Featured Research

from universities, journals, and other organizations

Disclosure Of Organ Transplant Risks: A Question Of When, Not If

Date:
June 27, 2008
Source:
University of Pennsylvania School of Medicine
Summary:
Physicians and bioethicists are calling for a new, more standardized way for patients in need of organ transplants to be informed of the risks they face. If adopted, their policy recommendations could promote greater equity in how organs are allocated while restricting patients' abilities to "cherry-pick" the best organs.

University of Pennsylvania School of Medicine physicians and bioethicists are calling for a new, more standardized way for patients in need of organ transplants to be informed of the risks they face. If adopted, their policy recommendations could promote greater equity in how organs are allocated while restricting patients' abilities to "cherry-pick" the best organs.

Writing in the June 26 issue of the New England Journal of Medicine, a Penn team led by Scott Halpern, MD, PhD, of the Pulmonary, Allergy and Critical Care division, highlights the recent Chicago case in which four patients were infected with HIV and Hepatitis C following liver, heart and kidney transplants. Although the donor did not test positive for HIV at the time of his death -- all U.S. donors are screened for infectious diseases -- local organ procurement officials and the transplant surgeons knew the man had engaged in behaviors that boosted his risk of HIV. The recipients, however, were not made aware of this risk at the time the organs were offered, and as a result, at least one of the recipients is suing the transplant organization and hospital.

The Penn researchers argue that while patients do not have the right to know every detail about the specific donor their organ will come from, that the current system does not adequately protect patients' rights to make fully informed decisions regarding the risks they are willing to accept. Thus, Halpern and colleagues propose that the United Network for Organ Sharing (UNOS), the national clearinghouse for organ allocation, create a policy requiring transplant programs to disclose "all foreseeable risks" of the surgery to potential recipients at the time that they are placed on the waiting list for an organ.

They argue that all patients should be given the option of accepting or declining organs that would come from suitable but suboptimal donors -- including donors with risks for infectious diseases, older donors, or donors after cardiac death whose organs might be less hardy because they were deprived of blood flow for short periods of time before transplant. Currently, UNOS requires only that kidney recipients be allowed to accept or decline organs from so-called "expanded-criteria donors" -- those who are older or have diseases such as hypertension -- and even this narrow requirement is unevenly adhered to across the nation.

In addition to encouraging more systematic disclosure of the general risks of transplantation when patients are listed, the researchers say it is wrong to disclose specific risks associated with a particular donor at the time an organ becomes available. "Allowing a patient to cherry-pick his organs by telling him everything about a potential donor creates the potential for discrimination, inefficiency, and inequity in how organs are allocated," Halpern says. "By contrast, notifying patients of all foreseeable risks of transplantation at the time they are placed on the waiting list protects their right to decide how much risk they will accept without any of these negative consequences for society."

A particularly sensitive issue -- and one that makes this issue especially timely -- is the remote but real possibility that HIV and other socially stigmatized infections might be transmitted through organ transplantation. Because of the nation's ongoing shortage of organs -- 10 percent of patients awaiting transplant die each year -- patients with behavioral risk factors for HIV are not barred from donating organs as they are from donating blood.

In their paper, the authors provide new data indicating that more than five percent of organ donors are classified as "high risk" for undetectable HIV infection. Donors classified as "high risk" currently include homosexual men, people who have been jailed, injection drug users, and people who have received certain blood products, although Halpern notes that officials at the Centers for Disease Control and Prevention (CDC) are currently reevaluating these definitions.

The researchers caution that telling patients about a specific donor's HIV risk factors, without emphasizing the greater risks associated with using organs from donors with hypertension or diabetes, could breed discrimination in how organs are allocated due to biases against homosexuals or drug users. "Permitting patients to evaluate specific donor characteristics could wrongly introduce social bias as a legitimate rationale for guiding the allocation of a public good," the authors write.

And since organs must be harvested and transplanted quickly, time spent deliberating stands to impede chances to find a properly matched recipient or perform a surgery free of complications "Even modest delays resulting from organ-specific consent would be difficult to justify in view of the strong moral bases and broad public support for maximizing efficiency in the allocation of scarce organs," they said.

Additional authors on the New England Journal of Medicine paper are Abraham Shaked, MD, PhD, Director of the Penn Transplant Institute, Arthur Caplan, PhD., Chair of the Department of Medical Ethics, and Richard D. Hasz, MFS, vice president for clinical services at the Gift of Life Donor Program.


Story Source:

The above story is based on materials provided by University of Pennsylvania School of Medicine. Note: Materials may be edited for content and length.


Cite This Page:

University of Pennsylvania School of Medicine. "Disclosure Of Organ Transplant Risks: A Question Of When, Not If." ScienceDaily. ScienceDaily, 27 June 2008. <www.sciencedaily.com/releases/2008/06/080625193906.htm>.
University of Pennsylvania School of Medicine. (2008, June 27). Disclosure Of Organ Transplant Risks: A Question Of When, Not If. ScienceDaily. Retrieved August 2, 2014 from www.sciencedaily.com/releases/2008/06/080625193906.htm
University of Pennsylvania School of Medicine. "Disclosure Of Organ Transplant Risks: A Question Of When, Not If." ScienceDaily. www.sciencedaily.com/releases/2008/06/080625193906.htm (accessed August 2, 2014).

Share This




More Health & Medicine News

Saturday, August 2, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Texas Quintuplets Head Home

Texas Quintuplets Head Home

Reuters - US Online Video (Aug. 1, 2014) After four months in the hospital, the first quintuplets to be born at Baylor University Medical Center head home. Linda So reports. Video provided by Reuters
Powered by NewsLook.com
Ebola Patient Coming to U.S. for Treatment

Ebola Patient Coming to U.S. for Treatment

Reuters - US Online Video (Aug. 1, 2014) A U.S. aid worker infected with Ebola while working in West Africa will be treated in a high security ward at Emory University in Atlanta. Linda So reports. Video provided by Reuters
Powered by NewsLook.com
Ebola Vaccine Might Be Coming, But Where's It Been?

Ebola Vaccine Might Be Coming, But Where's It Been?

Newsy (Aug. 1, 2014) Health officials are working to fast-track a vaccine — the West-African Ebola outbreak has killed more than 700. But why didn't we already have one? Video provided by Newsy
Powered by NewsLook.com
Study Links Certain Birth Control Pills To Breast Cancer

Study Links Certain Birth Control Pills To Breast Cancer

Newsy (Aug. 1, 2014) Previous studies have made the link between birth control and breast cancer, but the latest makes the link to high-estrogen oral contraceptives. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins