Public policy governing organ and tissue procurement in the United States. Results from the National Organ and Tissue Procurement Study.

Objective: To determine why Required Request policies, which mandate that hospitals request donation from donor-eligible families, have not resulted in increased organ procurement.

Setting: Stratified sample of 23 acute-care general hospitals in two metropolitan areas.

Design: Chart review identified all eligible donors in study hospitals during a 20-month period.

Assessing the significance of treatment effects: comments from the perspective of ethics.

The process of designing research protocols for testing treatment effects and reporting the results of such research demands both explicit and implicit value judgments. When measuring the effects of alternative treatments, those judgments can include decisions about what outcomes to measure and for which persons they should be measured, how to aggregate disparate outcomes, and how to decide whether differences are substantial enough to differentiate between treatments. Researchers and reviewers often do not acknowledge problems of this sort, and default solutions are based on common usage rather than any epistemologic justification.

Predictors of cancer prevention attitudes and participation in cancer screening examinations.

Background: Few current data are available regarding factors associated with participation in cancer screening examinations in the general population.

Methods: To identify factors associated with participation in cancer screening examinations, random population samples of 25- to 74-year-old men and women in six various-sized communities in three upper-Midwestern states (n = 4,915) were surveyed in 1987-1989. Multivariate-adjusted means were calculated and compared using analysis of covariance.

Trends in diabetes prevalence among stroke patients and the effect of diabetes on stroke survival: the Minnesota Heart Survey.

This study documented trends in the prevalence of diabetes among men and women hospitalized for acute stroke and determined the effect of diabetes on short- and long-term survival following stroke. These issues were investigated in the Minnesota Heart Survey, a population-based surveillance system that has monitored trends in stroke morbidity and mortality in the Minneapolis-St Paul metropolitan area since 1970. Clinical data were obtained from the hospital records of 50% samples of residents ages 30 to 74 years who were discharged with a diagnosis of acute stroke in 1970, 1980, and 1985.

Knowledge, attitudes, and personal practices regarding prevention and early detection of cancer.

Methods: To determine population knowledge, attitudes, and personal practices regarding prevention and early detection of cancer, random population samples of 25- to 74-year-old men and women in six various-sized communities in three upper-midwestern states (N = 4,915) were administered surveys and interviews during 1987-1989.

Results: Four-fifths of respondents believed cancer to be preventable. Knowledge of warning signs/symptoms of cancer and of leading causes of cancer, however, was low.

Is altruism enough? Required request and the donation of cadaver organs and tissues in the United States.

The lack of an adequate supply of cadaver organs and tissues for transplantation to those in need poses a major challenge to the transplant community and to those responsible for public policy. Historically, Americans have relied upon a combination of altruism and voluntarism to generate an adequate supply of cadaver organs and tissues. The ongoing shortage of organs and tissues has led, in recent years, for calls to abandon these values in favor of either a market system or a system of presumed consent.