Suchergebnisse

AbstractBackground: Disparities in access to and in outcome of organ transplantation are widely discussed topics among transplant researchers in many Western countries. Among various types of disparities examined in existing studies, "geographic disparity," i.e., disparity due to a recipient's location, is most common. Despite a number of articles that acknowledge the existence of geographic disparities, the literature has been relatively silent about the historical and international efforts to address these issues. Literature discussing remedies or proposing analytical tools to identify remedies is even rarer. This paper investigates potential causes of geographic disparity and advocates possible methodological approaches to analyze and address the disparity. Methods: The paper conducts an in‐depth review of geographic disparity and the policy efforts to reduce the disparity in the United States, Canada, France, Spain, the United Kingdom, and Australia. The current organ allocation systems in these countries are also reviewed and compared. Possible causes of the disparity and future analytical approaches are discussed based on the findings of these reviews. Findings: Geographic disparity in organ transplant service is ubiquitous in all countries studied. Many Western countries have a similar organ allocation system with some difference in the degree of interregional and national‐level sharing enforced by the government. The organ allocation system in these countries tends to have some inherent mechanism to favor a "home region" where organs are harvested, implying that the locations of candidates matter in accessing a transplant. Geographic allocation boundaries prevalent in the United States were found to be another potential source of geographic disparity. Conclusions: Developing an equitable organ allocation system is a multifaceted problem. The allocation procedure needs to reflect priorities of urgent cases and some geographic areas, patient's severity level, waiting time, cold ischemia time (CIT) and associated travel distance, condition of and compatibility between organ and recipient, etc. Failing to reflect these factors adequately results in disparity of some sort. The implications of geographic boundaries in organ allocation need to be studied further. Utilization of relatively new methodological approaches, such as Geographic Information Systems (GIS) and system dynamic modeling, would help develop a system that allocates organs more equitably.

Iran is the only country in the world currently with a legalized compensated kidney donation system, in which kidney sellers are matched with end‐stage renal disease patients through a regulated process. From a practical point of view, this model provides an abundance of kidneys for transplantation as opposed to the American model that relies on altruistic donation. The major concern about adopting the Iranian model is the possibility of exploitation. A large body of literature exists on this topic, but few have focused on its cultural aspects. This paper sheds light on the cultural implications of the Iranian model by providing empirical evidence on the social stigmas against kidney sale in Iran. We claim that these stigmas act as barriers to entry to the supply market of kidneys. Due to the conditions created by social stigmas, kidney sellers are forced to consider not only monetary rewards but also cultural factors. Thus, they tend to be more cautious and try to avoid impulsive decisions. Such social stigmas act as unofficial regulatory forces to keep kidney sale as the last resort for the poor, to diversify the supply market by age, and to stretch the decision‐making process in the absence of a mandatory waiting period for transplantation.

AbstractA review of David Watts' Bedside Manners critiquing writing style, content, and lack of overt statements about policy.

AbstractSexually transmitted infections (STIs) among U.S. military personnel and neighboring communities prior, during, and after deployment are a threat to military readiness and community health. This pilot study used data from the Virginia Department of Health. Geographic and spatial pattern analysis of two STIs, Chlamydia trachomatis and Neisseria gonorrhoeae, were conducted. Of special interest was the STI spread patterns correlated with locations of military staging bases, in the aftermath of September 11, 2001. Higher prevalence rates of STIs were found in the counties contiguous to military installations.

AbstractThe World Medical & Health Policy Journal fills a unique niche dedicated to the interdisciplinary intersection of politics, policy, research, medicine and global public health. The Editors hope that this first issue, with notable contributors from around the world and a distinguished group of expert advisors, will help to shed light on some of the difficult decisions health care providers make on a routine basis.

INTRODUCTION: Living-donor kidney transplantation is the gold standard treatment for patients with end-stage kidney disease. However, potential donors ubiquitously face financial as well as logistical barriers. To remove these disincentives from living kidney donations, the governments of 23 countries have implemented reimbursement programmes that shift the burdens of non-medical costs from donors to the governments or private entities. However, scientific evidence for the effectiveness of these programmes is scarce. The present study investigates whether these reimbursement programmes designed to ease the financial and logistical barriers succeeded in increasing the number of living kidney donations at the country level. The study examined within-country variations in the timing of such reimbursement programmes. METHOD: The study applied the difference-in-difference (two-way panel fixed-effect) technique on the Poisson distribution to estimate the effects of these reimbursement programmes on a 17 year long (2000–2016) dataset covering 109 countries where living donor kidney transplants were performed. RESULTS: The results indicated that reimbursement programmes have a statistically significant positive effect. Overall, the model predicted that reimbursement programmes increased country-level donation numbers by a factor of 1.12–1.16. CONCLUSION: Reimbursement programmes may be an effective approach to alleviate the kidney shortage worldwide. Further analysis is warranted on the type of reimbursement programmes and the ethical dimension of each type of such programmes.