Listing and Ethical Issues

The shortage of organs has given rise to ethical issues around who should have priority for transplant (Rodrigue and Sobel 2003; Veatch 2000). These issues include questions about allocation of organs— for example, whether pediatric patients should receive preference over adults and to what extent the high rates of nonadherence in adolescents should be taken into consideration. Other complicated issues involve transplantation in patients who have lost their graft due to nonadherence, such as whether these patients should be relisted or what to do when patients become adherent after a period of nonadherence. Some ethical questions revolve around informed consent—for example, if a potential parent donor can give informed consent when the alternative is to wait for a donor while the child suffers potential severe medical complications, including death. Additionally, can a related living donor really filter out overt and/or inadvertent pressure from family to be a donor? Difficult issues also arise when a young child or child with disabilities needs an organ to survive, but the parents have demonstrated problematic caretaking behaviors. These challenging issues represent only a few of the myriad ethical concerns faced by transplant teams.

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