Postmortem Organ Research Articles

A novel combinatory treatment against a CDDP-resistant non-small cell lung cancer based on a Ruthenium(II)-cyclopentadienyl compound

The therapeutic approach to many solid tumors, including non-small cell lung cancer (NSCLC), is mainly based on the use of platinum-containing anticancer agents and is often characterized by acquired or intrinsic resistance to the drug. Therefore, the search for safer and more effective drugs is still an open challenge.Two organometallic ruthenium(II)-cyclopentadienyl compounds [Ru(η5-C5H4CHO)(Me2bipy)(PPh3)]+ (RT150) and [Ru(η5-C5H4CH2OH)(Me2bipy)(PPh3)][CF3SO3] (RT151) were tested against a panel of cisplatin-resistant NSCLC cell lines and xenografts. They were more effective than cisplatin in inducing oxidative stress and DNA damage, affecting the cell cycle and causing apoptosis. Importantly, they were found to be inhibitors of drug efflux transporters. Due to this property, the compounds significantly increased the retention and cytotoxicity of cisplatin within NSCLC cells. Notably, they did not display high toxicity in vitro against non-transformed cells (red blood cells, fibroblasts, bronchial epithelial cells, cardiomyocytes, and endothelial cells). Both compounds induced vasorelaxation and reduced endothelial cell migration, suggesting potential anti-angiogenic properties. RT151 confirmed its efficacy against NSCLC xenografts resistant to cisplatin. Either alone or combined with low doses of cisplatin, RT151 showed a good biodistribution profile in the liver, kidney, spleen, lung, and tumor. Hematochemical analysis and post-mortem organ pathology confirmed the safety of the compound in vivo, also when combined with cisplatin.To sum up, we have confirmed the effectiveness of a novel class of drugs against cisplatin-resistant NSCLC. Additionally, the compounds have a good biocompatibility and safety profile.

Effects of portraying an innocent versus non-innocent identified victim on intentions to donate organs post-mortem.

The need for more people to register as organ donors is a pressing concern. This preregistered experiment examined whether portraying a patient in need of an organ transplant as leading a healthy lifestyle (an "innocent victim") can serve to increase people's intentions to register as post-mortem organ donors. Participants not previously registered as organ donors (N = 348) were randomly assigned to an innocent identified victim, non-innocent identified victim, or statistical victims condition. The identified victim was a 42 year-old woman in need of a liver transplant. The experimental manipulation produced marginally significant effects on self-reported intentions to register as an organ donor. Moreover, participants in the innocent victim condition were more likely relative to those in the non-innocent victim condition to sign up on an e-mail list to receive additional information about organ donation.

Conhecimento ético e deontológico dos estudantes de medicina sobre a doação de órgãos e tecidos no Brasil

Organ donation and transplantation have been taking place in Brazil for decades, acting as an effective alternative for individuals who do not benefit from conventional treatments. This requires a regulatory framework that allows for organ removal while respecting bioethical and legal standards. This study aims to assess the knowledge of future health professionals regarding the ethical and deontological issues involved in organ and tissue donation. This descriptive and qualitative study was carried out with medical students from the first to the fifth year at a university in the west of the state of Paraná, Brazil, with a sample of 131 participants. The results showed 84.7% of students had never attended classes on the subject during their undergraduate years. Despite this lack of formal education, 53.4% correctly identified the concept of brain death. Additionally, 94.7% expressed willingness to donate their organs and 31% believed certain groups should be excluded from the transplant list. The findings suggest a gap in university curricula regarding the subject, yet students are actively seeking alternative ways to gain knowledge. Moreover, there was a high acceptance rate among students for post-mortem organ donation. Opinions diverged significantly on ethical and individual issues such as the exclusion of people from the transplant list.

Das Angehörigengespräch im Rahmen der postmortalen Organspende aus der Sicht von Ärzt:innen und Pflegenden: Ergebnisse einer qualitativen Interviewstudie aus Österreich

ZusammenfassungDie enge Widerspruchslösung in Österreich erlaubt eine postmortale Organspende bei fehlendem Widerspruch zu Lebzeiten, da von einer mutmaßlichen Zustimmung ausgegangen wird. Liegt kein Eintrag im Widerspruchsregister vor, wird die Familie zum mutmaßlichen Willen der verstorbenen Person befragt.Um die praktische Umsetzung der Widerspruchslösung in Österreich zu beschreiben, sollen relevante Aspekte der Angehörigengespräche und die Rolle der Familie im Entscheidungsprozess zur postmortalen Organspende identifiziert werden.Es wurden insgesamt zehn leitfadengestützte Expert:inneninterviews mit Ärzt:innen und Pflegepersonen an einer österreichischen Krankenanstalt durchgeführt, die mithilfe der qualitativen Inhaltsanalyse nach Mayring unter Anwendung von MAXQDA ausgewertet wurden.Herausforderungen beim Ermitteln des mutmaßlichen Patient:innenwillens im Angehörigengespräch können aufgrund von unterschiedlichen Kulturen/Religionen, Uneinigkeit und Entscheidungsunfähigkeit in der Familie aufgrund von Trauer und der Schwierigkeit der Angehörigen, das Hirntodkonzept zu begreifen, entstehen. Daher ist eine gute Vorbereitung, ausreichend Zeit, interdisziplinäre Zusammenarbeit, das Schaffen von Vertrauen und professionelle Gesprächsführung sowie das Eingehen auf Fragen und Bedürfnisse von Angehörigen durch Ärzt:innen und Pflegepersonen in einem geeigneten Setting notwendig. Die Kommunikation mit Angehörigen bezüglich einer postmortalen Organspende ist sowohl für das Gesundheitspersonal als auch die Familie belastend.Anhand der Ergebnisse wird die Anwendung des Kommunikationsleitfadens der Gesundheit Österreich mit Erweiterung um die Information zur Gesetzeslage sowie regelmäßige Kommunikationsschulungen des Gesundheitspersonals empfohlen. Zudem wird eine flächendeckende Information der Bevölkerung zur Förderung der intrafamiliären Diskussion gefordert.

Brain death diagnostics: use of ancillary tests

AbstractWith the determination of the definitive, irreversible loss of the overall function of the cerebrum, cerebellum and brain stem (irreversible loss of brain function, IHA, "brain death"), the death of the human being is determined from a scientific-medical point of view. The determination of IHA, with cardiovascular function being maintained by intensive care, requires special diagnostics ("brain death diagnostics"). This is carried out in the intensive care unit either to assess the medical prognosis, or as a prerequisite for post-mortem organ donation. In Germany, in accordance with the Transplantation Act, the procedural rules for determining IHA are laid down in corresponding guidelines of the German Medical Association (RL-BÄK), the 5th update of which has been in force since September 2022. Here, the indications, the requirements and the technical procedures of ancillary tests (electroencephalography, early auditory and somatosensory evoked potentials, Doppler and duplex sonography, computed tomography angiography, radionuclide perfusion scintigraphy, digital subtraction angiography) according to the German guidelines are outlined.

Forty-eight-year follow-up of a female worker exposed to highly enriched uranium via chronic and acute inhalation.

The United States Transuranium and Uranium Registries (USTUR) is a unique resource of data and materials for studying biokinetics of uranium in the human body. In this study, bioassay data and post-mortem organ activities from a female whole-body USTUR donor who was exposed to highly enriched uranium were analyzed using the IMBA Professional Plus® software to derive the best estimate of the total intake. The resulting radiation doses delivered to this individual's whole body and major target organs were calculated from estimated intake based on case-specific dose coefficients derived using the AIDE® software. Both intake and dose calculations were carried out using the biokinetic and dosimetric models recommended by the International Commission on Radiological Protection (ICRP) in its Occupational Intakes of Radionuclides publication series. Different exposure scenarios including chronic and acute inhalation intakes were tested. A combination of a chronic inhalation intake and two acute inhalation intakes appears to best describe the bioassay data. To fit this female individual's autopsy data, the transfer rate from the liver to the blood was increased by a factor of 8 and the transfer rate from the kidneys to the blood was decreased by a factor of 2.2. This resulted in the best fit to all data (p=0.519). The total intake was estimated to be 44.1kBq, and the committed effective dose was 211mSv with 96.8% contributed by 234U. 96.6% of the committed effective dose was contributed by the lungs. The remaining 3.4% of the committed effective dose was contributed by all systemic tissues and organs with the highest contribution (0.40%) from the red bone marrow. It is concluded that the current ICRP models, with the adjustment for smoking status, adequately describe uranium biokinetics for this individual except retention in the liver and kidneys. However, this study was based on a single case and may not be sufficient to identify any apparent sex-specific differences in uranium biokinetics.

Willingness toward post-mortem body donation to science at a Mexican university: an exploratory survey

BackgroundVoluntary post-mortem donation to science (PDS) is the most appropriate source for body dissection in medical education and training, and highly useful for biomedical research. In Mexico, unclaimed bodies are no longer a legal source, but PDS is legally possible, although scarcely facilitated, and mostly ignored by the general population. Therefore, we aimed to evaluate the attitude and willingness for PDS and to identify a sociodemographic profile of people with willingness toward PDS.MethodsA validated on-line survey was distributed by the convenience method via the social networks of a Catholicism-inspired, private university in northern Mexico. Frequency analyses of all variables and coded free comments were complemented with association studies.ResultsAlthough the responder cohort (n = 143) was too small and biased to be representative of the university community (n = 13,500), willingness to post-mortem organ donation was 90.7% and to PDS 70.7%. In this cohort, PDS willingness had the strongest association with mature age (> 40 years old; P, 0.0008). Among young adults, willingness to PDS was the lowest among volunteers from technical and business schools and the highest among those from the social sciences (P, 0.009). Respondents from the social sciences were also the most consistent between attitude and behavior with respect to organ donation. A free comment option revealed respondents were interested in the unusual taboo topic.ConclusionsA small, but sufficiently large proportion expressed willingness toward PDS. In our university cohort, which was biased in higher education and altruism, mature age and social interest were associated with PDS willingness.

Causes of Post-Mortem Carcass and Organ Condemnations and Economic Loss Assessment in a Cattle Slaughterhouse.

The study was undertaken to investigate the main causes of carcass and organ condemnations, as well as to estimate the financial losses suffered by a cattle slaughterhouse. In this regard, an active abattoir survey, based on standard post-mortem inspection procedures for meat, was conducted on 151,741 cattle, from January 2021 to December 2022. Overall, 13.27% (n = 20,125) of the carcasses expressed lesions or pathological conditions and, out of them, 1.15% (n = 1738) were totally confiscated, while another 12.12% (n = 18,387) were partially admitted for human consumption. In the case of organs, the general inspection data reveal that 12.28% (n = 18,630), 7.56% (n = 11,477), 1.89% (n = 2862), and 0.27% (n = 412) of the examined liver, lung, heart, and kidney specimens presented one or more types of abnormalities. In addition, regarding the types of specific pathological findings, dystrophies/anomalies (69.8%), circulatory disorders (40.6%), fecal contamination (60.9%), and suspected bacterial/viral infections showed a dominant occurrence in the liver, lung, heart, and kidneys, respectively. Consequently, the total direct financial losses resulting from edible part condemnation over the two years was estimated at EUR 4,021,717.3, which represents 1.17% of the total achievable net revenue without carcass and organ condemnation. Of this, EUR 3,661,400.4 (1.07%) and EUR 360,316.9 (8.73%) was related to carcass and organ condemnation, respectively. The study results demonstrate that the post-mortem inspection of meat at the slaughterhouse level plays a crucial role in identifying pathological lesions, in addition to some other issues, such as fecal contamination or non-compliant laboratory results, relevant to both public health and economic factors.

Successful liver transplantation from a donor with occlusive portal vein thrombosis

Introduction. The shortage of donor organs has been and remains the basic problem of clinical transplantation and the expansion of the organ pool by using marginal donor organs has become one of its solutions. In this regard, every decision to use a "non-standard" or "non ideal" organ for transplantation should be made carefully.Aim. Demonstration of successful liver transplantation from a donor with brain death and occlusive thrombosis of the splanchnic venous system.Description. A 34-year-old donor without serious concomitant pathology was diagnosed with total portal thrombosis during liver procurement. After cold aortic perfusion, a thrombectomy from the portal vein was performed. At the “backtable” stage, an additional perfusion was made through the portal vein, the results of which confirmed the patency of the portal system. The liver graft was transplanted to a 33-year-old recipient; the postoperative period was uneventful, the patient was discharged on the 17-th postoperative day.Conclusions. Portal vein thrombosis in a donor liver is rare. A positive decision on liver transplantation from a donor with portal vein thrombosis should be based on the confirmed patency of the portal system. It is desirable that these data be supplemented by a histological examination of the donor liver. The donor organs shortage needs to expand the criteria for post-mortem organ donation. However, every decision should be made in the light of individual characteristics of the donor-recipient pair.

Turkish Validity and Reliability Study of the Postmortem Organ Donation Attitude Scale

Bu araştırmanın amacı bireylerin Ölüm Sonrasına Yönelik Organ Bağışı Tutum Ölçeği’ni Türkçeye uyarlamak, geçerlilik ve güvenirliğini gerçekleştirmektir. Yöntem olarak ölüm sonrası organ bağışı tutumunu belirlemek için Andrei (2012)'nın geliştirmiş olduğu ölçekten yararlanılmıştır. Ölçeğin uygulanmasının ardından açıklayıcı ve doğrulayıcı faktör analizi, yakınsak ve ıraksak geçerlilik analizleri ile güvenirlik analizi yapılmıştır. Çalışmanın örneklemini çalışmaya katılmayı kabul eden sağlık bilimleri alanında öğrenim gören 450 öğrenci oluşturmaktadır. Ölçeğin Kaiser-Meyer-Olkin değeri 0,898’dir. Açıklayıcı faktör analizi soncuna göre orijinal ölçekteki gibi dört alt boyutlu bir yapı bulunmuş ve toplam açıklanan varyans değeri %70,83 olarak tespit edilmiştir. Ölçeğin uyum iyiliği indeks değerleri iyi ve kabul edilebilir düzeydedir. Ölçek faktörlerinde yakınsak geçerlilikleri (CR>AVE; AVE>50) ve ıraksak geçerlilikleri (MSV70 olup MaxR(H)>CR olduğu gözlenmiştir. Sonuç olarak, ‘Ölüm Sonrasına Yönelik Organ Bağışı Tutum Ölçeği’nin dört faktörlü Türkçe formu kullanılabilecek uygun bir ölçektir.

Making a dead woman pregnant? A critique of the thought experiment of Anna Smajdor

In a thought-provoking article – or how she herself named it, ‘a thought experiment’ – the philosopher-medical ethicist Anna Smajdor analyzed in this journal the idea of whole-body gestational donation (WBGD) in brain-dead female patients, as an alternative means of gestation for prospective women who cannot or prefer not to become pregnant themselves. We have serious legal, economical, medical and ethical concerns about this proposal. First, consent for eight months of ICU treatment can never be assumed to be derived from consent for post-mortem organ donation; these two are of an incomparable and entirely different medical and ethical order. Moreover, the brain-dead woman is very likely to be medically unfit for high-tech surrogacy and the brain-dead state poses a high risk for deficient embryo/fetal development. Second, from a scarcity perspective, occupying an ICU bed for eight months appears to be unjust. The costs for eight months of ICU treatment are far too high compared to the costs of surrogacy for a living, selected, and healthy woman. Neither insurance companies nor prospective parents will want to pay these exceptionally high costs for a dead woman if a living surrogate mother can be hired for a considerably lower amount. Third, there is an increased risk for harm of the child to be in WBGD. And finally, WBGD risks violating the brain-dead woman’s dignity and harming the interests of her loved ones. In short, there is simply no need for brain-dead women as surrogates.

Life beyond life: Perceptions of post-mortem organ donation and consent to donate-A focus group study in Italy.

Many factors such as personal and cultural beliefs, misinformation, fear of death and inadequate will registering procedures can influence post-mortem organ donation. The present study aimed to explore the perceptions, beliefs and information around post-mortem donation and will expression in different groups of the Italian population, to orient future interventions and raise awareness. Qualitative research with focus groups. A total of 38 focus groups involving 353 participants including the general population (young adults: 18-39, mature adults: 40-70), local and hospital health professionals, critical area health professionals (emergency room and intensive care), registry office employees and opinion leaders, were conducted in six regions from different parts of Italy between June and November 2021. Thematic analysis was conducted with the use of Atlas.ti9. Five overarching themes were identified: dilemmas regarding donation, resistance to donation, facilitators of donation, difficulties in terms of will expression and proposals to encourage will expression. Possible facilitators were having personal and professional experiences with organ donation, feeling useful for society, having reliable information and trust in the health care system. Potential barriers to donation were doubts and fears about brain death, bodily integrity concerns, religious beliefs, misinformation and distrust in the health care system. These results highlighted the significance of a bottom-up perspective with regard to identifying the personal perceptions and beliefs with regard to donation, underlining the urgency of creating tailored interventions to sensitize different groups of the population in terms of promoting an informed choice and a culture of donation.

The ethical significance of consent to postmortem organ retrieval.

Supporters of opt-in organ procurement policies typically claim that the absence of consent to postmortem transplantable organ retrieval is a normative barrier to such retrieval. On this ground, justification of opt-out policies is demanded. The paper shows that postmortem organ retrieval is normatively different from live organ removal, and so the doctrine of informed consent does not apply to it in the way it does in other types of cases. First, seen as the instrument of protection of autonomy or the right to self-determination, informed consent cannot be relied on in the case of dead persons; secondly, viewed as an instrument of annulment of harm or wrong to the dead (volenti non fit injuria), informed consent relies on indefensible accounts of posthumous harm or wrong. Postmortem organ retrieval in cases of absence of the decedent's consent and refusal is governed by other norms than those related to consent. Such norms include, among others, respectful treatment of human remains (such as those found in regulations of medicine, law enforcement, and research) and avoidance of inherently wrong contexts and purposes (such as killing for the purpose of organ retrieval or trade in the human body or its parts). It is concluded that the onus probandi is on the supporters of opt-in, rather than opt-out, policies of posthumous organ retrieval.

Anästhesiologisches Management von postmortalen Organspendern

The transplantation of organs from postmortem organ donors has been a lifesaving and quality-of-life-improving therapy for patients with irreversible organ failure for many years. In Germany, however, there has been an imbalance between the number of organs donated postmortem and the number of patients on the waiting list for years. The anesthesiological management of multiple organ harvesting (MOE) in postmortem organ donors is not an everyday challenge for various reasons: A lack of practical expertise due to the small number of MOE, even at university hospitals (usually <20 per year), complex pathophysiological changes in the cardiovascular system and other organ functions of the postmortem organ donor and the lack of guidelines complicate anesthesiological management. This paper compiles the existing literature and reviews whether evidence-based recommendations can be derived for anesthesiologic management for MOE.

In jars: The integration of historical anatomical and pathological potted specimens in undergraduate education

IntroductionAcross the UK, many anatomy departments possess historical potted wet cadaveric specimen collections, such as organs preserved in fluid-filled jars. Although considered obsolete by some for anatomical education, there is immense potential for their utilisation in teaching, particularly in institutes that have limited access to cadavers or have had body donation rates impacted by the Covid-19 pandemic. Another benefit of historical potted cadaveric specimens is that severe pathology, often not seen today, can be observed by the student. Material and methodsThe aim of this study was to understand students’ opinions and attitudes towards the use of historical anatomical and pathological potted wet specimen collections in undergraduate science teaching. Following their integration into the anatomy program of a Clinical Sciences degree, seventy-seven undergraduate students completed a five-point Likert questionnaire on their perspective for the integration of the historical potted specimens in anatomical education. This study was approved by the Research Ethics committee at the University of Bradford ResultsThe study demonstrated that 90 % of students found the collection useful in teaching, 92 % would like to see the collection used more in teaching, and 76 % of students found that the collection encouraged them to consider medical ethics and the donor. ConclusionsIn conclusion, the survey findings suggest that further utilisation of historical potted wet specimen collections would be useful in the teaching of anatomy and that these collections could potentially encourage conversations on post-mortem bodily integrity, ethics, and organ donation.

Organspende nach irreversiblem Hirnfunktionsausfall

The prerequisites for post-mortem organ donation in Germany include the determination of irreversible loss of brain function, consent to organ donation, and the exclusion of medical contraindications. In addition, mainly because of the shortage of donor organs in Germany and the sometimes controversial social and media discussions on the topic of organ donation, all physicians involved in the donation process must be familiar with the relevant laws, guidelines, and procedural instructions. This applies especially to those who are to carry out the verification of irreversible brain death. Only then, can they act safely in this challenging situation and serve as competent consultants for all involved.

Biographical lives and organ conscription.

According to 2021 data, the United States' opt-in system of posthumous organ donation results in seventeen Americans dying each day waiting for vital organs, while many good undonated organs go to the grave with the corpse. One of the most aggressive, and compelling, proposals to resolve this tragedy is postmortem organ conscription, also called routine salvaging or organ draft. This proposal entails postmortem retrieval of needed organs, regardless of the prior authorization or refusal of the deceased or his family. The argument of most proponents of conscription relies heavily upon a denial of the possibility of posthumous harms. While I also deny the possibility of posthumous harms, I argue this denial fails to acknowledge other serious wrongs that could be done to the deceased person and his corpse. While the person can no longer be harmed, his life, in a roughly biographical sense, can be damaged. Humans highly value life in this sense, often more than biological life. Respect for this sense of life also informs appropriate treatment of particular human corpses, which already have special value beyond mere resource. I will argue that conscription proponents fail to appropriately value lives and human corpses. This failure can lead to multiple wrongs, among them a wrongful exploitation of the vulnerability of a person's life and corpse and a disrespect of persons. While it is possible that some biographical lives could be made better, or at least less bad, by conscription, the judgments such decisions would require make conscription bad policy.

Differential impact of opt-in, opt-out policies on deceased organ donation rates: a mixed conceptual and empirical study

ObjectivesTo increase postmortem organ donation rates, several countries are adopting an opt-out (presumed consent) policy, meaning that individuals are deemed donors unless they expressly refused so. Although opt-out countries tend...

TO THE FORENSIC MEDICAL SUPPORT OF KIDNEY TRANSPLANTATION IN ST. PETERSBURG

The issues of organ and tissue transplantation are currently one of the urgent tasks of clinical medicine. This also applies to the practice of treating kidney diseases, where one of the effective methods is the transplantation of a donor organ. However, despite extensive practice to date, all the problems of organizing this process have not been solved. The aim of the work was to study the history of development and prospects of interaction between transplant doctors and forensic medical experts during kidney transplants in St. Petersburg. The period of the early 2000s to the present was analyzed. As a result of the study, the main difficulties of such joint work in the implementation of kidney transplants at different stages of the analyzed period were revealed. It is shown that the main condition for successful transplantation activity is adaptation to the requirements of society, detailed awareness of the requirements of laws and other governing documents, as well as strict and strict compliance with them. Only the joint efforts of transplantologists, city health managers, specialists of the city's Forensic Medical Examination Bureau and law enforcement agencies made it possible to create and develop an operating, constantly improving system of post-mortem organ donation. One of the key concepts in such a system was the development of requirements for "forensic medical support of organ transplantation". In cooperation with interested specialists of St. Petersburg, the city Bureau of Forensic Medical Examination organized round-the-clock shifts of forensic medical experts. Clear instructions have been developed for them with legal, medical and forensic contraindications to the collection of organs and tissues from the corpses of donors. This type of activity of the Bureau of Forensic Medical Examination was introduced as a state task.

'Take my kidneys but not my corneas'-Selective preferences as a hidden problem for 'opt-out' organ donation policy.

With aims to both increase organ supply and better reflect individual donation preferences, many nations worldwide have shifted from 'opt-in' to 'opt-out' systems for post-mortem organ donation (PMOD). In such countries, while a prospective donor's willingness to donate their organs/tissues for PMOD was previously ascertained-at least partially-by their having recorded positive donation preferences on an official register prior to death, this willingness is now presumed or inferred-at least partially-from their not having recorded an objection to PMOD-on an official organ donation register. Using evidence regarding the presence and prevalence of selective donation preferences, and via exploration of how appeals to donation preferences are used to both motivate and legitimate shifts to opt-out frameworks, this paper draws attention to a set of previously unexplored problems for opt-out organ donation arising in contexts where: (a) individuals demonstrate selective post-mortem organ/tissue donation preferences, (b) legislation provides prospective donors with the opportunity to selectively permit/refuse the donation of certain organs/tissues in line with these preferences. While selective preferences pose few problems for opt-in systems where a selective occasion is built into the process of signing the donor register, this is not the case for opt-out systems. The loss of this selective occasion can cause significant problems where appeals to preferences motivate/legitimate shifts to opt-out but evidence regarding variable preferences does not feed into determinations regarding organ/tissue exclusions. The nature of these problems depends on how the authorization aspect of 'opt-out' systems is framed (e.g. as presumed consent, deemed consent or, given the role of familial consent in many jurisdictions as consent in name only).