Cadaver organs should be automatically availableThe shortage of donor organs and tissue for transplantation constitutes an acute emergency which demands radical rethinking of our policies and radical measures. While estimates vary and are difficult to arrive at there is no doubt that the donor organ shortage costs literally hundreds of thousands of lives every year. “In the world as a whole there are an estimated 700 000 patients on dialysis . . .. In India alone 100 000 new patients present (...) with kidney failure each year” . Almost “three million Americans suffer from congestive heart failure . . . deaths related to this condition are estimated at 250 000 each year . . . 27 000 patients die annually from liver disease . . .. In Western Europe as a whole 40 000 patients await a kidney but only . . . 10 000 kidneys”1 become available. Nobody knows how many people fail to make it onto the waiting lists and fail to register in the statistics. “As of 24th November 2002 in the United Kingdom 667 people have donated organs, 2055 people have received transplants, and 5615 people are still awaiting transplants.”2Conscious of the terrible and unnecessary tragedy that figures like these represent I have been advocating for more than 20 years now some radical measures to stem this appalling waste of human life. The measure which is the subject of Hamer and Rivlin’s paper 3 concerns the automatic availability of all cadaver organs—a measure, which I first advocated publicly in 1983.4THE AUTOMATIC AVAILABILITY OF DONOR ORGANSWe need to begin by being clear about just what it is I propose and why. At the moment in the United Kingdom we …. (shrink)

Volume 20, Issue 7, July 2020, Page 193-195.

Procurement of organs from non-heart-beating cadaver donors raises concerns. Standards for optimal patient care during withdrawal of life-sustaining therapy are evolving and continue to be debated and studied. Consensus on specific procedures and methods has not been attained, however, and protocols for the procurement of organs from patients following the withdrawal of life-sustaining therapies may compromise the evolving standards and harm the patient and the attendant family. In addition, there is little evidence to suggest that such protocols will (...) significantly increase the number of organs procured. "Non-heart-beating cadaver" protocols that do not give comprehensive attention to optimal patient/family care at the time of withdrawal of life-sustaining therapy ought not to be endorsed. (shrink)

Public entities around the world are increasingly deploying artificial intelligence and algorithmic decision-making systems to provide public services or to use their enforcement powers. The rationale for the public sector to use these systems is similar to private sector: increase efficiency and speed of transactions and lower the costs. However, public entities are first and foremost established to meet the needs of the members of society and protect the safety, fundamental rights, and wellbeing of those they serve. Currently AI systems (...) are deployed by the public sector at various administrative levels without robust due diligence, monitoring, or transparency. This paper critically maps out the challenges in procurement of AI systems by public entities and the long-term implications necessitating AI-specific procurement guidelines and processes. This dual-prong exploration includes the new complexities and risks introduced by AI systems, and the institutional capabilities impacting the decision-making process. AI-specific public procurement guidelines are urgently needed to protect fundamental rights and due process. (shrink)

Dear editorOrgans transplantation is the solution for many end stage insufficiencies, but organ shortage is still matter of debate. As a consequence, organ procurement (OP) remains currently the best way to provide organs in western countries. Besides, the news of the death of a loved one, especially when he is young and dies in violent circumstances, can be a devastating event for families. In those conditions, the process of donation request from the coordinators may be difficult and requires experience (...) and “tact”. Despite these precautions, refusals are not rare.An 18 year-old-patient was transported in shock after a car accident to our hospital. Emergent laparotomy was performed for mesenteric and hepatic trauma requiring liver packing. She also presented a cervical and cerebral trauma with a fast deterioration of the neurological status. A tentorial herniation was quickly suspected. The family had been contacted and the severity of the situation explained without mentioning brain. (shrink)

Summary The way patrimonial procuratorships (of the patrimonium, ratio privata, and res privata) functioned at the beginning of the 3rd century CE remains controversial. A recently published inscription from Proconsular Africa featuring a new equestrian procurator rationis patrimonii of ducenarius rank, combined with re-interpreting the patrimonial procuratorships held by M. Aquilius Felix, argues convincingly that the reform of the administration of imperial property carried out at the beginning of Septimius Severus’ reign may have been more comprehensive than previously believed.

Organ transplantation is an accepted therapy for major organ failure, but it depends on the availability of viable organs. Most organs transplanted in the U.S. come from either "brain-dead" or living related donors. Recently organ procurement from patients pronounced dead using cardiopulmonary criteria, so-called "non-heart-beating cadaver donors" (NHBCDs), has been reconsidered. In May 1992, the University of Pittsburgh Medical Center (UPMC) enacted a new, complicated policy for procuring organs from NHBCDs after the elective removal of life support. Seventeen months (...) later only one patient has become a NHBCD. This article describes her case and the results of interviews with the health care team and the patient's family. The case and interviews are discussed in relation to several of the ethical concerns previously raised about the policy, including potential conflicts of interest, the definition of cardiopulmonary death, and a possible net decrease in organ donation. The conclusion is reached that organ procurement from non-heart-beating cadavers is feasible and may be desirable both for the patient's family and the health care providers. (shrink)

Effective implementation and committed practice of sustainable procurement remain a significant challenge for many organisations across the globe. This paper sought to understand the extent to which employees’ perceptions influence the practice of sustainable procurement in the context of a developing country where sustainability awareness is low. Drawing on the Diffusion of Innovation theory, procurement officers’ perceptions of sustainable procurement were examined relative to the attributes of complexity, compatibility and relative advantage. Empirical data from 322 Ghanaian (...) organisations were analysed using descriptive statistics and structural equation modelling to determine the nature of procurement officers’ perceptions of sustainable procurement and the effects of the perceptions on relevant organisational practices. The findings indicate that whereas perceptions of relative advantage did not significantly influence the practice of sustainable procurement, perceptions of compatibility had a significant positive effect, and perceptions of complexity had a significant negative effect on sustainable procurement. This study offers insights into the link between employees’ perceptions and organisational sustainable procurement practice, thereby providing a conceptual basis for effective management of the pertinent relationships with implications for enhanced ethical practices in procurement and supply chain management. (shrink)

Improving the reliability of electricity supply is closely related to the national industrial economy and people’s livelihood. When procuring electricity, the large consumer faces the risk of insufficient electricity supply. Such insufficiency may be caused by the supply disruption of the upstream electricity generator and the fluctuation of electricity prices in the electricity pool. We establish an expected cost model for the large consumer and a revenue model for the electricity generator by introducing robustness and opportunity functions to analyse the (...) impact of supply disruption and price fluctuation on both members. Then, we obtain the optimal reliability level and subsidy rate. Our analytical results reveal the following points: During an electricity price fluctuation, the sufficient and necessary condition for the large consumer to expect high robustness of his own decision-making is to pay a high cost. The high uncertainty of electricity price leads to less revenue for the electricity generator; thus, the electricity generator should perform well in price forecasting. Without disruption risk, the electricity generator is reliable. Furthermore, the electricity pool is unreliable from the perspective of price. However, the electricity supply of the electricity generator is no longer reliable when considering disruption risk, whereas the electricity pool is reliable because the large consumer is tolerant of price fluctuation under this circumstance. Moreover, the impacts of market uncertainty and players’ attributes on the optimal strategies are explored. (shrink)

Background Requirements for organ donation after cardiac or imminent death have been introduced to address the transplantable organs shortage in the United States. Organ procurement organizations (OPOs) increasingly use the Internet for organ donation consent. Methods An analysis of OPO Web sites available to the public for enrollment and consent for organ donation. The Web sites and consent forms were examined for the minimal information recommended by the United States Department of Health and Human Services for informed consent. Content (...) scores were calculated as percentages of data elements in four information categories: donor knowledge, donor consent reinforcement, donation promotion, and informed consent. Results There were 60 Web sites for organ donation enrollment serving the 52 states. The median percent (10 percentile-90 percentile) content scores of the Web sites for donor knowledge, donor consent reinforcement, and donation promotion were 33% (20–47), 79% (57–86), and 75% (50–100), respectively. The informed consent score was 0% (0–33). The content scores for donor knowledge and informed consent were significantly lower than donor consent reinforcement and donation promotion for all Web sites (P < .05). The content scores for the four categories were similar among the 11 regions of the United Network for Organ Sharing. Conclusion The Web sites and consent forms for public enrollment in organ donation do not fulfill the necessary requirements for informed consent. The Web sites predominantly provide positive reinforcement and promotional information rather than the transparent disclosure of organ donation process. Independent regulatory oversight is essential to ensure that Internet enrollment for organ donation complies with legal and ethical standards for informed consent. (shrink)

The dead donor rule (DDR) governs procuring life-prolonging organs. They should be taken only from deceased donors. Miller and Truog have proposed abandoning the rule when patients have decided to forgo life-sustaining treatment and have consented to procurement. Organs could then be procured from living patients, thus killing them by organ procurement. This proposal warrants careful examination. They convincingly argue that current brain or circulatory death pronouncement misidentifies the biologically dead. After arguing convincingly that physicians already cause death (...) by withdrawing treatment, they claim no bright-line differences preclude organ removal from the living. The argument fails for those who accept the double effect doctrine or other grounds for distinguishing forgoing life support from active, intentional killing. If the goal is determining irreversible loss of somatic function, they correctly label current death pronouncement a “legal fiction.” Recognizing a second, public policy meaning of the term death provides grounds for maintaining the DDR without jeopardizing procurement. (shrink)

There has been a troublesome anomaly in the UK between cash payment to men for sperm donation and the effective assumption that women will pay to donate eggs. Some commentators, including Donald Evans in this journal, have argued that the anomaly should be resolved by treating women on the same terms as men. But this argument ignores important difficulties about property in the body, particularly in relation to gametes. There are good reasons for thinking that the contract model and payment (...) for gametes are both inappropriate, and that a model based on altruism should be applied to both sexes. (shrink)

Human body material removed post mortem is a particularly valuable resource for research. Considering the efforts that are currently being made to study the biochemical processes and possible genetic causes that underlie cancer and cardiovascular and neurodegenerative diseases, it is likely that this type of research will continue to gain in importance. However, post mortem procurement of human body material for research raises specific ethical concerns, more in particular with regard to the consent of the research participant. In this (...) paper, we attempt to determine which consent regime should govern the post mortem procurement of body material for research. In order to do so, we assess the various arguments that could be put forward in support of a duty to make body material available for research purposes after death. We argue that this duty does in practice not support conscription but is sufficiently strong to defend a policy of presumed rather than explicit consent. (shrink)

: Although "brain death" and the dead donor rule—i.e., patients must not be killed by organ retrieval—have been clinically and legally accepted in the U.S. as prerequisites to organ removal, there is little data about public attitudes and beliefs concerning these matters. To examine the public attitudes and beliefs about the determination of death and its relationship to organ transplantation, 1351 Ohio residents ≥18 years were randomly selected and surveyed using random digit dialing (RDD) sample frames. The RDD telephone survey (...) was conducted using computer-assisted telephone interviews. The survey instrument was developed from information provided by 12 focus groups and a pilot study of the questionnaire. Three scenarios based on hypothetical patients were presented: "brain dead," in a coma, or in a persistent vegetative state (PVS). Respondents provided personal assessments of whether the patient in each scenario was dead and their willingness to donate that patient's organs in these circumstances. More than 98 percent of respondents had heard of the term "brain death," but only one-third (33.7%) believed that someone who was "brain dead" was legally dead. The majority of respondents (86.2%) identified the "brain-dead" patient in the first scenario as dead, 57.2 percent identified the patient in a coma as dead (Scenario 2), and 34.1 percent identified the patient in a PVS as dead (Scenario 3). Nearly one-third (33.5%) were willing to donate the organs of patients they classified as alive for at least one scenario, in seeming violation of the dead donor rule. Most respondents were not willing to violate the dead donor rule, although a substantial minority was. However, the majority of respondents were unaware, misinformed, or held beliefs that were not congruent with current definitions of "brain death." This study highlights the need for more public dialogue and education about "brain death" and organ donation. (shrink)

The shortage of organs for transplantation by its nature prompts ethical dilemmas. For example, although there is an imperative to save human life and reduce suffering by maximising the supply of vital organs, there is an equally important obligation to ensure that the process by which we increase the supply respects the rights of all stakeholders. In a relatively unexamined practice in the USA, organs are procured from unrepresented decedents without their express consent. Unrepresented decedents have no known healthcare wishes (...) or advance care planning document; they also lack a surrogate. The Revised Uniform Anatomical Gift Act of 2006 sends a mixed message about the procurement of organs from this patient population and there are hospitals that authorise donation. In addition, in adopting the RUAGA, some states included provisions that clearly allow organ procurement from unrepresented decedents. An important unanswered question is whether this practice meets the canons of ethical permissibility. The current Brief Report presents two principled approaches to the topic as a way of highlighting some of the complexities involved. Concluding remarks offer suggestions for future research and discussion. (shrink)

In alignment with stated social, health, and environmental values, hundreds of hospitals in the United States are purchasing local, organic, and other alternative foods. Due to the logistical and economic constraints associated with feeding hundreds to thousands of people every day, new food procurement initiatives in hospitals grapple with integrating conventional supply chain norms of efficiency, standardization, and affordability while meeting the diverse values driving them such as mutual benefit between supply chain members, environmental stewardship, and social equity. This (...) paper provides empirical data and analysis on emerging values-based supply chains in hospitals that attempt to meet both the scale-based requirements and values-based goals of alternative food procurement initiatives. In particular, it examines tensions among industrial, economic, and alternative agrifood values in relation to a particular set of hospital supply chain players called Group Purchasing Organizations. Hospital membership in GPOs in the United States is ubiquitous, and 80–90 % of a hospital’s foodservice procurement comes through GPO channels in keeping with contract terms. GPO-governed supply chains are deeply rooted in industrial and commercial norms, in other words, price competition, economic efficiency, and forces of standardization through adherence to technical and quality standards. The bulk of alternative food procurement initiatives in the health care sector currently occur outside of the GPO–hospital relationship, however, over 90 % of hospital foodservice directors interviewed for this research expressed a desire to increase sustainable food procurement through their GPO. This study finds that, if alternative agrifood efforts in the health care sector are to integrate with GPO-governed supply chains without losing the robustness of the original values and goals that brought them into being, concerns related to supply chain structure, transparency and traceability of alternative food attributes, and alignment of definitions of local and sustainable food between all supply chain members will need to be addressed. This study also details points of flexibility in health care food supply chains and the potential for hospitals to create purchasing and informational alliances around common food goals in order to create new, values-based supply chain relationships both within and beyond GPO procurement channels. (shrink)

Recent ethics literature suggests that issues involved in non-heart-beating organ procurement are both highly charged and rather urgent. Some fear that NHB is a public relations disaster waiting to happen or that it will create a backlash against organ donation. The purpose of the study described below was to assess ethics committees' current level of involvement in and readiness for addressing the difficult issues that NHB organ retrieval raises—either proactively through policy development or concurrently through ethics consultation.

Recent ethics literature suggests that issues involved in non-heart-beating organ procurement are both highly charged and rather urgent. Some fear that NHB is a public relations disaster waiting to happen or that it will create a backlash against organ donation. The purpose of the study described below was to assess ethics committees' current level of involvement in and readiness for addressing the difficult issues that NHB organ retrieval raises—either proactively through policy development or concurrently through ethics consultation.

According to Karl Popper, science cannot verify its theories empirically, but it can falsify them, and that suffices to account for scientific progress. For Popper, a law or theory remains a pure conjecture, probability equal to zero, however massively corroborated empirically it may be. But it does just seem to be the case that science does verify empirically laws and theories. We trust our lives to such verifications when we fly in aeroplanes, cross bridges and take modern medicines. We can (...) do some justice to this apparent capacity of science to verify if we make a number of improvements to Popper’s philosophy of science. The key step is to recognize that physics, in accepting unified theories only, thereby makes a big metaphysical assumption about the nature of the universe. The outcome is a conception of scientific method which facilitates the criticism and improvement of metaphysical assumptions of physics. This view provides, not verification, but a perfect simulacrum of verification indistinguishable from the real thing. (shrink)

Recommending the identity of bidders in public procurement auctions has a significant impact in many areas of public procurement, but it has not yet been studied in depth. A bidders recommender would be a very beneficial tool because a supplier can search appropriate tenders and, vice versa, a public procurement agency can discover automatically unknown companies which are suitable for its tender. This paper develops a pioneering algorithm to recommend potential bidders using a machine learning method, particularly (...) a random forest classifier. The bidders recommender is described theoretically, so it can be implemented or adapted to any particular situation. It has been successfully validated with a case study: an actual Spanish tender dataset which has 102,087 tenders from 2014 to 2020 and a company dataset which has 1,353,213 Spanish companies. Quantitative, graphical, and statistical descriptions of both datasets are presented. The results of the case study were satisfactory: the winning bidding company is within the recommended companies group, from 24% to 38% of the tenders, according to different test conditions and scenarios. (shrink)

A large U.S. government investigation into arms procurement procedures with corporate contractors has recently led to guilty pleas to fraud and illegal use of classified documents. Operation Ill Wind has brought public attention to the criminal and unethical conduct of large defense contractors in their dealings with the government. This article will review how the defense contract bidding process operates and why illegal activity has been able to compromise the process. We will offer proposals to improve the process in (...) light of the present inquiry. (shrink)

L’accointance d’un attribut est-elle de même nature que celle d’un individu? Bien entendu, l’assimilation des attributs à des universaux, et par suite à des objets, conduit immédiatement à une réponse positive. Mais que dire des attributs en position de prédicat? Le présent article vise à soutenir l’univocité de l’accointance en montrant que les prédicats sont bien, malgré d’importantes différences, les objets possibles d’une accointance comparable à l’accointance d’individus. Pour cela, on envisagera les choses négativement, en examinant la façon dont, dans (...) l’un et l’autre cas, une absence d’accointance se trouve suppléée. Dans le cadre d’une interprétation épistémique de la théorie des types des Principia Mathematica justifiée par des raisons indépendantes, cette perspective amènera à comprendre l’axiome de réductibilité comme un principe d’accointance par procuration pour les prédicats, principe dont l’analyse russellienne des descriptions définies d’individu partage le schéma. (shrink)

Several European countries are approving legislative reforms moving to a presumed consent system in order to increase organ donation rates. Nevertheless, irrespective of the consent system in force, family's decisional capacity probably causes a greater impact on such rates. In this contribution we have developed a systematic methodology in order to analyse and compare European organ procurement laws, and we clarify the weight given by each European law to relatives' decisional capacity over individual's preferences (expressed or not while alive) (...) regarding the destination of his or her organs after death. In this sense, the results constitute the first comprehensive and comparative legislative mapping on European transplantation laws. (shrink)

In defending what he calls ‘full-blooded Epicureanism’, James Stacey Taylor argues that the dead cannot be harmed or wronged.1 This has implications for a range of bioethical issues pertaining to death, including posthumous organ procurement. Taylor claims that respecting the autonomy of persons requires that their desires regarding the treatment of their postmortem bodies be given due consideration while these persons are alive. It is not obvious what this means in practical terms, though Taylor says that respect for autonomy (...) requires that these wishes be recorded with the intention that they be followed. Yet if respect for autonomy only applies to the wishes of premortem persons, and if there are no posthumous harms or wrongs, then it is not clear why it would matter morally whether one's wishes about what to do with one's organs were fulfilled or thwarted after one's death.Most of us have an interest in what happens to our bodies not just during our lives but also after our deaths. Personal sovereignty and autonomy give persons a right to control what happens to their bodies, and since the body …. (shrink)

We examine whether the current regulatory regime instituted in South Korea and the United States would have prevented Hwang’s potential transgressions in oocyte procurement for somatic cell nuclear transfer, we compare the general aspects and oversight framework of the Bioethics and Biosafety Act in South Korea and the US National Academies’ Guidelines for Human Embryonic Stem Cell Research, and apply the relevant provisions and recommendations to each transgression. We conclude that the Act would institute centralized oversight under governmental auspices (...) while the Guidelines recommend politically-independent, decentralized oversight bodies including a special review body for human embryonic stem cell research at an institutional level and that the Guidelines would have provided more vigorous protection for the women who had undergone oocyte procurement for Hwang’s research than the Act. We also suggest additional regulations to protect those who provide oocytes for research in South Korea. (shrink)

This study investigates changes in sexual motivation over the duration of a partnership in a population sample stratified by age. The results replicate and extend the findings of a previous study that was based on a sample of college students. In the samples of 30- and 45-year-olds, male sexual motivation remains constant regardless of the duration of the partnership. Female sexual motivation matches male sexual motivation in the first years of the partnership and then steadily decreases. In the sample of (...) 60-year-olds, male sexual motivation always exceeds female sexual motivation, and both are little affected by duration of the partnership. This pattern is clearly evident for some measures of sexual motivation and less so or not at all for others. Interpretations of the current results from social constructivism or from mainstream psychology are difficult to conceive. The results seem more intelligible from an evolutionary perspective as reflections of evolved design for sexual motivation, fine-tuned to the different conditions governing the reproductive success of males and females. In this view male sexual motivation promotes a constant frequency of copulation in order to guard against cuckoldry. Female sexual motivation, in contrast, promotes copulation to solve the adaptive problem of procuring male resources by establishing and maintaining a pair bond. (shrink)

Sustainable Public Food Procurement (SPFP) is gaining recognition for its potential to improve the sustainability of food systems and promote healthier diets. However, SPFP faces various challenges, including coordination issues, actor dynamics, infrastructure limitations, unsustainable habits, and institutional resistance, among others. Drawing upon insights from the Multi-Level Perspective (MLP) on socio-technical transitions and the X-curve model on transition dynamics, this study investigates the role of transition intermediaries in facilitating SPFP-induced transformations in food systems. Focusing on four case studies in (...) Spain, we identify common barriers encountered in SPFP and analyse how distinct types of transition intermediaries contribute individually and collectively to address these challenges. Additionally, we explore how intermediary networks evolve throughout different phases of the transition process. Our findings reveal that SPFP barriers are systemic and interconnected, emphasizing the necessity of collective intermediation to overcome these obstacles. Furthermore, our results reveal how collective intermediation is orchestrated by pivotal intermediaries who mobilize diverse transition intermediaries, shaping multiple transition pathways. These intermediaries operate at both food system regimes and niches, challenging the conventional notion that transformative change can only originate from niche efforts. Lastly, we highlight the dynamic and flexible nature of intermediation in SPFP transitions, underscoring the importance of adaptability in strategies as these transitions evolve over time. Practical implications include the need for context-specific, adaptive approaches and strategies that leverage intermediary diversity. This research offers insights for policymakers, practitioners, and scholars into SPFP and broader transitions towards food systems transformation, fostering a more comprehensive understanding of these transition processes. (shrink)

The selection of the procurement model, which is a process of discretion exercised by procurement officials, is crucial to the Public-private Partnership procurement performance. From theoretical analysis and international practice, we could find that the negotiation method is more suitable for complex PPP projects, while the tendering method is widely used in China’s PPP procurement. To analyze the reasons for the phenomenon, we used the logit regression model to examine the influence of regulatory competition, risk aversion (...) preference, and tacit interaction on the procurement model selection based on the data of 8,926 PPP projects from 2009 to 2021 in China. The results indicate that regulatory competition leads to confusion in procurement model selection, while risk aversion preference and tacit interaction significantly promote the application of tendering. Moreover, the heterogeneity analysis of regions and return models prove that provincial capitals and municipalities are more susceptible to regulatory competition, risk aversion preference, and tacit interaction than ordinary cities. Compared with user-pay projects, government-pay projects and viability gap funding projects are more susceptible to regulatory competition and risk aversion preference, and less affected by tacit interaction. Therefore, to optimize the procurement model selection, policymakers should improve procurement policies to reduce the adverse effects of regulatory competition, risk aversion preference, and tacit interactions. (shrink)

Families play an essential role in deceased organ procurement. As the person cannot directly communicate his or her wishes regarding donation, the family is often the only source of information regarding consent or refusal. We provide a systematic description and analysis of the different roles the family can play, and actions the family can take, in the organ procurement process across different jurisdictions and consent systems. First, families can inform or update healthcare professionals about a person’s donation wishes. (...) Second, families can authorize organ procurement in the absence of deceased’s preferences and the default is not to remove organs, and oppose donation where there is no evidence of preference but the default is to presume consent; in both cases, the decision could be based on their own wishes or what they think the deceased would have wanted. Finally, families can overrule the known wishes of the deceased, which can mean preventing donation, or permitting donation when the deceased refused it. We propose a schema of 4 levels on which to map these possible family roles: no role, witness, surrogate, and full decisional authority. We conclude by mapping different jurisdictions onto this schema to provide a more comprehensive understanding of the consent system for organ donation and some important nuances about the role of families. This classificatory model aims to account for the majority of the world’s consent systems. It provides conceptual and methodological guidance that can be useful to researchers, professionals, and policymakers involved in organ procurement. (shrink)

One must technologize bodies to conceive of organ transplantation. Organs must be envisioned as replaceable parts, serving mechanical functions for the workings of the body. In this way, it becomes possible to imagine exchanging someone’s organs without changing anything essential about the selfhood of the person. But to envision organs as mechanical parts is phenomenologically uncomfortable; thus, the terminology used to describe the practice of organ retrieval seems to attempt other, less technological ways of viewing the human body. In this (...) paper, I analyze three common metaphors that currently contextualize the process of organ retrieval in English-speaking communities: harvesting the agrarian body, procuring the commodified body, and receiving the gifted body. These powerful images constrain the gaze toward the body in important ways. Every gaze both obscures and reveals. While each of these three metaphors makes sense of some aspects of organ retrieval, each of them is ultimately subject to being overtaken by what Jeffrey Bishop calls the technological imaginary. This imaginary deploys a gaze that obscures important elements of what it means to be human and does violence to parts of the phenomenological experience of transplantation and bodily existence. I argue that no matter how hard one tries to avoid the technological aspect of transplantation practices by embracing nonviolent metaphors—even the metaphor of gifting, which seems the most promising—it will never be possible to fully resist organ transplantation’s violence toward our phenomenological sense of embodiment. (shrink)

Summary Descriptions of the administration of imperial domains in Africa Proconsularis share much common ground in their interpretations. The literature features a widespread emphasis on the special role of the governments of Trajan and Hadrian in reorganising the imperial domains in this province – and especially in the Bagradas Valley, which has furnished us with exceptional epigraphic material in the form of agrarian inscriptions. While the 2nd-century administrative operations of imperial domains are fairly well understood – mainly due to this (...) category of inscriptions – the 1st century remains something of a mystery. Researchers have dated the beginning of fundamental changes to how domain administration was organised to the times of the Flavians, after the great confiscations of Nero. However, a re-interpretation of a procuratorial title from CIL VIII 14727 = ILPBardo 229 and a broader analysis of the epigraphic material shed new light on the beginnings of the administration of imperial domains in Africa Proconsularis, and especially in the grain-growing region of Byzacium; there, perhaps even in the mid-1st century, there was an imperial administration and a domain district modelled after another grain province of Egypt. (shrink)

Perioperative nurses assist in organ procurement surgery; however, there is a dearth of information of how they encounter making conscientious objection requests or refusals to participate in organ procurement surgery. Organ procurement surgical procedures can present to the operating room ad hoc and can catch a nurse who may not desire to participate by surprise with little opportunity to refuse as a result of staffing, skill mix or organizational work demands. This paper that stems from a larger (...) doctoral research study exploring the experiences of perioperative nurses participating in multi‐organ procurement surgery used a grounded theory method to develop a substantive theory of the nurses’ experiences. This current paper aimed to highlight the experiences of perioperative nurses when confronted with expressing a conscientious objection towards their participation in these procedures. A number of organizational and cultural barriers within the healthcare organization were seen to hamper their ability in expressing a conscience‐based refusal, which lead to their reluctant participation. Perioperative nurses must feel safe to express a conscientious objection towards these types of surgical procedures and feel supported in doing so by their respective hospital organizations and not be forced to participate unwillingly. (shrink)

: The supply of organs for transplant remains inadequate to meet the needs of waiting patients, in spite of many programs and approaches to increase rates of donation. Over the years there have been numerous proposals to introduce schemes that would move toward the outright sale of organs. Three articles in this issue of the Journal propose methods for increasing organ supply—two by moving toward a market approach and the third by advocating a change in social culture. All three suffer (...) from shortcomings, including the endorsement and encouragement of the exploitation of those who may offer organs. Although the shortage of organs must be addressed, the social price of a market in organs is too high, and proposals to encourage a rethinking of social responsibility are unlikely to be effective. (shrink)