Hard Truth Research Articles

(73) - The Hard Truth: Outcomes of Adolescent Recipients Following Lung Transplantation

(73) - The Hard Truth: Outcomes of Adolescent Recipients Following Lung Transplantation

Leo Philip Kadanoff

Leo Philip Kadanoff

Editor’s Choice: The hard truth about soft skills

Medical specialties, as their name suggests, require specialised skills and knowledge. But they also require learning a lot of skills that are common across different areas of medicine. BMJ Careers has previously reported on the research showing that, despite the growing recognition of the …

Bangladesh—A Model of Neoliberalism: The Case of Microfinance and NGOs

In 2006, a few months after the Nobel Peace Prize for Muhammad Yunus and Grameen Bank was announced, I was visiting Germany [where many] Germans…looked at it as a victory over neoliberalism. One German activist theatre group invited me to the show of their latest drama, Taslima and the Microcredit. The show was eye opening for me: I realized to what extent Grameen Bank had been misunderstood in the West, and how media campaigns and public relations activities, including embedded studies, created a myth around the Grameen Bank and Yunus.… The theatre organizers requested me to join a discussion following the show. Standing before a mesmerized audience, I had to tell them the hard truth with facts and figures. I said that, despite their best wishes, they were making a terrible mistake. Grameen had never been an alternative to the World Bank-pushed neoliberal economic model; rather, it was born and brought up as a necessary supplement to it.Click here to purchase a PDF version of this article at the Monthly Review website.

‘Between Window and Frame’: Distant Intimacy and Emotional Dialectics in Elia Kazan’s A Tree Grows in Brooklyn

This essay analyzes Elia Kazan’s A Tree Grows in Brooklyn (1945), an adaptation of Betty Smith’s bestselling novel of the same title (published two years earlier). The central visual elements in this film are thresholds or openings, such as windows, doorways, and stairways, which together comprise a liminal space whose crossings serve as the literal inscriptions of Kazan’s dialectical project. These are sites of indeterminacy, where personal transitions and economic transactions take place. Significantly, the film’s most intense moments of emotional harmony and discord occur in front of (or through) these in-between thresholds, where softness gives way to hardness (and vice versa). The alternating pattern of harmony, contrasted with interpersonal conflict, constitutes what the authors call the ‘emotional dialectics’ of the film. Transitions from dreamy contentment to harsh realization or an awareness of the hard truth of a situation occur rapidly in these liminal spaces. Building on the work of theorists such as André Bazin, Jean Mitry, and Dudley Andrew, the essay concludes that A Tree Grow in Brooklyn not only targets the relational chasms to be crossed by its main characters but also builds a bridge between the producers of the past (including director Kazan) and viewers of the present, contemporary audiences who are asked to peer through a cinematic ‘window’ and partake in a view of the warmth and intimacy to be found in an immigrant family’s life.

Deception and the death of Ilyusha: truth and the best interest of a dying child in The Brothers Karamazov.

For centuries, many physicians and parents assumed that it was ethically justifiable to lie to a dying child. The reasoning was clear. Because the lie would likely eliminate or prevent a concrete harm (the child's fear), and the lie is about a harm that is unavoidable anyway, a lie appeared to be the morally desirable thing to do. Today, the ethical consensus has shifted. Many doctors and other health professionals now argue that we have an obligation to tell children the cold, hard truth. In this article, I argue that "the cold, hard truth" (assuming we can know it with certainty) might not always be in the best interest of the patient. To illustrate the point, I analyze an episode in Dostoevsky's novel, The Brothers Karamazov, in which a child is dying, his father lies to him about it, and 2 doctors take very different approaches to the truth. Each of these individuals has a particular interest when it comes to the question of "the truth" about the death of Ilyusha. I use this story to ask whether it is ethically permissible to lie to a dying child and, if so, who has the moral authority to tell that lie.

Living hell: the dark side of the Civil War

Many Americans, argues Michael C. C. Adams, tend to think of the Civil War as more glorious, less awful, than the reality. Millions of tourists flock to battlefields each year as vacation destinations, their perceptions of the war often shaped by reenactors who work hard for verisimilitude but who cannot ultimately simulate mutilation, madness, chronic disease, advanced physical decay. In Living Hell, tries a different tack, clustering the voices of myriad actual participants on the firing line or in the hospital ward to create a virtual historical reenactment. Perhaps because the United States has not seen conventional war on its own soil since 1865, the collective memory of its horror has faded, so that we have sanitized and romanticized even the experience of the Civil War. Neither film nor reenactment can fully capture the hard truth of the four-year conflict. Living Hell presents a stark portrait of the human costs of the Civil War and gives readers a more accurate appreciation of its profound and lasting consequences. examines the sharp contrast between the expectations of recruits versus the realities of communal living, the enormous problems of dirt and exposure, poor diet, malnutrition, and disease. He describes the slaughter produced by close-order combat, the difficulties of cleaning up the battlefields-where tens of thousands of dead and wounded often lay in an area of only a few square miles-and the resulting psychological damage survivors experienced. Drawing extensively on letters and memoirs of individual soldiers, assembles vivid accounts of the distress Confederate and Union soldiers faced daily: sickness, exhaustion, hunger, devastating injuries, and makeshift hospitals where saws were often the medical instrument of choice. Inverting Robert E. Lee's famous line about war, suggests that too many Americans become fond of war out of ignorance of its terrors. Providing a powerful counterpoint to Civil War glorification, Living Hell echoes William Tecumseh Sherman's comment that war is cruelty and cannot be refined. Praise for Our Masters the Rebels: A Speculation on Union Military Failure in the East, 1861-1865. This excellent and provocative work concludes with a chapter suggesting how the image of Southern military superiority endured in spite of defeat. (Civil War History). Adams' imaginative connections between culture and combat provide a forceful reminder that Civil War military history belongs not in an encapsulated realm, with its own categories and arcane language, but at the center of the study of the intellectual, social, and psychological currents that prevailed in the mid-nineteenth century. (Journal of American History). Praise for The Best War Ever: America and World War II: Adams has a real gift for efficiently explaining complex historical problems. (Reviews in American History). Not only is this mythologizing bad history, says Adams, it is dangerous as well. Surrounding the war with an aura of nostalgia both fosters the delusion that war can cure our social ills and makes us strong again, and weakens confidence in our ability to act effectively in our own time. (Journal of Military History).

At the Helm, Kirk or Spock? Why Even Wholly Rational Actors May Favor and Respond to Charismatic Leaders

Charisma is seen as a generally positive attribute for a leader to possess, yet many studies give it a “mixed report card”: finding it can have little or no effect, or worse a negative effect. This paper develops a model to explain why. The key insight is that presenting the cold hard truth is often incompatible with simultaneously firing up followers—a tradeoff exists between information and inspiration. In particular, a temptation exists to hide bad news behind upbeat rhetoric. Rational followers understand such appeals conceal bad news. But as long as any followers are swayed by such appeals—respond to the leader’s charisma—rational followers’ pessimism is tempered, and more so the more charismatic the leader. Hence, a more charismatic leader can generate better responses from all followers with an emotional appeal than can a less charismatic leader. This is a benefit to charisma. But this power has a dark side: a highly charismatic leader is tempted to substitute charm for action—she is less likely to learn relevant information and, on certain margins, works less hard herself—all to her followers’ detriment.

The Merman's Prayer and Other Stories by Syed Manzoorul Islam

reviews a nineteen-year-old Muslim man fall in love during a summer holiday in Lebanon. The latter’s father has no objection to the girl, provided she embraces Islam upon marriage, but points out other, financial, difficulties . However, horrified at the prospect of her daughter’s conversion and her husband’s anger, the girl’s mother insists that the relationship end. Interspersed with the episodes of this sad tale are the “what if?” reminiscences of a middle-class American woman who remembers a close, black, male friend of her college days, an inexplicably broken relationship between a white American man and a Senegalese woman, and the admonitions of her mother (“You can have friends, but keep your distances! Keep your distances!”), words echoed by her allegedly tolerant husband when his son wants a black friend to stay over. “Distances” poignantly embodies insights into the infinite value and precarious fragility of relationships in a harsh world. The reader, or at least this reader , wishes the stories in the last two sections were less “dreamlike” and more “rooted in time and space,” to quote the approving assertions of the back-cover blurb. Generally speaking , the further along in the book the story is, the less successful it is. Unconvincing and overwritten, works like “The Fisherman,” “Noor El Qamar,” and “Tell Me, Mayra” strain the reader’s patience. Finally, Interlink has not taken sufficient care with this collection. “[S]he had to improvise daily to maintain Simone and Charles occupied” is not English, “she could no longer bare the thought” is a solecism, and there are eccentricities of capitalization and punctuation throughout. M. D. Allen University of Wisconsin, Fox Valley Syed Manzoorul Islam. The Merman’s Prayer and Other Stories. Translated by the author. Dhaka, Bangladesh. Daily Star Books. 2013. isbn 9789849027171 The first thing that strikes the reader who encounters the stories in this collection is the narrator’s role: how he talks to readers and plays with their expectations, dropping frequent hints in the process that this is a story he is a part of, or has received in a dream, or heard from a friend, or witnessed in his community. The narrator rarely pretends to be omniscient ; he is often confused and can’t seem to locate his place in the narration . He is familiar with all the major players in a story. Irony and humor are inseparable traits of his stories, as in “The Two Assassins.” Yet his narration has conspicuous resemblance with Bengali oral narratives wherein fairies and winged horses are as real as anything else in the material world. The narrator’s intention is all too clear: he is not offering reality as it is— he’s offering a world that defies reality or, to be more exact, manipulates it, to re-create fresh new possibilities and new realities for his characters. His characters come from all walks of life, from workers to abused women to those belonging to the middle class. Only their actions and reactions surprise us. They are victims of real life but refuse to give in to societal pressures. Sultana, the female protagonist in “Parapar Hotel,” had been forced into prostitution by a certain police officer and was privy to many secret crimes committed by the city’s political big guns. They feel threatened by her and want the police officer to get rid of her. Sultana, however , senses this well before and turns the table on the officer in such a way that he and his cohorts end up getting wasted instead. Magic plays a vital role in the narrative. In “Living Dead,” the soul of a young man is released from his body while he’s been in a coma to find out how he is missed, but what he experiences is hard truth: everyone has just forgotten him, and even his mother eventually forsakes him. 60 worldliteraturetoday.org Simon Fruelund Milk and Other Stories K. E. Semmel, tr. SFWP Milk and Other Stories is a compilation of fourteen short stories that follow the lives of fourteen ordinary individuals. These stories depict mundane moments that lead to moments of profound emotion. Instead of inflating ordinary moments, Fruelund makes the ordinary...

The hard truth about human trafficking

The hard truth about human trafficking

The hard truth about human trafficking

In Brief Human trafficking is an appalling, yet often unspoken about, tragedy that affects more than 14,500 people annually. Read this article to learn about how to recognize a potential victim and, hopefully, save his or her life.

Mark Twain, Nietzsche, and Terrible Truths That Can Set Us Free

Mark Twain, Nietzsche, and Terrible Truths That Can Set Us Free

The Power of Small When the Small Is Really Big

HR Discussion - Success is usually achieved by doing small things consistently. Think big! Have you heard this motivational advice before? It sounds nice, it seems to make sense. However, when you really think about it, the small is usually bigger than the big. One day, I was reading a very interesting article by Laura Vanderkam, titled “How to Change Your Life Before Breakfast.” Her insight was an eye opener. She claims you really can change your life by making the best use of the couple of hours before breakfast. She believes early mornings are the secret key to building habits that will make us happier, more productive, and successful—exercising, doing spiritual practices, reading, writing, for instance. Laura’s insight led me to think of the power of the small: Success is usually achieved by doing small things–consistently. It’s not always easy to get out of a comfortable bed to hit the gym. We are always encouraged to think big and have big dreams. Indeed, it’s important. However, a person often gets stuck when it comes to getting started. Having a big goal can paralyze you. When it looks big, it’s difficult to know when, where, or how to start. The hard truth is that if you don’t start, you’ll never get where you want to go. When you have a big goal, don’t just think about how you’re going to achieve it. Focus on doing one small action that gets you started. It could be any action in any direction. It doesn’t really matter. The most important thing is to get the ball rolling and start building momentum.

Vehicle-based studies of driving in the real world: The hard truth?

Real-world studies of driving behaviour and safety have face validity and have the distinct advantage of focussing on driving in its natural habitat. But their very naturalism can lead to problems with confounds and with noise in the data. This paper reviews the three major categories of on-road studies — controlled observation, field operational tests and naturalistic driving studies — and discusses the major applications of each study type. It also assesses some of the methodological issues that arise in one or more category of study.

The Journal and Originality

When you click on the journal’s content or open up the hard cover of Neurocritical Care, you expect to see something new or even something provocative. And yet there are less earth shaking issues. That is the hard truth, and it applies to all journals—great and small. Every editor would like to see the most original work by the most original study group, and only the journals with the highest impact factor can count on it. To publish an important first observation that may go on to become a landmark in the literature of neurocritical care is a lofty goal, but something we could work toward. Although the architect, Ludwig Mies van der Rohe, famously said ‘‘It is better to be good than to be original’’, in our continuously growing specialty, we have to be both. Skeptics will point out that all concepts have been articulated before. Just go back far enough, and you will find it. They would say just look at renewed interest in the spreading depression already proposed by Leao in 1944— How about penicillin neurotoxicity now more often seen as cefepime neurotoxicity. I need not remind this readership that before we diagnosed cerebral salt wasting, we had SIADH and even before that—guess what—cerebral salt wasting. Can we still be original? We should forcefully reject the ‘‘everything has been done before’’ argument. I continue to be pleasantly surprised by the highly interesting submissions over the years. In our field, advancement could come with a new original description, but this may also include an important rarity that has immediate consequences for management. There is no shortage of careful clinical descriptions of difficult patients, a new treatment, the first review of a major topic, and a never seen before neuroimage. We continue to publish papers that may seem a niche interest to some, but to others, their life’s work. Therefore, authors submitting material to the journal have noticed that although their papers are important observations, the work has been rejected because it lacks novelty. I have been rejecting papers that are not advancing our knowledge, are much of the same, and certainly studies that do nothing but confirming the obvious. Also, over the years, manuscripts have been rejected without external review. I have taken the liberty to reject papers that fail to meet our increasing higher standards, and papers that are clearly serving the interest of the industry. I have, to the best of my knowledge, not rejected a well-executed manuscript but reconsidered if I was wrong or too quick on the draw. In truth, the originality of a paper remains our most important measure. Editors would want to avoid significant time spent on very weak manuscripts. Does this include case reports—the bane of journals? Case reports are rarely cited and may reduce impact factor if other worthwhile papers—that could be cited—are not published. Imagine a case that leads to a new concept or insight. We do not want to miss that. So how could we define ‘‘originality’’ in a manuscript? Does it all have to be pristinely novel? What is synonymous with originality? One could say it should contain an innovative thought, a probing study into a new area, a rarely photographed or video-recorded clinical sign and even more closer to the bedside a validated new tool. Unoriginal does not need a definition, and we all recognize shopworn and uninspiring material. E. F. M. Wijdicks (&) Division of Critical Care Neurology, Mayo Clinic, Rochester, USA e-mail: wijde@mayo.edu

The Lance Armstrong Saga

For cycling enthusiasts and LIVESTRONG supporters, October 2012 will forever be imprinted in our memories as the month of damning revelations and the demise of a hero. Literally millions of people worldwide believed in Lance Armstrong. For more than a decade, he inspired us with his phenomenal comeback and unrivaled good works in the fight against cancer. Sadly, he duped us. On January 17, after three more months of denial and increased seclusion, Armstrong came clean with Oprah Winfrey as a vast audience watched. The Armstrong question now has been answered. For the sake of his children, he finally admitted to using performance-enhancing drugs and is now seeking amends. Like no other story about drugs in sport, this one should rally us to action. It is no longer about Armstrong; it is about the charade of drugfree sport with all its nuances and complexities. We can only imagine the immense pressures in professional and world class sport. We understand why top athletes have networks of coaches and advisors to support training and maximize competitive effort. Their livelihood and prominence depend on it. Fans, the media, and corporate sponsors want to see splendid athletes competing at the highest level, so every potential aid is explored. Science and technology have spawned performanceenhancing advances, each with its own controversy. For example, cyclists benefit from improved bicycle materials and design, swimmers from bodysuits, and endurance athletes from altitude tents. All manner of dietary strategies and mental training techniques are used to gain an advantage. We see how doping could be viewed as just another tool. The World Anti-Doping Agency updates its extensive list of prohibited substances and methods annually. Notable on the list are anabolic steroids, erythropoietin, growth hormone, stimulants, narcotics, and blood doping. Banned drugs either impart an unfair advantage or are used to mask those that do. Many also pose significant health risks. National and international sports federations follow this antidoping code or a slight variation of it. Recent reports confirm doping is widespread in professional cycling, and most ‘‘dirty’’ cyclists are never caught. Doping is entrenched in other sports too; baseball, football, track and field, and weight lifting are obvious ones. Insiders are savvy and know how to beat the system. They live with the deception, while the public believe doping is limited and controlled by drug testing. Athletics like politics has its cover-ups, detections, and apologies. Following the United States Anti-Doping Agency report in October, many hoped Armstrong would see the light, admit his misdeeds, and show remorse. With his admission in January, he has an oddly unique opportunity to make a real difference, again. He could be a powerful force in dismantling the charade surrounding drugs in sport. Time will tell what role he takes. From youth leagues and pick-up games to national tournaments and the Olympics, we love sports. They are an outlet for our innate drive to play and compete, and cherished entertainment for young and old. Many pleasant memories are related to sport. We have all played a sport, ran a race, or competed on a team. Indeed, many learned about hard work, cooperation, and fair play through a sport. At the top levels though, the power of money reigns and ideals take a backseat. Questionable short cuts and secret strategies become necessary for getting ahead. Or so it seems. If doping in sport is to be eliminated, professionals need to stand up and admit the scope of the problem. Let us not shield the public from the hard truth. We all have been complacent. Fans overlook misdeeds and shady dealings as long as no one gets caught or is hurt. Then when a scandal breaks, we are outraged V for a few weeks. Like the Romans who filled the Coliseum 2,000 years ago, spectators still revel in the display of fierce competition but are not concerned with the details of preparation. Sport is a joy and a dilemma. It can be simple and pure but also complicated and corrupt. Armstrong’s saga is a stark reminder that doping in sport is insidious. Despite decades of well-intentioned and serious efforts, the current antidoping system is falling short. The recent stripping of Address for correspondence: Phillip B. Sparling, EdD, FACSM, Georgia Institute of Technology, School of Applied Physiology, Atlanta, GA 30332; E-mail: phil.sparling@gatech.edu.

“Clean Hands”: Post-Political Form in Richard Powers’s Gain

Richard Powers's 1998 novel Gain is composed of two main narratives: nearly two-hundred year history of Clare, Inc., a fictional American corporation, and story of final few months in life of Laura Bodey, a Lacewood, Illinois woman stricken with ovarian cancer, probably due to exposure from local Clare chemical plant. Interspersed between two narratives are bits of free-floating text depicting Clare packaging, advertisements, brochures, scripts for TV commercials, press releases, and other public relations media. One of novel's most obvious formal peculiarities is fact two main storylines never truly intersect: executives at Clare are never aware of Laura as an individual, and Laura is never able to confront executives personally, nor discover exact cause of her illness. In an interview, Powers comments: book implicitly promises that all open frames will come together. challenge of a book that's created out of two incommensurable frames is to show how they entangle without contriving a say, in form of a lawsuit. Gain suggests that any lawsuit resolution would be a red herring. A lawsuit is not to give Laura any redress. No lawsuit is to change of existence or recast between personal and (Last) Actually, novel does feature a lawsuit--a class-action suit filed in name of those sickened by Clare chemicals, including Laura Bodey--but, just as Powers suggests, this lawsuit never culminates in a dramatic between defendants and plaintiffs, in or outside courtroom. Instead, corporation settles, suddenly and inexplicably, and Laura can only surmise that the common stock has fallen to unacceptable levels ... an offer is more cost-effective solution (333). anti-climatic quality of this resolution underscores what a courtroom might obscure--that no lawsuit is going to give Laura any redress. The lack of any kind of dramatic between Laura and Clare suggests, moreover, that no such could resolve novels central conflict. That is, this omission signals that novel is not ultimately concerned with conflict between an individual consumer and individual corporation, but with, as Powers puts it, the of existence, broader dialogue between personal and corporate. Powers's comments suggest, furthermore, that deferring a dramatic serves not only a rhetorical function, directing attention to larger social processes on display, but also a mimetic one, representing a hard truth about these rules of existence: in era of multinational corporations, relationship between powerful and powerless is increasingly mediated and complex, making confrontation more and more unlikely. By counterposing act of representing complex processes against traditional ... contriving [of] confrontation, Powers evokes long-running debates about relationship between social and aesthetic form. To gain a critical perspective on his aesthetic strategies, it's worth briefly recalling Georg Lukacs's intervention in these debates. While Lukacs acknowledges that global economy is (already, in 1932) too complex and decentralized to depict in terms of character relationships, he argues that representing this sum of facts about global economy is not same as representing social totality (Reportage 74).Totality, in Lukacs's account, is dialectical unity of social form and content, the inextricable coalescence of accident and necessity (58). Capturing it means capturing the relationship of characters to objects and events, a dynamic interaction in which characters act and suffer (Narrate 112)--the turbulent, active interaction of men (126). In Gain, I argue, this antagonism is missing. …

Problems and Prospects of Investigative Journalism in Rivers State, Nigeria: A Study of the Tide and Hard Truth Newspapers.

The practice of investigative journalism in Nigerian is facing several challenges which pose great threat to the benefits that accrue from this vital aspect of the journalism profession. Hence, this paper examines the problems and prospects of investigative journalism in Rivers State, Nigeria using the survey research method. A total of 56Journalists (43 from The Tide and13 from The Hard Truth newspapers) were sampled. The findings indicated that investigative journalism is practised in Nigeria but its level of practice is abysmally low due to myriads of problems bedevilling the practice. However, there are greater prospects of its practice with the signing of the Freedom of Information (FOI) Bill into law in 2011. Hence, the paper recommends a proactive approach to investigative journalism while harnessing the opportunities as envisaged in the FOI Act. Key words : Investigative Journalism, Newspaper, Social Responsibility, Public Interest.

Shadows (review)

Reviewed by: Shadows Karen Coats Bick, Ilsa J. Shadows. Egmont, 2012. [528p]. (The Ashes Trilogy) Trade ed. ISBN 978-1-60684-176-1 $17.99 E-book ed. ISBN 978-1-60684-378-9 $17.99 Reviewed from galleys R Gr. 9-12. In this sequel to the nail-biting horror of Ashes (BCCB 10/11), Alex must face the hard truth that the supposedly good people of Rule, a small enclave of those who survived the electromagnetic pulse that killed much of the world's population, are actually feeding the Changed (teenagers who have been transformed into mute cannibals by the same pulse). Elsewhere, Tom has recovered in the wilderness and searches for Alex as he tries to avoid the bounty hunters looking for the Spared; Peter is not so lucky, and ends up in the hands of Finn, whose sadistic experiments [End Page 7] might have some utility if he weren't bat-guano crazy. Meanwhile, Chris and Lena have also escaped Rule, but their path through Changed territory is threaded with danger. Bick amps up both the gore and the suspense in an already hair-raising, edgy thriller series, and her prose style has grown even richer, offering imagery that is disturbingly vivid and horrifically, perversely beautiful at times. She also deepens and complicates the motivational base by introducing a fraught history of intergenerational conflict and corruption as well as the possibility that main characters, including Alex and Lena, are still vulnerable to having their status change from Spared to Changed. Readers should be warned to clear their calendars before they pick this up, because they won't be doing much of anything else until they turn the last, cliff-hanging page. Copyright © 2012 The Board of Trustees of the University of Illinois

Perils of the information highway: We need better road maps

How did we ever get through the day without turning to Google for answers to ordinary life questions or complex medical puzzles? We assume ourselves to be smart enough to weed out the irrelevant information, advertisements, and blogs and make the best choices. In this issue of Liver Transplantation, Melloul et al.1 look at the quality of living donor information available on the Internet, and they demonstrate some serious deficiencies. The authors evaluated 32 Web sites with the Ensuring Quality Information for Patients tool (a 36-item checklist), and they report that the median number of topics addressed by the Web sites was only 16, with morbidity and mortality being addressed by only 22% and 41% of the Web sites, respectively. What do you do if your loved one needs a liver transplant? He or she is finally on the list, has endured numerous tests, and has accepted the fact that indeed there is no survival without a new organ, and then the final hard truth comes: from where will this liver come? There are more than 17,000 people on the waiting list in the United States, every 11 minutes a new name is added, and 20% of the patients die on the list each year because they become too sick to receive an organ. Deceased organ donation has decreased across the nation, and the situation is particularly severe in states such as New York, in which there were 423 donors in 2009 but only 379 donors in 2010 (a decrease of 10.4%).2 Families of loved ones hear these staggering facts during the evaluation process. They are aware that longer wait times (especially for patients with blood type O or A) translate into greater illness burden, suffering, and hardship for all. Then, there is hope: living donation is offered as a life boat, as an option to earlier organ access. For many donors, the decision to donate is emotionally based and spontaneous and occurs during the early months of the recipient evaluation. Potential donors decide to help because of love and desperation and in an attempt to avoid the caregiver burden. They quickly scan the family members and dynamics and self-select the fittest member (eg, a person who is single and psychologically/physically strong with good coping skills and no children). After the initial and often impulsive decision to donate, they then turn to the Internet for answers. In the privacy of their homes, without pressure from family members, friends, or potential recipients, they search for answers, facts, risks, and benefits. It would be ideal if their first hit on the Internet were a Web site compliant with international standards for quality-of-donor information, that is, a Web site that is not institutionally based, has clear statistics for donors and recipients, and addresses complications, postdonation quality-of-life issues, normal recoveries, and risks of long-standing health issues. This Web site would not take away from the information received during the extensive donor evaluation at each institution. It would allow for better learning, repetition, and processing of information. No real learning occurs during the donor evaluation because the donor is highly anxious and is concerned only about being accepted and being told that his or her liver, health, and psychological and physical well-being are perfect. Donors appear to express understanding and are able to repeat risks and benefits superficially. However, most donors are concerned about where they should sign the consent form and when the surgery can be performed. The consent forms are never fully read but are quickly scanned, and all donors think that complications can happen, but not to them. Once a donor has been accepted by an institution, the pressure is off, and the donor can then go back to the Web site as often as he or she desires to process information before, during, and after donation. Ideally, this Web site would use both written and visual tools to convey information (eg, videos, computer animation, and interactive learning). It would include the testimonials of donors with complications and donors without complications. The site would include links to other Web sites with information on recipient illnesses and the risks of transplantation because the psychological well-being of the donor is very much connected to the recipient's outcome. The better the donor understands the risk to the recipient, the better the donor will be prepared for complications in the recipient or graft failure. I commend Melloul et al.1 for showing us the pitfalls of current Web sites, and I look forward to improved road maps. The challenge for the transplant community is determining how to collaborate and maintain and manage Web sites as learning tools.