The legal basis of organ transplantation (author''s transl)

Report on the legal basis of organ transplantation in Belgium, France, Italy, Luxembourg, the Netherlands, Great Britain, Sweden, Denmark, Norway, Iceland and Finland. Reference is made to the legal uncertainty in the Federal Republic of Western Germany. The Federation probably has no legislative competence for an adequate transplantation law. Amendments of the xi 168 StGB suggested by individual Federal States are discussed. The synopsis of the existing legal rules in the above mentioned countries suggests the proposal of general legal principles which should guarantee 1. the best medical care in transplantation medicine especially in renal explantates 2. a legal protection for the physician 3. a protection for personal rights of the donor. The author feels that the rights of those persons who provide for the corpses should be superceded by these considerations.     

Evaluation of Legal Risks for E-Commerce in Construction

E-commerce is steadily becoming a reality in the construction industry. However, despite the increasing rate of utilization by owners and contractors alike, the legal implications of using e-commerce in construction have not been studied in depth. This paper fills this gap in literature. It identifies and analyzes the different types of legal risks involved in the use of e-commerce in construction. It also outlines the risk that contractors and professionals may face in their e-commerce implementations. A classification of e-commerce legal risks is also introduced. The legal risks discussed include agency, jurisdiction, contract formation, validity and errors, authentication, attribution, nonrepudiation, privacy, conflict of laws, and conflict between law and technology.     

Legal Risks Faced by Foreign Architectural, Engineering, and Construction Firms in China

The extensive opportunities in China’s construction industry are expected to attract many foreign architectural, engineering, and construction (AEC) firms to her shores. However, these foreign firms may face many legal risks and obstacles, mainly because of the differences in culture and operating environment from their home countries. This study investigates the legal risks that foreign AEC firms encounter when operating in China, and how these risks are managed. Data were collected from 21 foreign (non-Chinese) AEC professionals who have extensive experience in China. Legal risks faced by foreign AEC firms in China include: difficulty in complying with the innumerable laws and regulations at the central, provincial, and local levels of the government; keeping up with new laws and regulations that are constantly being enacted; seeming reluctance of Chinese business associates to enter into binding contracts; and lack of sanctity of contracts and contractual obligations not being carried out fully, leading to disputes. Based on the research findings, a framework for managing legal risks is proposed for use by industry practitioners. The framework recommends to practitioners several measures to manage the legal risks. These include relationship-based strategies like establishing close relationships with the Chinese government officials and Chinese business associates and careful selection of Chinese business partners. It is recommended that foreign AEC professionals adopt the mindset that in China, the contact is to be continuously negotiated and reinterpreted. To achieve this, industry practitioners should provide a substantial contingency sum. It is also important to emplace permanent staff in China so that they can understand the local environment and monitor the changes taking place there.     

“Impairment” and performance issues in clinical supervision: After the 2008 ADA Amendments Act.

Management of supervisees who do not meet performance standards is an area of special concern in clinical training. Supervisors may inappropriately apply the concept of impairment when assessing or describing substandard performance; legal liability is introduced when the construct is misapplied. The Americans With Disabilities Act (ADA) Amendments Act of 2008 (effective January 1, 2009) has compounded the legal risks associated with the inappropriate use of impairment. This article briefly describes the historical use of the term impairment, discusses the legal risks associated with the misapplication of the construct, and presents best practices in clinical supervision when addressing supervisee performance within the legal constraints of the ADA. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Political, Economic, and Legal Risks Faced in International Projects: Case Study of Vietnam

The aim of this research is to investigate the political, economic, and legal (PEL) risks faced by foreign firms when undertaking construction projects in Vietnam. The specific objectives are to investigate the types of PEL risks faced and the risk response techniques adopted. The data collection instrument was a questionnaire with open ended questions. The data collection method was in-depth face to face interviews with 18 experts from France, Hong Kong, Malaysia, Singapore, and the United States who have managed construction projects in Vietnam. The major risks faced include corruption, termination of public projects, bureaucratic administrative system to obtain permits and approvals, changing and inconsistent regulations, inadequate legal framework, fluctuation of exchange, and interest and inflation rates. Ways to respond to these risks are recommended by the experts. Foreign firms undertaking construction projects in Vietnam may make use of these findings to identify their PEL risks and determine the appropriate risk response measures to give their projects a higher chance of success.     

Legal Issues of Integrated Network for Construction and Real Estate Sector

In Singapore, one of the most important steps in the overall information technology strategy for the construction and real estate sector is the development of an integrated network for the sector to cover the entire life cycle of any development. It is the first of its kind in the world. The productivity and competitiveness of the construction and real estate sector have been greatly enhanced through the introduction and implementation of the adopted integrated network since 2002. Some of the legal issues related to the integrated network are global trading, contract enforceability, liability risks, security breaches, and intellectual properties protection, a lack of alignment in jurisdictions, confidentiality, legal liability, and service dependency risks. The paper addresses online security and legal issues related to the integrated network for the sector to establish trust and confidence among the end users of the system. Some of the legal issues encountered during the implementation and lessons learnt will also be briefly discussed.     

Behavioral medicine: Its malpractice risks for psychologists.

Psychologists are becoming increasingly involved in the management of physical disease. Although the authors applaud the application of psychological principles to ameliorate disease, they warn against certain legal hazards. Psychologists must be careful not to cross the line of practicing medicine without a license. Furthermore, health psychologists may experience greater risks of civil liability when they work in health care areas than when they provide more traditional mental health treatment. Suggestions are made to help reduce the legal risks to health psychologists. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alteration of rendering and meat hygiene legislation in the course of the BSE/TSE crisis. Validity of decisive legal provisions (1)

The decisive European legal provisions to fight bovine sponfiform encephalopathy in the context of the rendering and meat-hygiene legislation are the Commission Decisions 96/449/EC "on the approval of alternative heat treatment systems for processing animal waste with a view to the inactivation of spongiform encephalopathy agents" and 97/534/EC "on the prohibition of the use of material presenting risks as regards transmissible spongiform encephalopathies". Both decisions are based on Council Directives which do not provide the necessary authorization for these decisions by the Commission. Consequently, both have to be regarded as legally invalid. Furthermore, the legal acts to convert these decisions into German law (Rendering Plants Regulation and Meat-Hygiene Regulation) have to be considered invalid--partly due to formal and partly due to factual reasons. Because of the thus created legal uncertainty the legal provisions in question can only come fully into force after the elimination of this specifically described legal shortcomings or after clarification of the legal situation by the responsible courts.     

Induction of immunologic tolerance for transplantation

In the second half of the 20th century, the transplantation of replacement organs and tissues to cure disease has become a clinical reality. Success has been achieved as a direct result of progress in understanding the cellular and molecular biology of the immune system. This understanding has led to the development of immunosuppressive pharmaceuticals that are part of nearly every transplantation procedure. All such drugs are toxic to some degree, however, and their chronic use, mandatory in transplantation, predisposes the patient to the development of infection and cancer. In addition, many of them may have deleterious long-term effects on the function of grafts. New immunosuppressive agents are constantly under development, but organ transplantation remains a therapy that requires patients to choose between the risks of their primary illness and its treatment on the one hand, and the risks of life-long systemic immunosuppression on the other. Alternatives to immunosuppression include modulation of donor grafts to reduce immunogenicity, removal of passenger leukocytes, transplantation into immunologically privileged sites like the testis or thymus, encapsulation of tissue, and the induction of a state of immunologic tolerance. It is the last of these alternatives that has, perhaps, the most promise and most generic applicability as a future therapy. Recent reports documenting long-term graft survival in the absence of immunosuppression suggest that tolerance-based therapies may soon become a clinical reality. Of particular interest to our laboratory are transplantation strategies that focus on the induction of donor-specific T-cell unresponsiveness. The basic biology, protocols, experimental outcomes, and clinical implications of tolerance-based transplantation are the focus of this review.     

A simple model of the optimal time for allogenic bone marrow transplantation in chronic granulocytic leukemia

Allogenic bone marrow transplantation is the treatment of choice in chronic granulocyte leukemia patients, while the best results are achieved when it is performed in the chronic phase of the illness. That is why time optimization for bone marrow transplantation in chronic granulocyte leukemia means making priority lists for transplantation according to medical indications. This study comprises a very simple model of optimal time for bone marrow transplantation in chronic granulocyte leukemia. It is based on data of the International Bone Marrow Transplant Registry (IBMTR) on bone marrow transplantation results in different phases of chronic granulocyte leukemia and prognostic model for survival of younger leukemic patients according to which there are three groups of patients. The mathematical method estimated cumulative risks of the final therapeutic results. This model has shown that the time limit for transplantation is the fourth year of the disease in the low risk group; the third year of the disease in the medium risk group and the second year in the high risk group of patients.     

Psychologists' knowledge of their states' laws pertaining to Tarasoff-type situations.

This study examined psychologists' knowledge of their legal and ethical responsibilities with imminently dangerous clients. We randomly surveyed 1,000 psychologists from four states and received 300 useable responses (30%). Most psychologists (76.4%) were misinformed about their state laws, believing that they had a legal duty to warn when they did not, or assuming that warning was their only legal option when other protective actions less harmful to client privacy were allowed. Moreover, in spite of the inaccuracy of their knowledge, many respondents were confident that they understood the duty to protect in their own state. Contrary to expectation, we found no significant association between legal knowledge and continuing education in legal and ethical issues, graduate training in ethics, or clinical experience with dangerous clients. These findings suggest that educational experiences during and after graduate school may not be meeting the needs of professionals to understand the complicated array of state laws and ethical duties regarding dangerous clients. We recommend several changes in the provisions of these experiences to better protect psychologists and clients from unintentional risks. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sertoli cell transplants: their use in the treatment of neurodegenerative disease

The efficacy of treating neurodegenerative diseases with the transplantation of fetal tissue has been demonstrated in animal models of Parkinson's disease, Huntington's disease and stroke. In the clinical setting, neural transplantation as a treatment for patients with Parkinson's disease has shown promising results. However, for this treatment method to be effective neuronal survival needs to be improved through either trophic support or localized immunoprotection. Co-transplanting Sertoli cells, which express many nutritive, regulatory, trophic and immunosuppressive factors, with fetal neural cells could provide both of these requirements. Such a strategy could enhance the recovery benefits associated with transplantation and decrease the need for, and the risks associated with, long-term systemic immunosuppression.     

Informed consent: recent changes in the law

Physicians have the legal duty to disclose all risks and consequences of a proposed procedure. This duty must be understood as a reversal of previous legal doctrine. Disclosure is adequate only when a patient has enough information from that disclosure to decide for himself which way he wants to go and what treatment he wants to choose from among the options available to him. Relevance of disclosure, not fullness, is the criterion of sufficiency. The idea that the doctor or the profession knows best what the patient should do has been rejected as a legal standard in the District of Columbia, California, New York, Wisconsin, Kansas and Rhode Island. It is expected that more states will follow this trend. The informed part of the doctrine of informed consent is only the tip of an iceberg of social change.     

Fatal amniotic fluid embolism during induced abortion, 1972-1975

From 1972 to 1975, four women have died in the United States from documented amniotic fluid embolism during legal induced abortion. These women, whose pregnancies ranged from 14 to 35 menstrual weeks, had intra-amniotic saline instillation (three cases) and hystereotomy (one case). Performance of abortion in the first trimester and use of curettage technics could minimize the risks of this catastrophe.     

Familial melanoma

Short bowel syndrome is the clinical manifestation of a fundamental reduction in the functional intestinal absorptive surface area and malabsorption. The development of total parenteral nutrition has improved the natural course of this disease. Home parenteral nutrition-related complications continue to generate significant morbidity and mortality for these patients. Small-bowel transplantation is an alternative to home parenteral nutrition. There are significant risks of graft rejection and the potential complications of long-term immunosuppression. Small-bowel transplantation is an option, but it should be reserved for patients no longer considered candidates for continued home parenteral nutrition.     

Lung transplantation in chronic obstructive lung diseases

Lung transplantation (uni- or bilateral) is an accepted treatment option for patients with end-stage chronic obstructive pulmonary disease. Pulmonary function improves significantly and 5-year-actuarial survival is more than 70% at acceptable early mortality rates. Careful evaluation of risks and benefits in necessary because of the known donor-organ shortage and the risks of life-long immunosuppressive treatment. The bronchiolitis obliterans syndrome is still a nonsolved problem in the long-term course after LTx and it can influence late graft function and patient survival.     

Results of renal transplantation in boys treated for posterior urethral valves

The results of renal transplantation in boys treated for posterior urethral valves were evaluated and compared with a matched control group. Patient and graft survival was equal in both groups, although serum creatinine levels were slightly higher in the posterior urethral valves group. Postoperative complications, such as urinary tract infections, occurred more frequently in the posterior urethral valves group. Urodynamic evaluation was performed before transplantation in 11 of 20 patients. Adequate treatment of bladder dysfunction, such as poor compliance and/or hyperreflexia, is essential in diminishing the risks of secondary graft damage due to severe bladder dysfunction.     

An overview of professional liability in occupational therapy

Occupational therapists occasionally are sued for professional malpractice; thus, they need to be aware of the law of malpractice, those areas of practice that present the greatest legal challenges, and strategies to reduce client injury and liability risks. This article provides an overview of the law of professional malpractice, explains the impact of various employment relationships on liability risks, reviews specific malpractice actions against occupational therapists, and provides suggestions on how to reduce the risk of injuring a client in therapy. By increasing one's awareness of the legalities of professional malpractice and implementing certain strategies, therapists can improve quality of care and reduce their exposure to malpractice liability.     

Quality of life issues: parenteral nutrition to small bowel transplantation--a review

Parenteral nutrition (PN) has given life to patients with chronic intestinal failure who would otherwise have died. Home parenteral nutrition has improved the quality of life for many children. However, morbidity from this therapy remains significant with complications of line sepsis, lack of venous access, hepatic dysfunction, and pulmonary embolism. These complications are common in younger children. Detailed discussion must take place with the family regarding risks and benefits of PN. In those children developing complications of PN, intestinal transplantation is a logical extension of treatment. Early referral of patients for assessment is vital because significant mortality occurs when liver disease is established. Time is needed to counsel families on the potential benefits and risks of this treatment, including the physical and emotional demands made on the child and family. Overall worldwide survival for isolated small bowel transplantation is currently 50% and for combined small bowel and liver transplantation 40%. Significant complications are rejection, sepsis, and lymphoproliferative disease. Postoperative management can be complex and prolonged; child and parents require a great deal of physical and emotional support. The burden of care for parents decreases significantly after the first year. Small bowel transplantation offers a realistic alternative to PN. The choice of treatments is influenced by expected quality of life, which is just beginning to be evaluated.     

Service-learning for graduate students

OBJECTIVES: The European Commission funded EUROTOLD Project sought to examine the legal and ethical implications of living donor organ transplantation within Europe, facilitated by a multi-centre study acquiring data on practices, laws, policies, attitudes and decision-making processes. METHODS: Methods involving primary sources included interviews with clinical staff and past and present organ donors and recipients, and questionnaire surveys of transplant centres, individual clinical staff and legal experts. These strategies were supplemented by an examination of secondary sources such as official reports, transplantation literature, etc. RESULTS: The surveys generated substantial new evidence relating to transplant centre policies and practices, and the attitudes of physicians toward living donation generally and the use of certain specific classes of donor. The latter was facilitated by the use of case scenarios, providing a window upon factors influencing judgments in this sphere. The interview data confirmed earlier findings about donor decision-making. CONCLUSIONS: Responding centres and clinicians displayed a fairly liberal attitude toward living donation but substantial diversity nonetheless exists with regard to living donor transplant volumes between centres and surrounding acceptable waiting times for transplant. Further research is required to identify precisely the reasons underpinning such disparity.