associated with poor understanding of brain death and fear of being deprived of the deceased body. Practical implications of this study include encouraging people to state their attitudes toward organ donation and improving the level of information available to the general public on the meaning of brain death and on the medical aspects of organ transplantation.

Organ Procurement in Patients with Fatal Head Injuries The Fate of the Potential Donor

A 46-month, retrospective review of all victims of fatal head injury at a level 1 trauma center was undertaken to estimate donor organ availability, determine causes of procurement failure, and analyze the functional results of organs transplanted from this group of donors. Causes of procurement failure in 126 patients who died principally from their head injuries included failure of initial resuscitation (14%), ineligibility (28%), failure of physiologic support (14%), and denial of consent (20%). Of 73 eligible donors, 29 (41%) were able to donate one or more vascular organs (heart, liver, kidney). In only one instance was an eligible donor not appropriately identified as such. Failure of physiologic support to prevent early death (25%), and denial of consent (34%) were found to be the two major, potentially remediable causes of procurement failure in this series. Based on this data, an estimated 29 patients/million population/year will survive initially and meet all eligibility requirements for organ donation. Data on 47 kidneys transplanted from the donor group demonstrated a 77% overall graft survival rate at a follow-up period averaging 23 months. Prolonged donor hypotension, but not the use of high-dose vasopressors, adversely affected allograft survival. The current limitations of organ procurement in victims of fatal head injury stem from a limited ability to maintain cardiopulmonary function long enough for the procurement process to be completed and a high overall rate (46%) of denial of consent for organ harvest by next of kin.