The recent review of the Unrelated Live Transplant Regulatory Authority (ULTRA) provides administrative and statistical information regarding living donor kidney transplantation in the United Kingdom.1 However, it leaves much unsaid. For example, although the report does mention the number of live kidney donations from unrelated donors that ULTRA has approved, (69 in 2002: S Pioli, personal communication, 2001) it fails to mention that the United Kingdom has a low live kidney donation rate compared with other European countries (in 1999, 5.3 kidney donors per million population in the UK; 8.7 in Switzerland, 11.5 in Sweden, 24.6 in Norway).2 More importantly, the report does not address the fundamental question of whether the legal framework underlying ULTRA is morally justified. The legal regime in the United Kingdom proceeds on the tacit assumption that genetically unrelated donors are much more vulnerable to coercion than are related donors, and hence are more in need of protective regulation. In this article, we argue that the distinction drawn in the United Kingdom between genetically related and unrelated donors is difficult to justify, that it unnecessarily discourages live organ donation, and that the law should be changed. The Unrelated Live Transplant Regulatory Authority is a creature of the Human Organ Transplant Act (HOTA), which was enacted by parliament in 1989, and which came into force, with regulations, on 1 April 1990.3–5 The Human Organ Transplant Act was enacted hastily after the General Medical Council’s inquiry into the notorious case of a British physician’s involvement in transplants involving Turkish peasants.6 Young men were inveigled by an agent to travel to London, ostensibly to take up new jobs. In fact, they were being recruited as living donors of kidneys transplanted into fee paying foreign patients. The consequent debate in the media attracted an emotional …

This manual is designed to provide teaching modules on medical ethics for health care professionals in developing countries. The author acknowledges that, although there are common themes, their medical ethical dilemmas are often quite different from those which occur in developed countries and the approach needs to be somewhat less Western in orientation. Emphasis is properly given to topics such as AIDS/HIV and the status of women and children which create special local problems. Although universal principles of medical ethics are affirmed, care is taken to avoid the trap of imposing “our” views and solutions on “their” situations. As a teaching aid the manual is well constructed, starting with the enunciation of general principles, followed by comment and a series …

The death of Christiaan Barnard has revived some personal memories. More importantly, it reminds us that his operations at the end of 1967 initiated the production of a set of legal and philosophical justifications for the removal of a beating heart from a prospective donor. Thirty four years later they remain a topic of controversy.#### Summary pointsIn 1967, when Christiaan Barnard carried out the first human heart transplants, there were no guidelines for the diagnosis of death of beating heart donorsThe relative success of Barnard's second heart transplant was followed by a period of uncontrolled copycat operations in many countries, with predictably poor resultsThe UK definition of brainstem death, introduced by the Conference of Royal Colleges and their Faculties in 1976, has proved reliable and robust in clinical practiceOn 3 December 1967 the heart of a young female accident victim was transplanted into a middle aged man suffering from intractable heart failure caused by coronary artery disease. He died 18 days later from extensive bilateral pneumonia. This limited success was hailed throughout the world as a major medical triumph, turned Barnard into an international superstar, and provided the impetus for him to try it again.His second subject, Dr Philip Blaiberg, was given a heart transplant less than two weeks later, which brings me to the very minor role I played in the whole saga. The “donor,” a young man who had had a severe subarachnoid haemorrhage while bathing in the sea, was admitted under my care. He was, in fact, the last patient I was permitted to admit to Groote Schuur Hospital in Cape Town. A government banning order (under the blanket “Suppression of Communism Act”) included a clause that stopped me from teaching or entering any educational institution. This came into effect next morning.On my …

Is there a moral case for changing the law regulating organ donation from a system of "contracting in" to "contracting out" or "presumed consent" in those countries that have not yet done so? Contracting in refers to a system in which the law requires that donors and/or relatives must positively indicate their willingness for organs to be removed for transplantation. In a contracting out system, organs may be removed after death unless individuals positively indicate during their lifetimes that they did not wish this to be done, a system also known as presumed consent.

OBJECTIVES:To explore the way ethical principles develop during a medical education course for three groups of medical students--in their first year, at the beginning of their penultimate (fifth) year and towards the end of their final (sixth) year.DESIGN:Survey questionnaire administered to medical students in their first, fifth and final (sixth) year.SETTING:A large medical school in Queensland, Australia.SURVEY SAMPLE:Approximately half the students in each of three years (first, fifth and sixth) provided data on a voluntary basis, a total of 385 students.RESULTS:At the point of entry, minor differences were found between medical students and first year law and psychology students. More striking were differences between male and female medical students, suggesting early socialization had a substantial impact here.CONCLUSIONS:Results indicate that substantial changes in attitude have developed by the beginning of fifth year with little change thereafter. Gender difference persisted. Some difference in ethical attitudes were found when groups of different ethnic backgrounds were compared. The impact of a move to a graduate medical course, which gives high priority to ethics within a professional development domain, can now be evaluated.

When the practice of buying kidneys from live vendors first came to light some years ago, it aroused such horror that all professional associations denounced it 1 British Transplantation Society Working PartyGuidelines on living organ donation. BMJ. 1986; 293: 257-258 Crossref PubMed Scopus (22) Google Scholar , 2 The Council of the Transplantation SocietyOrgan sales. Lancet. 1985; 2: 715-716 PubMed Google Scholar and nearly all countries have now made it illegal. 3 World Health OrganizationA report on developments under the auspices of WHO (1987-1991). WHO, Geneva1992: 12-28 Google Scholar Such political and professional unanimity may seem to leave no room for further debate, but we nevertheless think it important to reopen the discussion.

A shortage of donor organs limits most transplant programmes: some patients die of otherwise untreatable end-organ failure, others, in chronic renal failure, are obliged to continue with costly and distressing dialysis procedures. The Council on Ethical and Judicial Affairs of the American Medical Association stated in 1995 that it is ethically permissible for an anencephalic neonate to be an organ donor, although still legally alive by virtue of the current definition of death. If changes in public thinking and the law were to make possible the use of organs from patients in permanent vegetative state, it would be necessary, as in the case of abortion, to include a conscience clause allowing doctors and nurses the right to refuse to take part in the procedure. For religious, cultural, and other traditional reasons, it is likely that the proposal would be rejected, nevertheless, the arguments in favour are sufficiently compelling to justify serious debate.

Training of the physician in the United Kingdom comprises two separate but contiguous elements: (1) Preparation for and success in the entrance examination (MRCP or equivalent); this is usually covered by the title, General Professional Training (GPT); (2) further or Higher Medical Training (HMT) in General (Internal) Medicine or one of its specialties; this usually leads to accreditation which is a desirable but not essential prerequisite to appointment as a consultant. The minimum period associated with these is 3 years for GPT and 4 years for HMT.

Serum thyroglobulin (Tg) was measured on repeated occasions in 416 patients with differentiated thyroid cancer for up to 7 years after initial therapy. All patients had thyroidectomy and/or ablative 131I therapy and all measurements were done while patients were receiving T4 replacement. Tg was measured using a double-antibody radioimmunoassay. Overall correlation between serum Tg concentration and presence or absence of cancer was 95.9%. At the time of initial measurement 295 patients had serum Tg less than 5 micrograms/l, and in latest analysis only 1.7% of these patients showed evidence of disease. Initially there were 19 patients of a total of 121 with serum Tg greater than 5 micrograms/l in whom no cancer was apparent. In eight of these 19 subjects recurrent or metastatic disease has been diagnosed up to 3.5 years after the first measurement indicating that in these cases serum Tg values were 'predictive'. Serum Tg appears to be a sensitive and specific means of detecting residual, recurrent or metastatic thyroid cancer and in most situations can replace routine, expensive and inconvenient radioactive thyroid scans; these should be performed when serum Tg values are elevated or when there is clinical evidence suggesting recurrence.

same parents came a complex ideology, linked with a recognisable and honoured ancestry. The few survivors must have felt also that they had been chosen for their subsequent, roles. It would be understandable for such individuals to idealise their parents, even when recognising that they,were less than perfect. In other works Bettelheim deals with the legends and fairy tales about parents and children. In TheEmpty Fortress,I which describes his work with autistic children, he examines the literature on,so called "feral children." He questions the authenticity of the accounts of these children and speculates on the reasons for the persistence ofthe myth, so cordially believed by those psychologists who tend to minimise the importance of the influence of parents on their children. Bettelheim has recently turned from writing, but he is sought after by television interviewers. He may well have given up the enchantments of authorship just as he has had to give up his treatment of untreatable children; but he can say, like Prospero in the epilogue of The Tempest,

On 7 December the presidents of the Royal Colleges ofPhysicians, Surgeons, and Obstetricians and Gynaecologists issued the following joint statement Each day we learn of new problems in the NHS?beds are shut, operating rooms are not available, emergency wards are

1 Selwyn S. Skin preparation, the surgical "scrub" and related rituals. In: Karran S, ed. Connsrsies in surgical sepsis. Eastbourne and New York: Praeger, 1980:23-32. 2 Selwyn S. Aseptic rituals unmasked. BrMedJ 1984;289:1642-3. 3 Lidwell OM, Lowbury EJL, Whyte W, Blowers R, Stanley SJ, Lowe D. Airborne contamination of wounds in joint replacement operations: the relationship to sepsis rates. J Hosp Infect 1983;4:111-2 1. 4 Lidwell OM, Lowbury EJL, WhyteW, BlowersR, Stanley SJ, Lowe D. The effect ofultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. BrMedJ 1982;285:10-4. 5 Medical Research Council. Design and ventilation of operating-room suites for control of infection and comfort. Lancet 1%2;ii:945-51. 6 Lidwell OM. Bacteriological considerations. In: Johnston DA, Hunter AR, eds. The design and utilization ofoperating theates. London: Arnold, 1984:22-38. 7 Dondero TJ Jr,,Rendtorff RC, Mallison GF, et al. An outbreak of legionnaires' disease associated with contaminated air-conditioning cooling tower. N EnglJ Med 1980;302:365-70. 8 Howorth FH. The air in the operating theatre. In: Johnston DA, Hunter AR, eds. The design and utlation ofoperating theatres. London: Arnold, 1984:39-60. 9 Clark RP, Reed PJ, Seal DV, Stephenson ML. Ventilation conditions and airborne bacteria particles in operating theatres: proposed safe economies. Hyg (Camb) 1985;95:325-35.

bers of the Gloucestershire Medical Society which met in the parlour of the Fleece Inn, Rodborough, and became known as the Fleece Medical Society. It was before this society in July 1788 that Parry presented his famous paper entitled 'An Inquiry into the Symptoms and Causes of the Syncope Anginosa, commonly called Angina Pectoris' in which he clearly stated the coronary origin of the symptom. He failed to publish his observations until 11 years later (1799), a delay that also characterised his publication on exophthalmic goitre, for he had seen his first case in 1786 and correctly recognised it to be a new and distinct syndrome; publication did not take place until 1825, three years after his death, but still well in advance of Graves' description of the disease. The first edition of Osier's textbook of 1892 discusses exophthalmic goitre under the eponyms of Graves and von Basedow, whose description followed in 1840. The third edition of 1898 refers to it as Parry's disease and contains a defence of Parry's right to the eponym. Both Parry and Graves recognised the important triad of the disease?exophthalmos, palpitations and goitre? but they failed completely to appreciate the role of the thyroid in its genesis. The goitre was regarded as a swelling or diverticulum designed to siphon off the superfluous blood in the circulation, thereby preventing a serious flooding of the brain. Graves, in fact, referred to the thyroid as 'analogous to those tissues properly called erectile'. At the time there was no comprehension of the role of endocrine glands as organs which secreted materials into the circulation and certainly not of disease which might follow excessive secretion. The fact that these organs were known to be ductless must have contributed to this lack of comprehension. I should like to review how the light gradually dawned. The story is sometimes said to have started with John Hunter, but his experiments on transplantation of a cock's testis appear to have been carried out as experiments in transplantation rather than studies of the organ's function and there is nothing to suggest that he comprehended their endocrine significance. Arnold Adolf Berthold published in 1849 the results of similar experii

Conference Abstract| January 01 1985 Thyroid Stimulating Hormone (TSH) and Triiodothyronine (T3) May Interact in Regulating Thyroglobulin (TG) Release E.G. Black; E.G. Black 1Department of Medicine, University of Birmingham, Queen Elizabeth Hospital, Birmingham B15 2TH Search for other works by this author on: This Site PubMed Google Scholar M.C. Sheppard; M.C. Sheppard 1Department of Medicine, University of Birmingham, Queen Elizabeth Hospital, Birmingham B15 2TH Search for other works by this author on: This Site PubMed Google Scholar R. Hoffenberg R. Hoffenberg 1Department of Medicine, University of Birmingham, Queen Elizabeth Hospital, Birmingham B15 2TH Search for other works by this author on: This Site PubMed Google Scholar Author and article information Publisher: Portland Press Ltd Online ISSN: 1470-8736 Print ISSN: 0143-5221 © 1985 The Biochemical Society and the Medical Research Society1985 Clin Sci (Lond) (1985) 68 (s11): 70P–71P. https://doi.org/10.1042/cs068070Pb Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Citation E.G. Black, M.C. Sheppard, R. Hoffenberg; Thyroid Stimulating Hormone (TSH) and Triiodothyronine (T3) May Interact in Regulating Thyroglobulin (TG) Release. Clin Sci (Lond) 1 January 1985; 68 (s11): 70P–71P. doi: https://doi.org/10.1042/cs068070Pb Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1985 The Biochemical Society and the Medical Research Society1985 Article PDF first page preview Close Modal You do not currently have access to this content.

Conference Abstract| December 01 1984 Can Serum Thyroglobulin Predict Immediate Relapse in Graves Disease When Discontinuing Carbimazole? R Wilkinson; R Wilkinson 1Department of Medicine, University of Birmingham, Queen Elizabeth Hospital Birmingham B15 2TH Search for other works by this author on: This Site PubMed Google Scholar E Black; E Black 1Department of Medicine, University of Birmingham, Queen Elizabeth Hospital Birmingham B15 2TH Search for other works by this author on: This Site PubMed Google Scholar R Hoffenberg R Hoffenberg 1Department of Medicine, University of Birmingham, Queen Elizabeth Hospital Birmingham B15 2TH Search for other works by this author on: This Site PubMed Google Scholar Clin Sci (Lond) (1984) 67 (s9): 19P. https://doi.org/10.1042/cs067019P Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Citation R Wilkinson, E Black, R Hoffenberg; Can Serum Thyroglobulin Predict Immediate Relapse in Graves Disease When Discontinuing Carbimazole?. Clin Sci (Lond) 1 December 1984; 67 (s9): 19P. doi: https://doi.org/10.1042/cs067019P Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu nav search search input Search input auto suggest search filter All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1984 The Biochemical Society and the Medical Research Society1984 Article PDF first page preview Close Modal You do not currently have access to this content.

Total and free thyroid hormones were measured in a group of asymptomatic subjects with high circulating TSH concentrations and a previous history of radioiodine therapy. Subjects in the high TSH group all fell within the normal range for measurements of total T4, total T3 and T4/TBG ratio. Concentrations of free T4 or free T3 were below the normal range in more than half (9 out of 17) of the high TSH group suggesting that these measurements are more sensitive indices of thyroid failure than measurement of total hormones or T4/TBG ratio.