[The definition of death and organ retrieval: a persisting philosophical controversy].

Since the publication of the recommendations of the ad hoc committee of the Harvard Medical School to examine the definition of brain death in 1968, philosophical discussions concerning the licit character of organ retrieval in brain dead patients never ceased. The present paper summarizes the main arguments of supporters and opponents of this procedure.

[Ethics of organ retrieval after controlled cardiac arrest].

The article tells the evolution of the terminology concerning non heart beating donors during the two last decades and describes summarily the procedure of organ retrieval after controlled cardiac arrest. We then consider the various ethical problems created by this practice. We discuss in detail therapeutic withdrawal, the treatment of the donor during the agonal period, death certification, the doctor's conflict of interests, the presence of the family at the time of death, the quality of the organs and organ retrieval after euthanasia.

[Serendipity, beneficial error, and chance in the development of kidney transplantation].

Serendipity played an essential role in two major developments of organ transplantation: the method of continuous hypothermic perfusion of the kidney and the introduction of ciclosporin in the clinical setting. An erroneous reasoning lead to the creation of an efficient preservation fluid: Collins's solution. However, these investigations would have failed without the open-mindedness and the tenacity of the clinicians.

Some historical notes on the diagnosis of death--the emergence of the brain death concept.

This paper demonstrates that discussions about the diagnosis of death and the meaning of states of suspended animation existed long before the publication of the Harvard criteria in 1968. The surgeons who started retrieving kidneys from heart beating cadavers have been accused to redefine death in order to obtain high quality organs. In fact, they were not aware of modifying a definition.

[The evaluation of medical treatments in the course of ages: from antiquity to the first randomized controlled trial].

This paper describes the chief landmarks in the slow development of therapeutic research from antiquity to the first randomized controlled trial.

[Christian religions and organ transplantation].

The present paper describes the position of catholic, protestant and orthodox Churches concerning the various aspects of organ retrieval and transplantation. The official position of the catholic Church, defined by the pope favors these activities if they respond to strict rules. The absence of magisterium in the protestant and orthodox Churches causes sometimes divergent opinions among the members of the clergy.

[Experience about more than 2000 renal transplantations at the university of Brussels].

Since 1965, more than 2000 renal transplantations (including more than 100 living-donor transplantations) have been performed at the University of Brussels. An end-stage renal disease patient candidate to renal transplantation will be therefore followed from his enrolment on the waiting list to the long-term post-transplant period. Improvement in the outcome of renal transplantation is achieved due to better knowledge in many fields of medicine, such as immunology, infectious disease, metabolic diseases (hyperlipemia, diabetes mellitus), pharmacology, use of immunosuppressive regimen, a more adequate cardiovascular prevention and treatment.

[Placebo and placebo effects (second part) : ethical aspects].

The use of placebo is controversial. It is generally accepted when no treatment exists for the disease under study but a polemic persists when a therapy is already regularly applied by medical practitioners. The paper cites and comments on the publications of national and international institutions (Belgian Medical Board, World Medical Association, Council for International Organizations of Medical Sciences) on this topic.

[Placebo and placebo effects (first part): definition, clinical aspects, mechanisms].

There are many papers devoted to placebo and placebo effects. The present article tries to provide a precise definition of these concepts and to take stock of our knowledge on this topic. Considering that most of the publications dealing with this phenomon are of poor scientific quality, some authors deny its existence.

[The enigma of the renal allografts performed in man in the early 1950s].

In the early 1950s, a few renal allografts were performed without immunosuppression in man. The paper describes these attempts and tries to explain the behavior of the medical doctors who undertook these human experimentations taking into account their personality, the knowledge at that time and the absence of treatment for end stage chronic renal failure.

[Evidence based surgery: ethical and methodological aspects].

Recently, it has been said that surgical clinical research was of poor quality because there are few randomized controlled trials in this area. This type of experimental protocol comes up against many difficulties in surgery and may induce a conflict between scientific requirements and ethical principles. Improving the quality of observational studies with simple measures may palliate the problem.

Sclerosing peritonitis: report of three cases.

Sclerosing peritonitis is a dramatic complication of continuous ambulatory peritoneal dialysis and chronic peritoneal inflammation. Both visceral and parietal surfaces of the peritoneal cavity are involved. A thickened peritoneum encloses the small intestine in a "cocoon" formation which often leads to intestinal occlusion.

History of the ISS/SIC: Robert Danis, a true general surgeon.

Robert Danis created his Prize in 1947 to reward a surgeon-member of the Société Internationale de Chirurgie (presently ISS-SIC), "author of the most important and personal work in connection with surgical treatment of fractures." Consequently, many people believe that Robert Danis was an orthopedic surgeon. In fact, he was a man interested in all fields of surgical activity, not only in bone and joint surgery.

Persistent hyperparathyroidism requiring surgical treatment after kidney transplantation.

There are not many publications describing long-term follow-up of persistent hyperparathyroidism requiring surgical treatment after kidney transplantation (PHSKT). In some patients adenomas, rather than multiglandular disease, have been incriminated as the cause of PHSKT. We reviewed the charts of 45 patients followed for 12 to 146 months (median 45 months) after parathyroidectomy for PHSKT.

Long-term results of subcutaneous parathyroid grafts in uremic patients.

Hypothesis: Parathyroid glands are normally surrounded (entirely or partially) by fatty tissue. Subcutaneous parathyroid grafts are thus located in a normal environment. Therefore, we postulated that the late results of subcutaneous implantation of parathyroid tissue in uremic patients should be at least as good as those reported for intramuscular grafting.

[What degree of freedom is there for living donors?].

The shortage of cadaveric donors has induced a renewed interest in living kidney donation. This paper describes the legal, religious and ethical factors which ensure or restrict the autonomy of the potential donor. We conclude that it is possible with appropriate measures to protect his freedom of choice.

Male recipients of kidneys from female donors are at increased risk of graft loss from both rejection and technical failure.

The aim of the present retrospective study was to uncover the factor(s) responsible for the poor outcome of cadaver kidney grafts from female donors in male recipients. The 741 transplantations performed at our center from August 1983 to September 1997 were distributed into four groups according to recipient and donor gender: female donor to female recipient (F to F: n = 117), male donor to female recipient (M to F: n = 172), female donor to male recipient (F to M: n = 170), and male donor to male recipient (M to M: n = 282). All the patients received immunosuppressive therapy based on corticosteroids and cyclosporine, associated or not with either azathioprine or prophylactic anti-lymphocyte globulin.