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there have traditionally been many more living donor organs used than cadaver organs. This is due to cultural beliefs that include the Confucian tenet of respect for bodily integrity, as well as controversy over the acceptance of a definition for brain death, which limits the availability of cadaver organs.

There have been several factors identified with regards to what motivates people to donate organs. The two most commonly cited reasons for donation include helping to save a family member's life and improving the donor's own quality of life. Other factors that have been identified include guilt for past behaviors and concerns about family disapproval or forms of family pressure. It is important to note that all donations should be altruistic and free of any coercion either by family members or the medical team. One ethical dilemma that is currently being debated is whether or not to provide financial incentives for organ donation to help alleviate the organ shortage. Those in favor of financial incentives argue that an increased supply of organs would result in many more lives being saved, which would mitigate any potentially questionable ethical issues. Another potential consequence of financial incentives that has been argued is that the money from the sale of an organ might have a positive impact on the economic well being of donors. The arguments against financial incentives include a departure from American and western society's ethical standards, the fear of the human body and its parts being treated as commodities, and the potential consequence of exploiting the financial distress of the poor.

Many potential donors are in favor of donating immediately after they learn about the possibility of a living-related transplantation. This is especially true in cases where parents donate to their children. In the situation where parents are donating a part of their liver to a child there is a small risk of complications. In addition, there may also be unrealistic expectations or fantasies that may set parents up for extreme guilt or self-reproach if the donor liver fails. Determining if there are unrealistic expectations and forming an alliance if further support is needed may be the goals of psychiatric referral. However, psychiatric evaluation and follow-up support is essential for all living donors. Important elements that should be included in any donor evaluation include: donor motives and decisionmaking processes; description of the relationship with the recipient; prior and current beliefs about organ donation; ability to provide informed consent; attitudes of significant others toward decision to donate; availability of support from family and/or friends; past and current psychological problems and treatments; past and current substance use history; any current life stresses; and financial preparations for time off work. The majority of donors do well in terms of psychological adjustment. However, throughout the evaluation process and in follow-up it is critical to keep in mind the well being of the donor and to make sure that physically, emotionally, and financially they will not be at risk for complications.

Emergency Evaluations

There are situations when a decision to transplant is made on an emergency basis. What most likely presents as an emergency situation today is acute liver failure due to toxins such as acetaminophen; however, there are numerous medi

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