Cadaveric donation rates have remained static, whereas transplant waiting lists continue to rise as demand for renal transplants far exceeds supply. One solution to bridge the supply and demand gap is to increase live donation. If live donation is to increase, it is important to offer evidence-based psychologic and social support to ensure that transplant clinical success is not at the cost of psychologic and social harm. This article reports the findings of two substantive qualitative studies, both examining similar aspects of live donation: study A from a psychologic perspective and study B from a social-cultural perspective. The findings show that living-related renal donors do not express regret after donation and do report enhanced self-esteem. The decision to donate is immediate and altruistic for most parents, although some fathers expressed a degree of ambivalence. The decision to donate is more difficult and complex for siblings and may lead to conflict between family of birth and family of marriage. Reciprocity and feelings of obligation did not appear to cause relationship difficulties for siblings but were reported by some of the adolescent recipients who had received a parental graft, leading to psychologic distress and social-familial alienation. These two qualitative studies have demonstrated psychosocial risks within the live donation process. These risks should be recognized within transplant programs and professional care provided to ensure confidential presurgery donor and recipient advocacy and continuing psychosocial support for the family unit postdonation.
Summary: The methods suggested in the Report of the Coliform Sub‐Committee of the Society for Applied Bacteriology (Report, 1949) have been used in isolating and studying the coli‐aerogenes content of 142 samples of farm water supplies in two distinctive areas of Britain. The Gram‐negative cultures were grouped into typical, anaerogenic, non‐lactose‐fermenting and ‘unclassifiable’types, forming 54.2, 2.9, 10.9 and 32.0% of the 384 cultures respectively. Among the 261 coli‐aerogenes cultures, Bact. coli, intermediate and aerogenes‐cloacae organisms were found with frequencies of 32.2, 19.5 and 48.3% respectively. The majority of anaerogenic coli‐aerogenes organisms resembled Bact. coli type II while the predominant non‐lactose‐fermenters resembled Bact. cloacae and Bact. aerogenes type I. The reactions of 123 ‘unclassifiable'strains were such that very few could be regarded as Bact. coli types owing to the high incidence of gelatin liquefaction and growth in citrate broth.
About 20% of water samples examined 20 hr. after sampling, this period including 18 hr. storage at 3-5', had coli-aerogenes and Bact. coli contents significantly lowerlthan those determined after 2 hr. at air temperature. Samples with over 50 such organisms/100 ml. at the earlier testing time seldom showed an increased content after refrigeration overnight. The results of statistical analysis of the data confirmed the findings of other workers that coli-aerogenes bacteria are less abundant in samples of water stored before analysis. Colony counts at 37" and 22' did not reflect this reduction in numbers.THE effect of storage of samples on the content of coli-aerogenes bacteria in water has been studied by many workers since Houston (1911, 1913) reported a reduction in numbers during storage. Clemesha (1912) and Rogers (1917) analysed polluted water or water artificially polluted with faeces. They, and Winslow & Cohen (1918), Gray (1932), and Burke-Gaffney (1933) reported Bact. coli to be more liable to reduction on storage than members of the aerogenes-cloacae and intermediate groups.Platt (1935) confirmed this using pure strains at 18", but reported that Bact. coli was the more resistant at 0" and 37". Ruchhoft, Coulter, Adams & Sotier (1933) found that Bact. coli and Bact. aerogenes types died out during storage at similar rates. Other workers who have reported a diminution of coli-aerogenes bacteria after icing samples of water include Caldwell & Parr (1933) and Webster & Raghavachari (1935), but later Raghavachari & Iyer (1939) did not confirm this.Owing to the importance of these organisms in water this investigation was undertaken with the object of surveying the frequency and extent of the significant changes in numbers of presumptive coli-aerogenes bacteria and Bact. coli which occurred in samples of farm water supplies kept overnight in the refrigerator. EXPERIMENT& METHODSTreatment of samples. Fifty-two samples from farm water which arrived at the laboratory during the afternoon were examined within 2 hr. of sampling. The unused portions of about 400 ml. each were kept overnight in the refrigerator at 3-5" and tested next morning when 20 hr. old. The temperature of the samples dropped fiom 17+5" to 5" in 5&1& hr.Bacteriological examination of samples. On each sample the determinations made were : the presumptive coli-aerogenes content, the direct presumptive Bact. coldThe eflect of refrigeration on water analyses I09 content at 44", and the colony counts at 22" and 37" (in duplicate). The techniques prescribed by the Ministry of Health (1939) were used, except that additional 0.01 ml. portions of water were inoculated into MacConkey broth tubes at 37" and 44", thus making possible the determination of up to 18 x lo3 organisms/lOO ml. RESULTS Presumptive coli-aerogenes contentBuchanan -Wollaston (1941, 1942) showed that it was preferable to record changes in the number offertile tubes rather than in the ' most probable number ' of organisms calculated from Tables. Accordingly, the numbers of fertile tubes...
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