Dialysis is a process of cleansing the blood, remove waste products like urea through diffusion and excess fluids

through ultrafiltration from the body by passing it through a special machine with filter; it is primarily used to provide an artificial replacement for lost kidney function in people with renal failure. Kidney hold an important roles in maintaining human health, it maintain human bodys internal equilibrium of water and materials when it is healthy. Therefore when kidney failure, a treatment have to be replace the work of kidneys used to do, although it is an imperfect replacement .There are two main types of dialysis, hemodialysis and peritoneal dialysis, both types of filters remove wastes and excess water from the blood in different ways and its risk and benefits. #Choice 1 As an engineer working for a company designing dialysis equipment for worldwide use, I am assigned to design a new dialysis machine. This dialysis equipments target market is both economically-developed countries and thirdworld countries. Economically-developed countries are used to describe countries that have a high level of development according to economic criteria such as gross domestic product (GDP) and industrialization while third world countries refers to the economically underdeveloped countries with characteristics such as poverty, high birthrates and economic dependence on the advanced countries. Here are some examples of economically-developed countries and third world countries; United State of American, United Kingdom and Germany represent economicallydeveloped countries in the mean while countries in Middle East, South Asia and Africa represent third world countries. In economically-developed countries there are working dialysis systems; however in the third world countries access to dialysis equipment is limited. While designing the new dialysis machine, there are two choices in the design wise: first, using disposable filters that would be replaced with each patient; second, using a reusable filter that could be cleaned, autoclaved and reused with each patient but its price is 100 times more expensive. Both of these designs have advantages and disadvantage towards economically-developed countries and third world countries. Due to manufacturing and FDA approval costs, my company can only move forward on one design, therefore only one of the two designs will be select and this design must be suitable for worldwide use. Some analyses and researches were done on both designs and an optimal choice is selected based on beneficial for my company and also ethically.

Dialysis machines target market is mainly hospitals both government and private sector, dialysis center and maybe some of the specialist clinic. In economically-developed countries, almost all hospitals consists of at least one dialysis machine, but in third-world countries, only civil hospital or private hospital consist of dialysis machine. Normally patient wont purchase dialysis machine for personal usage, so the target market of dialysis machine is small. As an employee of the company, I should not only do my job as an engineer to design a new and functional machine for the company but also design a profitable machine. Therefore, through the companys point of view, first design will be preferable because disposable filters will bring continuous flow of profit to the company instead of short term profit by second design although second design is expensive than first design. As mention before, target market of dialysis machine is mainly hospital, and basically they will not purchase many dialysis machines but just one or two machines. If they already purchased a dialysis machine, they will not purchase a new until their machine is failure. In this situation, our company will meet a hard time if the demand of dialysis machine in the market is saturated. However, the first design of dialysis machine would have to replace the filter with each patient every time when they are undergoing dialysis treatment; therefore a number of disposable filters will have to be purchase from our company. Although the first design is cheaper than second design but in long term wise, it is profitable for the company, hence it is preferable in the company economically point of view. In design and manufacturing consideration, second design dialysis machine is not preferable due to its reusable filter. Second design dialysis machine involving an expensive reusable filter that could be cleaned, autoclaved, and reused with each patient. The reusable function of the filter increases the complexity of designing and manufacturing, hence increase more carefulness and cost to manufacture them. In the meanwhile, reusable dialysis machine require frequent fixed period maintenance to ensure the machines filter is still under safe condition, the cleaning process is undergo with the right procedure so the filter is not contaminate. However, the disposable design is not require fixed period maintenance but only warranty because disposable filter will not contaminate and danger patients health. Based on above discussion, disposable filter is still preferable in the companys point of view because of less troublesome, easier with high long term profit.

In economically-developed countries point of view, they are affordable for either design and also have professional skills on dialysis or medicine, therefore other consideration will take in account. According to an article, data collected during the period of 1976 to 2002 by the Centers for Disease Control and Prevention (CDC) reveal that approximately 20% of dialysis centers using the reusable dialysis machine in 1976 and increasing to 80% in 1997, and subsequently declining to approximately 60% in 2002. This trend has further declined in recent years due to that presence of disposable filter. A few studies are stated that with using the reusable dialysis machine, the mortality risk and hospitalization risk are increased if compare with using disposable filter dialysis machine. The second design, dialysis machine with a reusable filter is an economically and safe machine for dialysis treatment if the cleaning, autoclaved process follow the AAMI standard. When using the dialysis machine with reusable filter, there are a need for technician training, record keeping, room maintenance for safely and sterilization and extensive quality assurance program that are inevitable. However, this is unclear in the practical setting where human errors are bound to affect aspects of reuse processes. Errors can range from collection, labeling, storage, and cleaning of used filters. Since in economically-developed countries, our design would be an improvement, so dialysis machine with disposable filter is preferable. This is because of disposable filter decreases the rates of infection and contamination while disposable filter simplifies some of the operation aspects of dialysis and make it convenient. In third world counties point of view, economic consideration have to be take in account to reduce cost of purchasing dialysis machine. Due to this reason, if only economical consideration is taking in account, the second design with higher startup cost but is cheaper in the long-term use will be selected. However, third world countries which have limited access to dialysis equipment and professional or skilled people, dialysis machine with reusable filter is not suitable for third world country. The reason is because the reusable filter would require a sufficient level of training to clean, autoclave them, if untrained personnel is cleaning them could be more dangerous and might cause the filter contaminated. Contaminated filter cannot be used again for dialysis to prevent patient have second infection.

Both designs have their own advantages and difficulties in third world countries. When taking economic consideration, second design is preferable but in professional skill and safety consideration, first design is preferable. Third world countries might able to afford the cost of purchasing the dialysis machine with disposable filter but not able to afford long term purchasing filters. The purchase of disposables in the third world is difficult and not typically funded by charitable organizations and government entities that might be willing to purchase or donate the equipment. This is a difficult situation to choose between two designs, regardless which design is selected; company will also faces ethical issue. An optimal selection of the design of dialysis machine will be selected based on the different point of view we discussed above. The selection will both meet the economically and ethically requirement. As discuss above, the first design is preferable for economically-developed countries due to its convenient and safety purpose and companys point of view which will bring a long term profit to the company. However, if first design is selected, unethical issue faced because third world countries is not able to afford long term purchase of filter. The company will be labeled as an unethical company which only concern about the profit of the company. If second design is selected, another unethical issue is faced. The second design requires trained person to control the machine, which is limited in third world countries. Hence, it is unethical as it is dangerous for untrained personnel to control the machine. In conclusion, I will choose first design as the company design because it is more practical and profitable to go on with first design, the dialysis machine with disposable filter. The unethical issue faced by third world country can be solved by finding fund or charitable organization linked with our company, when dialysis machine is sold to third world countries, discount on purchasing filters will be provided by our company and also charitable organization. Through this solution, we can achieve a win-win solution for everyone. The company is able to earning the profit at the meanwhile helping people.

#Choice 2 Secondary infection is a risk in dialysis, such an infection in a patient with kidney disease could result in long-term injury and increased risk of death. To reduce the second infection, three designs of machine with same function but different secondary infection rate are introduced. The first design will have a secondary infection rate of 1 in 1000. The second design will have a secondary infection rate of 1 in 1000000 and cost 10 times the first design. The third design will have a secondary infection rate of 1 in 5000000 and cost 100 times the first design. A design will be choose based on the economically and ethically issue. The first design is the cheapest but with highest secondary infection rate (0.1%), the second design is 10 times expensive than the first design but lower secondary infection rate (0.0001%) than the first design. The third design is the most expensive design but with lowest secondary infection rate (0.00002%). We can see that in these three designs, the secondary infection rate is near to 0 percentages but never decreased to zero. This is because no matter how secure the machine is, there is still a probability for the patients have secondary infection. In economical point of view, the first design will definitely be the preferable design due to its low cost of manufacturing and also low selling price, but its secondary infection rate is very high and is unethical to sell this machine to hospital. In ethically point of view, the third design will be preferable due to its almost zero secondary infection rates, but it is not practical to design this machine because it is too expensive and not affordable for most of the hospital or patients. Therefore, I will choose the second design with low secondary infection rates (0.0001%) but yet reasonable price which is affordable by mostly hospital in the world. Definitely it will make a difference if the design was primarily for the economically-developed countries or for third-world countries. In economicallydeveloped countries, they have a healthy lifestyle compare to the third world countries residents, hence a result the number of people have kidney failure will be less and the secondary infection will not obvious. Most people in the economicallydeveloped countries have mid-level or above income, mean that they are able to afford the second design dialysiss treatment fee.

However in third world country, most people is come from low income family therefore although second design has lower cost compare to third design but still they might not able to afford the high payment for the treatment. Not only that, third world country resident which have low quality of lifestyle so rate of people have kidney failure as malnutrition is more compare to economically-developed country. In this situation, due to the number of patient is more, so the rate of secondary infection will be higher. In conclusion, second design is the most suitable design for both type of country, since it cover them economically and also ethically.