**روان**
•
أشكرك أختي والله انك تعبت جعل ربي كل حرف كتبتيه في ميزان حسناتك
maitha04
•
ان شاءالله ترجعيين بالسلامه
وبغييت منك هالموضوعيييين :)
1- Write about Ramadan
2- Write about the EID celebration
وجزاكِ الله خيــــــــر على الموضوع الراااااائعه :26:
وبغييت منك هالموضوعيييين :)
1- Write about Ramadan
2- Write about the EID celebration
وجزاكِ الله خيــــــــر على الموضوع الراااااائعه :26:
السلام عليكم حبيباتي انا رجعت الحمد الله
و اي موضوع تبونه انا موجوده
و شكرا على رسايلكم و ردودكم
و صدق وحشتوني كلكممممممممممممممممممممم
و اي موضوع تبونه انا موجوده
و شكرا على رسايلكم و ردودكم
و صدق وحشتوني كلكممممممممممممممممممممم
maitha04 :
ان شاءالله ترجعيين بالسلامه وبغييت منك هالموضوعيييين :) 1- Write about Ramadan 2- Write about the EID celebration وجزاكِ الله خيــــــــر على الموضوع الراااااائعه :26:ان شاءالله ترجعيين بالسلامه وبغييت منك هالموضوعيييين :) 1- Write about Ramadan 2- Write...
Ramadan
Ramdan, the ninth month of the Islamic year, is a holy month of fasting ordained by
the Koran for all adult Muslims . According to the Koran, the fast of Ramadan has been
instituted so that believers will become more pieous. This particular month was designated
because it was the month during which Muhammad received the first of the Koran's
revelations.
The fast during Ramadan begins each day at dawn and ends immediately at sunset. During the
fast Muslims are forbidden to eat, drink, or smoke. Before going to sleep each night, special
congregational prayers are offered in which long passages of the Koran are read. The night
between the 26th and 27th days of Ramadan, the night of the first revaltion, is called the Night of
Determination, during which God determines the course of the world for the following year. The
day after the end of Ramadan is called the Fast-Breaking and is celebrated with special prayers
and festivities.
This marks the end of Ramadan, the month of fasting, and is a festival of great celebration. In Islamic countries it is a public holiday. The first Eid was celebrated in 624 CE by the Prophet Mohammed (pbuh) with his friends and relatives.
Muslims are not only celebrating the end of fasting, but thanking Allah for the help and strength that he gave them throughout the previous month to help them practice self-control.
The festival begins when the first sight of the new moon is seen in the sky.
Muslims in most countries rely on news of an official sighting, rather than looking at the sky themselves.
Eid ul Fitr is very much a community festival and people go out into the streets to exchange greetings, and visit friends and relatives.
The celebratory atmosphere is increased by everyone wearing best or new clothes, and decorating their homes. There are special services out of doors and in Mosques, processions through the streets, and of course, a special celebratory meal?eaten during daytime, the first daytime meal Muslims will have had in a month.
Eid is also a time of forgiveness, and making amends.
Eid ul Adha (10 Dhul-Hijja)
The Festival of sacrifice which marks the end of the Hajj or holy pilgrimage, which is one of the 5 pillars of Islam, however it is celebrated by all Muslims, not just those who are on the pilgrimage.
The festival remembers the prophet Ibrahim?s willingness to sacrifice his son when God ordered him to. God appeared in a dream to Ibrahim and told...
Ramdan, the ninth month of the Islamic year, is a holy month of fasting ordained by
the Koran for all adult Muslims . According to the Koran, the fast of Ramadan has been
instituted so that believers will become more pieous. This particular month was designated
because it was the month during which Muhammad received the first of the Koran's
revelations.
The fast during Ramadan begins each day at dawn and ends immediately at sunset. During the
fast Muslims are forbidden to eat, drink, or smoke. Before going to sleep each night, special
congregational prayers are offered in which long passages of the Koran are read. The night
between the 26th and 27th days of Ramadan, the night of the first revaltion, is called the Night of
Determination, during which God determines the course of the world for the following year. The
day after the end of Ramadan is called the Fast-Breaking and is celebrated with special prayers
and festivities.
This marks the end of Ramadan, the month of fasting, and is a festival of great celebration. In Islamic countries it is a public holiday. The first Eid was celebrated in 624 CE by the Prophet Mohammed (pbuh) with his friends and relatives.
Muslims are not only celebrating the end of fasting, but thanking Allah for the help and strength that he gave them throughout the previous month to help them practice self-control.
The festival begins when the first sight of the new moon is seen in the sky.
Muslims in most countries rely on news of an official sighting, rather than looking at the sky themselves.
Eid ul Fitr is very much a community festival and people go out into the streets to exchange greetings, and visit friends and relatives.
The celebratory atmosphere is increased by everyone wearing best or new clothes, and decorating their homes. There are special services out of doors and in Mosques, processions through the streets, and of course, a special celebratory meal?eaten during daytime, the first daytime meal Muslims will have had in a month.
Eid is also a time of forgiveness, and making amends.
Eid ul Adha (10 Dhul-Hijja)
The Festival of sacrifice which marks the end of the Hajj or holy pilgrimage, which is one of the 5 pillars of Islam, however it is celebrated by all Muslims, not just those who are on the pilgrimage.
The festival remembers the prophet Ibrahim?s willingness to sacrifice his son when God ordered him to. God appeared in a dream to Ibrahim and told...
لا يمكنك مشاهدة هذا التعليق لانتهاكه شروط الاستخدام.
التبرع بالأعضاء
Organ donation is the removal of the tissues of the human body from a person who has recently died, or from a living donor, for the purpose of transplanting or grafting them into other persons. Organs and tissues are removed in procedures similar to surgery, and all incisions are closed at the conclusion of the surgery. Steps are taken to provide a traditional funeral viewing so that people will not know the deceased was a donor. People of all ages may be organ and tissue donors. See "organ transplant" for discussion of the mechanics and history of organ transplantation.
In numerical terms, donations from dead donors far outweigh donations by living ones. The laws of different countries allow either the potential organ donor to consent or dissent to the donation during his life time, or his relatives to consent or dissent. Due to these different legislative possibilities, the number of donations per million people varies substantially in different countries.
Organs and tissues which can be donated
Organs that can be procured include: the heart, intestines, kidneys, lungs, liver, pancreas. These are procured from a brain dead donor or a donor where the family has consent for donation after cardiac death also known as DCD. This is where the donor has not progressed to brain death.
The following tissues can be procured: bones, tendons, corneas, heart valves, femoral veins, great saphenous veins, small saphenous veins, pericardium, skin grafts, and the sclera (the tough, white outer coating surrounding the eye). These are only procured after someone has died.
Organs that can be donated from living donors include the lung, partial liver or pancreas and the kidney.
Legislation regarding organ donation
There are basically four different legislative approaches to the donation, if the donor has not explicitly dissented. The least restrictive approach is the "dissent solution", according to which the donor has to explicitly dissent to donation during his lifetime. According to the "extended dissent solution", relatives may dissent in the event the potential donor has not consented.
The different legislative approaches are the main reason that countries like Spain (27 donors per million inhabitants) or Austria (24 donors per million inhabitants) have higher "donor rates" than Germany (13 donors) or Greece (6 donors). In most countries with the dissent solutions, there is no "waiting list" for donations, or the list is short, while most countries with consent solutions have substantial "organ shortages".
Under United States law, the regulation of organ donation is left to states within the limitations of the federal National Organ Transplant Act of 1968. Each state's Uniform Anatomical Gift Act seeks to streamline the process and standardize the rules among the various states, but it still requires that the donor make an affirmative statement during her or his lifetime that she or he is willing to be an organ donor. Many states have sought to encourage the donations to be made by allowing the consent to be noted on the driver's license. Still, it remains a pure consent system rather than an extended consent system or even a dissent opt-out system. Curiously, though, relatives can still dissent even in the presence of evidence of explicit consent by the potential organ donor (driver's liscence, living will, registry information, etc.). As such, many organ donation campaigns in the United States encourage family communication about one's decision to donate or not to donate.
Teleological issues
On teleological or utilitarian grounds, the moral status of "black market organ donation" relies upon the ends, rather than the means. In so far as those that donate organs are often impoverished and those that can afford black market organs are typically well-off, it would appear that there is an imbalance in the trade. In many cases, those in need of organs are put on waiting lists for legal organs for indeterminate lengths of time — many die while still on a waiting list.
Organ donation is fast becoming an important bioethical issue from a social perspective as well. While most first-world nations have a legal system of oversight for organ transplantation, the fact remains that demand far outstrips supply. Consequently, there has arisen a black market often referred to as transplant tourism.
The issues are weighty and controversial. On the one hand are those who contend that those who can afford to buy organs are exploiting those who are desperate enough to sell their organs. Many suggest this results in a growing inequality of status between the rich and the poor. On the other hand are those who contend that the desperate should be allowed to sell their organs, and that stopping them is merely contributing to their status as impoverished. Further, those in favor of the trade hold that exploitation is morally preferable to death, and insofar as the choice lies between abstract notions of justice on the one hand and a dying person desperately in need of an organ on the other hand, the organ trade should be legalized. Conversely, surveys conducted among living donors postoperatively and in a period of five years following the procedure have shown an extreme regret in a majority of the donors who said that given the chance to repeat the procedure, they would not . Additionally, many study participants reported a decided worsening of economic condition following the procedure
Legalization of the organ trade carries with it its own sense of justice as well. Continuing black-market trade creates further disparity on the demand side: only the rich can afford such organs. Legalization of the international organ trade could lead to increased supply, lowering prices so that persons outside the welathiest segments could afford such organs as well.
Exploitation arguments generally come from two main areas:
التبرع بالدم
Blood donation is a process by which a blood donor voluntarily has blood drawn for storage in a blood bank, generally for subsequent use in a blood transfusion.
Blood donation by the US Navy
Blood donations may be scheduled at local centres, or at times a "blood drive" will occur. These are events where a blood bank or other blood collecting organization will set up in a convenient location—such as a shopping centre, large employer, university, high school, or a local church—for people to stop in without appointment during their daily routine to donate blood. Sometimes a bloodmobile is used to run a blood drive. Usually a modified recreational vehicle, it is an easy place to run a blood drive because it is already set up for the process of blood donation.
Process
The process of giving blood involves screening the donor, the actual donation, and a brief recovery period. This applies to both whole blood donations and plasmapheresis, or donating only one's plasma (see "Donation" below).
Preparation
In the days prior to donating blood, it is important that donors prepare themselves for a process that can temporarily weaken the body. Donors should check their local blood bank's guidelines, as requirements and recommendations vary. Many blood banks recommend that potential donors drink extra water and fluids before donating. It may be advisable to avoid caffeinated beverages before donation. Eating well is also important, and can reduce the risk of reactions to donation. Eating foods high in iron (which has many dietary sources) is also a good idea; low hemoglobin levels may make a donor temporarily ineligible. This is especially true for women who have menstruated recently, because of iron loss in the menses. Some countries require donors to observe a limited or full fast before donation because of specific screening methods; in particular, some countries will discard blood taken too soon after a fatty meal. High levels of lipemia (essentially fat in the blood) can interfere with infectious disease testing.
Screening
Western countries typically impose screening for blood donor candidates. In the past, it was the practice in America and other countries to separate blood donations on the basis of race, ethnicity, or religion, or to exclude certain groups from the donor pool on those bases. Currently, in the United States, these practices have been eliminated, and donor attributes are considered only in terms of their likelihood to affect the probability of transmission of disease. All blood products in the U.S. are labeled as coming from either "paid" or "volunteer" donors, with paid units being more likely to transmit infection. (Several other countries avoid paid donations altogether for this reason.)
Blood donation at the Royal Melbourne Hospital during the 1940s.
Other donor characteristics are also taken into account: starting in 1985, the American Red Cross and Food and Drug Administration policies prohibit accepting blood donations from gay/bisexual men, specifically from any "male who has had sex with another male since 1977, even once," or from IV drug users or recent immigrants from certain nations with high rates of HIV infection. The inclusion of men who have sex with men on the prohibited list has created some degree of controversy ; the FDA & Red Cross cite the public policy need to protect the blood supply from HIV & similar diseases as justification for the ban, while others believe the ban to be discriminatory, since sexually active heterosexuals are not categorically banned and all donated blood is screened. Policies vary in other countries; for instance, Australia formerly had a similar ban, but now only prohibits donating blood within one year after male-male sex (longer than the typical window period for HIV blood screening tests performed on donated blood).
Similarly important donor eligibility requirement in the US is related to concerns about variant Creutzfeldt-Jakob Disease (vCJD): persons who have spent long periods of time in countries where "mad cow disease" is found are not eligible to donate. As part of the screening interview, blood donors are questioned about past residency in countries on the exclusion list, tracing back as far as 1980. The list of countries of residence that may disqualify a potential donor includes most of Western Europe (with stronger restrictions on those with past residence in the United Kingdom), Turkey, and all of Eastern Europe except Russia, Ukraine, Belarus, and the Baltic countries (those formerly part of the Soviet Union). From 1980 through 1996, if a person visited or resided in country on the exclusion list for a time that adds up to five years or more, the person is not eligible to donate; if a person spent time that adds up to three months or more in the United Kingdom, they are indefinitely deferred. This set of rules affects members of the US Armed Forces and others, who lived at least six months in certain European countries or 3 months in the United Kingdom from 1980 to 1996, who are therefore prohibited from donating blood. A similar policy with regard to vCJD applies in France, Quebec and in the rest of Canada.
When a donor arrives at a donation site, he or she typically fills out a consent form as well as answer an extensive questionnaire to help determine their eligibility. Questions include the donors' age, weight, most recent donation, current health, and various risk factors such as tattooing, drug use (recreational or performance enhancing), residency abroad, recent international travel, and sexual history. Answers are associated with the donor's blood, but not name, to provide anonymity.
Often the blood hemoglobin concentration will be checked next, typically performed by a phlebotomist. While various tests exist, the most common ones are:
Donated blood is tested by many methods, and a typical screening panel includes most of the tests below:
Donation
Disinfect, insert the cannula, pull out the cannula, dress the wound.
The blood donation itself happens next. The donor lies supine on a cushioned bench and extends an arm. The inner elbow is disinfected, and a cannula is inserted into the medial antecubital vein. A large bore needle is used to prevent hemolysis. The donor often has a tourniquet wrapped around his or her arm, or may be prompted to squeeze a ball repeatedly, to help speed the process. Blood flows from the vein, through the needle and a tube, and into a special collection bag which is placed on a small scale to measure the amount of blood withdrawn. After the bag is sufficiently filled, several test tubes are drawn from the same needle to be used for disease detection. Typically, around 450 millilitres, about a U.S. pint, is drawn during the blood donation process. The blood is stored in a blood bag which contains acid citrate dextrose, an anticoagulant which prevents blood clotting and preserves the blood for long periods of time.
A relatively large-bore needle is used for whole blood donations.
A mechanical tray tilts the bag to prevent congealing, and displays current volume and flow per minute.
Apheresis
Rather than donating whole blood, a donor sometimes has the option to donate only some blood components while retaining others. This process is known as apheresis, and is more involved, time consuming, and requires more specialized equipment. The benefit is that more of the desired components can be concentrated and removed, and the donor is usually able to donate significantly more frequently than if whole blood had been removed. In some cases, the usefulness of the removed components is not as sensitive to blood type considerations.
The typical method of apheresis is to draw whole blood from the donor, then centrifuge the blood to separate its components (see apheresis for more information). The desired components (e.g. platelets, plasma) are removed and then the remaining components are returned to the donor.
"Double red"
A recent innovation in apheresis is the "double red" donation, which extracts two units of red blood cells instead of the single unit of an ordinary whole-blood donation. This provides several benefits to both the donor and the blood bank. The donor can make the same red-cell contribution with half the visits, and the return of plasma to the body leaves the donator better hydrated. The process takes somewhat longer than a standard donation (about 35-45 minutes), but is much shorter than a regular apheresis visit. The blood bank receives twice the usual red-cell donation in each visit. Because more red cells are removed from the circulatory system, donors must meet some additional health requirements for a double-red donation.
Recovery
Once the donation is complete, the donor is given a bandage or gauze to stop further blood flow and is normally allowed to leave. Beverages and snacks may be provided to restore blood volume and blood sugar, and to settle the stomach. Often donors are encouraged to sit down for a few minutes to return to normality, as lightheadedness and faintness may occur. In some countries, stickers are worn by donors to show the donor's pride and to encourage others to give. The entire process, from screening through recovery has a variable time, it can take from some fifteen minutes to about one hour. The actual blood donation takes between four and fifteen minutes for whole blood donation. Donors are discouraged from heavy exercise or lifting for several hours. Plasma volumes will return to normal in around 24 hours, while red blood cells are replaced by bone marrow into the circulatory system within about 3-5 weeks, and lost iron replaced over 6-8 weeks. This recovery process can be accelerated by eating foods high in complex carbohydrates, iron, and other trace minerals. Due to the timeframe required for iron replacement, donors are eligible to donate whole blood approximately eight to twelve weeks after the previous donation, the exact period varying by country. In the USA, Whole Blood donations can be taken every 56 days, the waiting period for the "double red" apheresis donors is 112 days. Donors can donate far more frequently if taking iron supplements but this is generally only done under medical supervision.
Storage
Cryopreservation of red blood cells is done to store special, rare red blood cells for up to 10 years. The ten year outdate is not based on any specific research, it was chosen arbitrarily, and some blood banks maintain truly rare red blood cells past the ten years because there are no alternative sources. The cells are first incubated in a 40% glycerol solution which acts as a cryoprotectant ("antifreeze") within the cells. The units are then placed in special sterile containers in a deep freezer at less than -60 °C.
Donors for babies
A tiny percentage of adults may donate blood to small children in emergency rooms, newborn babies, and fetuses. To ensure the safety of blood transfusion to pediatric patients, including those in whom the immune systems are not fully developed, hospitals are taking every precaution to avoid infection and prefer to use specially tested pediatric blood units that are guaranteed negative for cytomegalovirus (CMV), because the consequences of CMV infection for newborns or low weight infants may be severe or even fatal. Additionally, for pediatric patients with certain disorders or in emergency, when there is no time to perform crossmatching, only O/Rh negative blood can be used for neonatal transfusion. Due to these specific restrictions, to be recognized as a baby donor an adult must test negative for cytomegalovirus, and some blood collection agencies such as the Red Cross also require baby donors that they be blood type O-negative. Since only 7% of US adults are O-negative and as few as 15% of adults do not carry CMV, only 1% of adults may qualify as baby donors. Other restrictions (body weight, HIV status, vCJD, etc. ) reduce the fraction of potential baby donors to less than 1 in 200. If an adult was not exposed to measles, mumps, rubella, or chicken pox, that amplifies the person's status as a baby donor.
Newborn babies that require multiple surgeries often need up to 20 units of blood in their first few weeks.
Complications
Slight bruising from the donation needle; shown 24 hours after donation
The finger prick and needle insertion typically cause only minor discomfort. Phlebotomists may, however, experience difficulties in obtaining enough blood from some donors.
During or shortly after the donation, hypovolemia may occasionally lead to a drop in blood pressure, with some donors experiencing light-headedness, nausea, or fainting. In some cases this may necessitate cancelling the donation, restoring blood volume with an intravenous infusion, or placing the donor in a Trendelenburg position (on a stretcher tilted "legs up"). Beverages may be given to replenish blood volume further, and the donor may have to remain in a horizontal position for a while under monitoring. Most blood banks encourage donors to rest for several minutes after donation (often while eating and drinking) to let them adjust to the loss of blood and reduce the risk of these problems.
In less than 1% of cases, improperly inserting the needle is followed by bruising of the arm in the weeks afterwards.
Negative medical reactions to blood donation are rare, and blood bank staff are trained to handle them.
Benefits
Donating blood may reduce the risk of heart disease for men and stimulate the generation of red blood cells.
In patients prone to iron overload (e.g. due to hemochromatosis), blood donation prevents the accumulation of iron. However, at this time the American Red Cross does not accept people with hemochromatosis to donate blood for other people. On the other hand, the Australian Red Cross Blood Service does accept blood from hemochromatosis as they recognise that it is a genetic disorder that does not affect the safety of the blood. In the US, a blood bank must allow patients with hereditary hemochromatosis to receive therapeutic phlebotomies (i.e. a blood donation) for free regardless of whether or not the blood can be used for transfusion. This is done to remove any financial incentive for therapeutic donors to lie about their health in order to be eligible, since normally they would pay for the phlebotomy.
Anecdotally, elderly people in good health have reported feeling invigorated by giving blood on a regular basis.
Other incentives are sometimes added by employers, usually time off for the purposes of donating. Blood centers will also sometimes add incentives such as assurances that donors would have priority during shortages or other programs. Other incentives may include prize drawings for donors and rewards for organizers of successful drives, especially during the summer months when blood is often in short supply. Very few blood donors (other than plasmapheresis donors) are paid for donating, as this again leads to concerns about donors being less than truthful about their health in order to receive a financial benefit.
The majority of blood donors, however, donate as an act of charity and do not expect to receive any direct benefit from the donation.
Organ donation is the removal of the tissues of the human body from a person who has recently died, or from a living donor, for the purpose of transplanting or grafting them into other persons. Organs and tissues are removed in procedures similar to surgery, and all incisions are closed at the conclusion of the surgery. Steps are taken to provide a traditional funeral viewing so that people will not know the deceased was a donor. People of all ages may be organ and tissue donors. See "organ transplant" for discussion of the mechanics and history of organ transplantation.
In numerical terms, donations from dead donors far outweigh donations by living ones. The laws of different countries allow either the potential organ donor to consent or dissent to the donation during his life time, or his relatives to consent or dissent. Due to these different legislative possibilities, the number of donations per million people varies substantially in different countries.
Organs and tissues which can be donated
Organs that can be procured include: the heart, intestines, kidneys, lungs, liver, pancreas. These are procured from a brain dead donor or a donor where the family has consent for donation after cardiac death also known as DCD. This is where the donor has not progressed to brain death.
The following tissues can be procured: bones, tendons, corneas, heart valves, femoral veins, great saphenous veins, small saphenous veins, pericardium, skin grafts, and the sclera (the tough, white outer coating surrounding the eye). These are only procured after someone has died.
Organs that can be donated from living donors include the lung, partial liver or pancreas and the kidney.
Legislation regarding organ donation
There are basically four different legislative approaches to the donation, if the donor has not explicitly dissented. The least restrictive approach is the "dissent solution", according to which the donor has to explicitly dissent to donation during his lifetime. According to the "extended dissent solution", relatives may dissent in the event the potential donor has not consented.
The different legislative approaches are the main reason that countries like Spain (27 donors per million inhabitants) or Austria (24 donors per million inhabitants) have higher "donor rates" than Germany (13 donors) or Greece (6 donors). In most countries with the dissent solutions, there is no "waiting list" for donations, or the list is short, while most countries with consent solutions have substantial "organ shortages".
Under United States law, the regulation of organ donation is left to states within the limitations of the federal National Organ Transplant Act of 1968. Each state's Uniform Anatomical Gift Act seeks to streamline the process and standardize the rules among the various states, but it still requires that the donor make an affirmative statement during her or his lifetime that she or he is willing to be an organ donor. Many states have sought to encourage the donations to be made by allowing the consent to be noted on the driver's license. Still, it remains a pure consent system rather than an extended consent system or even a dissent opt-out system. Curiously, though, relatives can still dissent even in the presence of evidence of explicit consent by the potential organ donor (driver's liscence, living will, registry information, etc.). As such, many organ donation campaigns in the United States encourage family communication about one's decision to donate or not to donate.
Teleological issues
On teleological or utilitarian grounds, the moral status of "black market organ donation" relies upon the ends, rather than the means. In so far as those that donate organs are often impoverished and those that can afford black market organs are typically well-off, it would appear that there is an imbalance in the trade. In many cases, those in need of organs are put on waiting lists for legal organs for indeterminate lengths of time — many die while still on a waiting list.
Organ donation is fast becoming an important bioethical issue from a social perspective as well. While most first-world nations have a legal system of oversight for organ transplantation, the fact remains that demand far outstrips supply. Consequently, there has arisen a black market often referred to as transplant tourism.
The issues are weighty and controversial. On the one hand are those who contend that those who can afford to buy organs are exploiting those who are desperate enough to sell their organs. Many suggest this results in a growing inequality of status between the rich and the poor. On the other hand are those who contend that the desperate should be allowed to sell their organs, and that stopping them is merely contributing to their status as impoverished. Further, those in favor of the trade hold that exploitation is morally preferable to death, and insofar as the choice lies between abstract notions of justice on the one hand and a dying person desperately in need of an organ on the other hand, the organ trade should be legalized. Conversely, surveys conducted among living donors postoperatively and in a period of five years following the procedure have shown an extreme regret in a majority of the donors who said that given the chance to repeat the procedure, they would not . Additionally, many study participants reported a decided worsening of economic condition following the procedure
Legalization of the organ trade carries with it its own sense of justice as well. Continuing black-market trade creates further disparity on the demand side: only the rich can afford such organs. Legalization of the international organ trade could lead to increased supply, lowering prices so that persons outside the welathiest segments could afford such organs as well.
Exploitation arguments generally come from two main areas:
- Physical exploitation suggests that the operations in question are quite risky, and, taking place in third-world hospitals or "back-alleys," even more risky. Yet, if the operations in question can be made safe, there is little threat to the donor.
- Financial exploitation suggests that the donor (especially in the Indian subcontinent and Africa) are not paid enough. Commonly, accounts from persons who have sold organs in both legal and black market circumstances put the prices at between $150 and $5,000, depending on the local laws, supply of ready donors and scope of the transplant operation , , . In Chennai, India where one of the largest black markets for organs is known to exist, studies have placed the average sale price at little over $1,000 . Many accounts also exist of donors being postoperatively denied their promised pay .
- The New Cannibalism is a phrase coined by anthropologist Nancy Scheper-Hughes in 1998 for an article written for The New Internationalist. Her argument was that the actual exploitation is an ethical failing, a human exploitation; a perception of the poor as organ recepticles which may be used to extend the lives of the wealthy
التبرع بالدم
Blood donation is a process by which a blood donor voluntarily has blood drawn for storage in a blood bank, generally for subsequent use in a blood transfusion.
Blood donation by the US Navy
Blood donations may be scheduled at local centres, or at times a "blood drive" will occur. These are events where a blood bank or other blood collecting organization will set up in a convenient location—such as a shopping centre, large employer, university, high school, or a local church—for people to stop in without appointment during their daily routine to donate blood. Sometimes a bloodmobile is used to run a blood drive. Usually a modified recreational vehicle, it is an easy place to run a blood drive because it is already set up for the process of blood donation.
Process
The process of giving blood involves screening the donor, the actual donation, and a brief recovery period. This applies to both whole blood donations and plasmapheresis, or donating only one's plasma (see "Donation" below).
Preparation
In the days prior to donating blood, it is important that donors prepare themselves for a process that can temporarily weaken the body. Donors should check their local blood bank's guidelines, as requirements and recommendations vary. Many blood banks recommend that potential donors drink extra water and fluids before donating. It may be advisable to avoid caffeinated beverages before donation. Eating well is also important, and can reduce the risk of reactions to donation. Eating foods high in iron (which has many dietary sources) is also a good idea; low hemoglobin levels may make a donor temporarily ineligible. This is especially true for women who have menstruated recently, because of iron loss in the menses. Some countries require donors to observe a limited or full fast before donation because of specific screening methods; in particular, some countries will discard blood taken too soon after a fatty meal. High levels of lipemia (essentially fat in the blood) can interfere with infectious disease testing.
Screening
Western countries typically impose screening for blood donor candidates. In the past, it was the practice in America and other countries to separate blood donations on the basis of race, ethnicity, or religion, or to exclude certain groups from the donor pool on those bases. Currently, in the United States, these practices have been eliminated, and donor attributes are considered only in terms of their likelihood to affect the probability of transmission of disease. All blood products in the U.S. are labeled as coming from either "paid" or "volunteer" donors, with paid units being more likely to transmit infection. (Several other countries avoid paid donations altogether for this reason.)
Blood donation at the Royal Melbourne Hospital during the 1940s.
Other donor characteristics are also taken into account: starting in 1985, the American Red Cross and Food and Drug Administration policies prohibit accepting blood donations from gay/bisexual men, specifically from any "male who has had sex with another male since 1977, even once," or from IV drug users or recent immigrants from certain nations with high rates of HIV infection. The inclusion of men who have sex with men on the prohibited list has created some degree of controversy ; the FDA & Red Cross cite the public policy need to protect the blood supply from HIV & similar diseases as justification for the ban, while others believe the ban to be discriminatory, since sexually active heterosexuals are not categorically banned and all donated blood is screened. Policies vary in other countries; for instance, Australia formerly had a similar ban, but now only prohibits donating blood within one year after male-male sex (longer than the typical window period for HIV blood screening tests performed on donated blood).
Similarly important donor eligibility requirement in the US is related to concerns about variant Creutzfeldt-Jakob Disease (vCJD): persons who have spent long periods of time in countries where "mad cow disease" is found are not eligible to donate. As part of the screening interview, blood donors are questioned about past residency in countries on the exclusion list, tracing back as far as 1980. The list of countries of residence that may disqualify a potential donor includes most of Western Europe (with stronger restrictions on those with past residence in the United Kingdom), Turkey, and all of Eastern Europe except Russia, Ukraine, Belarus, and the Baltic countries (those formerly part of the Soviet Union). From 1980 through 1996, if a person visited or resided in country on the exclusion list for a time that adds up to five years or more, the person is not eligible to donate; if a person spent time that adds up to three months or more in the United Kingdom, they are indefinitely deferred. This set of rules affects members of the US Armed Forces and others, who lived at least six months in certain European countries or 3 months in the United Kingdom from 1980 to 1996, who are therefore prohibited from donating blood. A similar policy with regard to vCJD applies in France, Quebec and in the rest of Canada.
When a donor arrives at a donation site, he or she typically fills out a consent form as well as answer an extensive questionnaire to help determine their eligibility. Questions include the donors' age, weight, most recent donation, current health, and various risk factors such as tattooing, drug use (recreational or performance enhancing), residency abroad, recent international travel, and sexual history. Answers are associated with the donor's blood, but not name, to provide anonymity.
Often the blood hemoglobin concentration will be checked next, typically performed by a phlebotomist. While various tests exist, the most common ones are:
- hematocrit: done in some places. requires a centrifuge. A measurement of no less than 38% allows donation to continue.
- colorimetric hemoglobin test using a hemoglobin photometer: a machine-read result from a chemical reaction on a testing strip.
- copper sulfate screening test (aka "float test"): measures the specific gravity of the donor's blood by placing a drop into a copper sulfate solution. The solution is calibrated so that a hemoglobin concentration of in >12.5 g/dl (the cut-off in the U.S. for donation) sinks.
Donated blood is tested by many methods, and a typical screening panel includes most of the tests below:
- Antibody to Hepatitis B core "anti-HBc"
- Hepatitis B Surface Antigen "HBsAg"
- Nucleic acid testing by Transcription Mediated Amplification (TMA) or Polymerase Chain Reaction (PCR) for Hepatitis B "HBV-NAT"
- Antibody to Hepatitis C "anti-HCV"
- Nucleic acid testing for HCV "HCV-NAT"
- Alanine Transaminase "ALT" (this test is used to check for liver problems which may be a sign of hepatitis and has been phased out as tests for hepatitis have improved)
- Antibody to HIV types 1 and 2 "Anti-HIV1/2"
- Nucleic acid for HIV "HIV-NAT"
- Antibody to HIV p24 antigen (this test has been mostly replaced by HIV NAT)
- Antibody to Human T-Lymphotrophic Virus I/II "anti-HTLV"
- Nucleic acid testing for West Nile Virus "WNV-NAT"
- Antibody to Chagas Disease
- Serologic test for syphilis "RPR" or "STS"
- Antibody to Cytomegalovirus "anti-CMV"
- Atypical red cell antigen screening
- Blood typing
Donation
Disinfect, insert the cannula, pull out the cannula, dress the wound.
The blood donation itself happens next. The donor lies supine on a cushioned bench and extends an arm. The inner elbow is disinfected, and a cannula is inserted into the medial antecubital vein. A large bore needle is used to prevent hemolysis. The donor often has a tourniquet wrapped around his or her arm, or may be prompted to squeeze a ball repeatedly, to help speed the process. Blood flows from the vein, through the needle and a tube, and into a special collection bag which is placed on a small scale to measure the amount of blood withdrawn. After the bag is sufficiently filled, several test tubes are drawn from the same needle to be used for disease detection. Typically, around 450 millilitres, about a U.S. pint, is drawn during the blood donation process. The blood is stored in a blood bag which contains acid citrate dextrose, an anticoagulant which prevents blood clotting and preserves the blood for long periods of time.
A relatively large-bore needle is used for whole blood donations.
A mechanical tray tilts the bag to prevent congealing, and displays current volume and flow per minute.
Apheresis
Rather than donating whole blood, a donor sometimes has the option to donate only some blood components while retaining others. This process is known as apheresis, and is more involved, time consuming, and requires more specialized equipment. The benefit is that more of the desired components can be concentrated and removed, and the donor is usually able to donate significantly more frequently than if whole blood had been removed. In some cases, the usefulness of the removed components is not as sensitive to blood type considerations.
The typical method of apheresis is to draw whole blood from the donor, then centrifuge the blood to separate its components (see apheresis for more information). The desired components (e.g. platelets, plasma) are removed and then the remaining components are returned to the donor.
"Double red"
A recent innovation in apheresis is the "double red" donation, which extracts two units of red blood cells instead of the single unit of an ordinary whole-blood donation. This provides several benefits to both the donor and the blood bank. The donor can make the same red-cell contribution with half the visits, and the return of plasma to the body leaves the donator better hydrated. The process takes somewhat longer than a standard donation (about 35-45 minutes), but is much shorter than a regular apheresis visit. The blood bank receives twice the usual red-cell donation in each visit. Because more red cells are removed from the circulatory system, donors must meet some additional health requirements for a double-red donation.
Recovery
Once the donation is complete, the donor is given a bandage or gauze to stop further blood flow and is normally allowed to leave. Beverages and snacks may be provided to restore blood volume and blood sugar, and to settle the stomach. Often donors are encouraged to sit down for a few minutes to return to normality, as lightheadedness and faintness may occur. In some countries, stickers are worn by donors to show the donor's pride and to encourage others to give. The entire process, from screening through recovery has a variable time, it can take from some fifteen minutes to about one hour. The actual blood donation takes between four and fifteen minutes for whole blood donation. Donors are discouraged from heavy exercise or lifting for several hours. Plasma volumes will return to normal in around 24 hours, while red blood cells are replaced by bone marrow into the circulatory system within about 3-5 weeks, and lost iron replaced over 6-8 weeks. This recovery process can be accelerated by eating foods high in complex carbohydrates, iron, and other trace minerals. Due to the timeframe required for iron replacement, donors are eligible to donate whole blood approximately eight to twelve weeks after the previous donation, the exact period varying by country. In the USA, Whole Blood donations can be taken every 56 days, the waiting period for the "double red" apheresis donors is 112 days. Donors can donate far more frequently if taking iron supplements but this is generally only done under medical supervision.
Storage
Cryopreservation of red blood cells is done to store special, rare red blood cells for up to 10 years. The ten year outdate is not based on any specific research, it was chosen arbitrarily, and some blood banks maintain truly rare red blood cells past the ten years because there are no alternative sources. The cells are first incubated in a 40% glycerol solution which acts as a cryoprotectant ("antifreeze") within the cells. The units are then placed in special sterile containers in a deep freezer at less than -60 °C.
Donors for babies
A tiny percentage of adults may donate blood to small children in emergency rooms, newborn babies, and fetuses. To ensure the safety of blood transfusion to pediatric patients, including those in whom the immune systems are not fully developed, hospitals are taking every precaution to avoid infection and prefer to use specially tested pediatric blood units that are guaranteed negative for cytomegalovirus (CMV), because the consequences of CMV infection for newborns or low weight infants may be severe or even fatal. Additionally, for pediatric patients with certain disorders or in emergency, when there is no time to perform crossmatching, only O/Rh negative blood can be used for neonatal transfusion. Due to these specific restrictions, to be recognized as a baby donor an adult must test negative for cytomegalovirus, and some blood collection agencies such as the Red Cross also require baby donors that they be blood type O-negative. Since only 7% of US adults are O-negative and as few as 15% of adults do not carry CMV, only 1% of adults may qualify as baby donors. Other restrictions (body weight, HIV status, vCJD, etc. ) reduce the fraction of potential baby donors to less than 1 in 200. If an adult was not exposed to measles, mumps, rubella, or chicken pox, that amplifies the person's status as a baby donor.
Newborn babies that require multiple surgeries often need up to 20 units of blood in their first few weeks.
Complications
Slight bruising from the donation needle; shown 24 hours after donation
The finger prick and needle insertion typically cause only minor discomfort. Phlebotomists may, however, experience difficulties in obtaining enough blood from some donors.
During or shortly after the donation, hypovolemia may occasionally lead to a drop in blood pressure, with some donors experiencing light-headedness, nausea, or fainting. In some cases this may necessitate cancelling the donation, restoring blood volume with an intravenous infusion, or placing the donor in a Trendelenburg position (on a stretcher tilted "legs up"). Beverages may be given to replenish blood volume further, and the donor may have to remain in a horizontal position for a while under monitoring. Most blood banks encourage donors to rest for several minutes after donation (often while eating and drinking) to let them adjust to the loss of blood and reduce the risk of these problems.
In less than 1% of cases, improperly inserting the needle is followed by bruising of the arm in the weeks afterwards.
Negative medical reactions to blood donation are rare, and blood bank staff are trained to handle them.
Benefits
Donating blood may reduce the risk of heart disease for men and stimulate the generation of red blood cells.
In patients prone to iron overload (e.g. due to hemochromatosis), blood donation prevents the accumulation of iron. However, at this time the American Red Cross does not accept people with hemochromatosis to donate blood for other people. On the other hand, the Australian Red Cross Blood Service does accept blood from hemochromatosis as they recognise that it is a genetic disorder that does not affect the safety of the blood. In the US, a blood bank must allow patients with hereditary hemochromatosis to receive therapeutic phlebotomies (i.e. a blood donation) for free regardless of whether or not the blood can be used for transfusion. This is done to remove any financial incentive for therapeutic donors to lie about their health in order to be eligible, since normally they would pay for the phlebotomy.
Anecdotally, elderly people in good health have reported feeling invigorated by giving blood on a regular basis.
Other incentives are sometimes added by employers, usually time off for the purposes of donating. Blood centers will also sometimes add incentives such as assurances that donors would have priority during shortages or other programs. Other incentives may include prize drawings for donors and rewards for organizers of successful drives, especially during the summer months when blood is often in short supply. Very few blood donors (other than plasmapheresis donors) are paid for donating, as this again leads to concerns about donors being less than truthful about their health in order to receive a financial benefit.
The majority of blood donors, however, donate as an act of charity and do not expect to receive any direct benefit from the donation.
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