Experience of Ethical Dilemmas Among Professionals Working in Pediatric Transplantation: An International Survey

Overview

Journal Pediatr Transplant

Specialty Pediatrics

Date 2022 Jul 19

PMID 35851709

Authors

Zainab Arslan

Jack Hennessy

Mignon I McCulloch

Anne I Dipchand

Debra S Lefko Witz

Stephen D Marks

Affiliations

Soon will be listed here.

Abstract

Background: Professionals working in pediatric transplantation commonly encounter complex ethical dilemmas. Most ethical research in transplantation is related to adult practice. We aimed to gain insight into ethical issues faced by transplant professionals when dealing with pediatric transplant recipients.

Methods: A two-stage study was designed; the first part was a questionnaire completed by 190 (80%) members of the International Pediatric Transplant Association (IPTA) from over 30 different countries. This was followed by a multidisciplinary focus group that explored the preliminary data of the survey.

Results: A total of 38% (56 of 149) respondents of the questionnaire had experienced an ethical issue between 2016 and 2018. Surgeons were more likely to have encountered an ethical issue as compared with physicians (60% vs. 35.7%, p = .035). Clinicians from Europe were more likely to have experienced an ethical issue in living organ donation compared with those from North America (78.9% vs. 52.5%, p = .005), with common ethical concerns being psychosocial evaluation and follow-up care of donors. The focus group highlighted the importance of a multidisciplinary approach to ethical issues.

Conclusion: The results of this study can direct future research into pediatric transplantation ethics with the aim of producing educational resources, policies, and ethical guidelines.

Citing Articles

Experience of ethical dilemmas among professionals working in pediatric transplantation: An international survey.

Arslan Z, Hennessy J, McCulloch M, Dipchand A, Lefko Witz D, Marks S Pediatr Transplant. 2022; 26(7):e14331.

PMID: 35851709 PMC: 9787614. DOI: 10.1111/petr.14331.

References

. The Declaration of Istanbul on Organ Trafficking and Transplant Tourism. Clin J Am Soc Nephrol. 2008; 3(5):1227-31. PMC: 4571160. DOI: 10.2215/CJN.03320708. View

de Villa V, Lo C, Chen C . Ethics and rationale of living-donor liver transplantation in Asia. Transplantation. 2003; 75(3 Suppl):S2-5. DOI: 10.1097/01.TP.0000046532.44975.57. View

Dew M, Switzer G, DiMartini A, Matukaitis J, Fitzgerald M, Kormos R . Psychosocial assessments and outcomes in organ transplantation. Prog Transplant. 2001; 10(4):239-59; quiz 260-1. DOI: 10.1177/152692480001000408. View

Abraham E, Wilson A, Goebel J . Current kidney allocation rules and their impact on a pediatric transplant center. Am J Transplant. 2009; 9(2):404-8. DOI: 10.1111/j.1600-6143.2008.02504.x. View

Lorts A, Ryan T, Matheny Antommaria A, Lake M, Bucuvalas J . Obtaining consensus regarding international transplantation continues to be difficult for pediatric centers in the United States. Pediatr Transplant. 2016; 20(6):774-7. DOI: 10.1111/petr.12769. View

Hoegy D, Bleyzac N, Robinson P, Bertrand Y, Dussart C, Janoly-Dumenil A . Medication adherence in pediatric transplantation and assessment methods: a systematic review. Patient Prefer Adherence. 2019; 13:705-719. PMC: 6511245. DOI: 10.2147/PPA.S200209. View

Andreoni K, Forbes R, Andreoni R, Phillips G, Stewart H, Ferris M . Age-related kidney transplant outcomes: health disparities amplified in adolescence. JAMA Intern Med. 2013; 173(16):1524-32. DOI: 10.1001/jamainternmed.2013.8495. View

Rodrigue J, Ladin K, Pavlakis M, Mandelbrot D . Disclosing recipient information to potential living donors: preferences of donors and recipients, before and after surgery. Am J Transplant. 2011; 11(6):1270-8. DOI: 10.1111/j.1600-6143.2011.03580.x. View

Arslan Z, Hennessy J, McCulloch M, Dipchand A, Lefko Witz D, Marks S . Experience of ethical dilemmas among professionals working in pediatric transplantation: An international survey. Pediatr Transplant. 2022; 26(7):e14331. PMC: 9787614. DOI: 10.1111/petr.14331. View

10.

Liu S, Liu C, Cao X, Shang B, Chen A, Liu B . The difference in the attitude of Chinese and Japanese college students regarding deceased organ donation. Transplant Proc. 2013; 45(6):2098-101. DOI: 10.1016/j.transproceed.2012.09.119. View

11.

Sharif A, Moorlock G . Influencing relatives to respect donor autonomy: Should we nudge families to consent to organ donation?. Bioethics. 2018; 32(3):155-163. DOI: 10.1111/bioe.12420. View

12.

Budiani-Saberi D, Delmonico F . Organ trafficking and transplant tourism: a commentary on the global realities. Am J Transplant. 2008; 8(5):925-9. DOI: 10.1111/j.1600-6143.2008.02200.x. View

13.

Dominguez-Gil B, Haase-Kromwijk B, Van Leiden H, Neuberger J, Coene L, Morel P . Current situation of donation after circulatory death in European countries. Transpl Int. 2011; 24(7):676-86. DOI: 10.1111/j.1432-2277.2011.01257.x. View

14.

Lomero M, Gardiner D, Coll E, Haase-Kromwijk B, Procaccio F, Immer F . Donation after circulatory death today: an updated overview of the European landscape. Transpl Int. 2019; 33(1):76-88. DOI: 10.1111/tri.13506. View

15.

Griffin K, Elkin T . Non-adherence in pediatric transplantation: a review of the existing literature. Pediatr Transplant. 2001; 5(4):246-9. DOI: 10.1034/j.1399-3046.2001.005004246.x. View

16.

Chen L, Wilson M . The globalization of healthcare: implications of medical tourism for the infectious disease clinician. Clin Infect Dis. 2013; 57(12):1752-9. PMC: 7107947. DOI: 10.1093/cid/cit540. View

17.

Zamawe F . The Implication of Using NVivo Software in Qualitative Data Analysis: Evidence-Based Reflections. Malawi Med J. 2015; 27(1):13-5. PMC: 4478399. DOI: 10.4314/mmj.v27i1.4. View

18.

Jawoniyi O, Gormley K, McGleenan E, Noble H . Organ donation and transplantation: Awareness and roles of healthcare professionals-A systematic literature review. J Clin Nurs. 2017; 27(5-6):e726-e738. DOI: 10.1111/jocn.14154. View

19.

Shaw D, Georgieva D, Haase B, Gardiner D, Lewis P, Jansen N . Family Over Rules? An Ethical Analysis of Allowing Families to Overrule Donation Intentions. Transplantation. 2016; 101(3):482-487. DOI: 10.1097/TP.0000000000001536. View

20.

Obermann K . Some politico-economic aspects of organ shortage in transplantation medicine. Soc Sci Med. 1998; 46(3):299-311. DOI: 10.1016/s0277-9536(97)00056-7. View