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Ethical Considerations

  • Jonna D. Clark
  • Denise M. Dudzinski
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)

Abstract

Over the past 60 years, incredible progress has been achieved in pediatric organ transplantation. Some children, who historically would have died with end stage organ failure, are living for decades. Yet, imbedded in this progress are numerous ethical considerations. The discrepancy between the supply and demand of transplantable organs persists, and questions of justice remain prevalent. Transplant professionals are faced with a moral tension, balancing their duty to provide the best medical care for each of their patients, knowing that their decisions directly impact outcomes for other unknown patients. When one child receives an organ, another child goes without and is faced with the risks, morbidities, and mortality associated with longer wait times. Can the supply of organs be increased without causing harm to children and their families? How should parental living organ donors be protected when they are desperate to save the lives of their dying children? How should scarce organs be allocated and who gets to decide? Who is eligible for transplant and what conditions, if any, preclude the opportunity for pediatric transplant? Should transplant professionals ever be obligated to compel a life-saving organ transplant against parental wishes? How do outcome measures and quality assessments of transplant centers impact common practices and decisions? In the following chapter, through a series of case based discussions, common ethical frameworks are used to illuminate important considerations required to address these difficult questions.

Keywords

Pediatric transplant ethics Organ donation Organ allocation Dead donor rule Organ donation after circulatory determination of death (DCDD) Organ donation after neurological determination of death (DNDD) Living organ donation Transplant eligibility Children with disabilities Parental refusal of treatment Rule of rescue Justice Equity Efficiency Respect for persons Medical best interest 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Pediatric Critical Care Medicine, Treuman Katz Center for Pediatric Bioethics, Department of PediatricsUniversity of Washington School of Medicine, Seattle Children’s HospitalSeattleUSA
  2. 2.Department of Bioethics and HumanitiesUniversity of Washington School of MedicineSeattleUSA

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