Rationing failure. The ethical lessons of the retransplantation of scarce vital organs

Ubel, Peter A.; Arnold, Robert M.; Caplan, Arthur L.

doi:10.1001/jama.270.20.2469

Cited by 92 publications

(83 citation statements)

References 14 publications

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“…Medical urgency is another important criterion in heart, lung, and liver transplantation. This helps explain why patients who require rapid retransplantation routinely receive it, 24 even though expected survival is markedly diminished. 24,26,27 Equity (equal access to organs among patients with equivalent need) is also recognized as important by both transplantation specialists and the public.…”

Section: Ethical Considerationsmentioning

confidence: 99%

“…This helps explain why patients who require rapid retransplantation routinely receive it, 24 even though expected survival is markedly diminished. 24,26,27 Equity (equal access to organs among patients with equivalent need) is also recognized as important by both transplantation specialists and the public. 28,29 Thus, most programs offer organs to patients infected with hepatitis C virus (HCV), patients with diabetes, older patients (up to a point), and black patients, despite clear evidence that post-transplantation survival is diminished in each of these groups.…”

Section: Ethical Considerationsmentioning

confidence: 99%

See 1 more Smart Citation

Solid-Organ Transplantation in HIV-Infected Patients

Halpern

Ubel²,

Caplan³

2002

N Engl J Med

128

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Section: Ethical Considerationsmentioning

confidence: 99%

Section: Ethical Considerationsmentioning

confidence: 99%

Solid-Organ Transplantation in HIV-Infected Patients

Halpern

Ubel²,

Caplan³

2002

N Engl J Med

128

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“…3 Second, given the severe shortage of organs available for transplantation, there is an ethical question of equity in the distribution of these scarce resources. 4,5 During 1996, 923 patients died while awaiting a liver, while 422 patients received retransplants. 3 Finally, retransplantation is known to be more expensive.…”

mentioning

confidence: 99%

Hepatic retransplantation in cholestatic liver disease: Impact of the interval to retransplantation on survival and resource utilization

et al. 1999

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The aim of our study was to quantitatively assess the impact of hepatic retransplantation on patient and graft survival and resource utilization. We studied patients undergoing hepatic retransplantation among 447 transplant recipients with primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) at 3 transplantation centers. Cox proportional hazards regression analysis was used for survival analysis. Measures of resource utilization included the duration of hospitalization, length of stay in the intensive care unit, and the duration of transplantation surgery. Forty‐six (10.3%) patients received 2 or more grafts during the follow‐up period (median, 2.8 years). Patients who underwent retransplantation had a 3.8‐fold increase in the risk of death compared with those without retransplantation (P < .01). Retransplantation after an interval of greater than 30 days from the primary graft was associated with a 6.7‐fold increase in the risk of death (P < .01). The survival following retransplantations performed 30 days or earlier was similar to primary transplantations. Resource utilization was higher in patients who underwent multiple consecutive transplantations, even after adjustment for the number of grafts during the hospitalization. Among cholestatic liver disease patients, poor survival following hepatic retransplantation is attributed to late retransplantations, namely those performed more than 30 days after the initial transplantation. While efforts must be made to improve the outcome following retransplantation, a more critical evaluation may be warranted for late retransplantation candidates.

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“…The Middle East countries lack an active network of organ sharing except between few countries such as Saudi Arabia, Kuwait, and Qatar. There are several dominant and distinctive models for practice of organ donation and transplant in the Middle East including the Turkish, 6 Iranian, 7 Pakistani, 8 and Saudi models. 9,10 All these programs have active living-and deceased-donor organ donation and transplant and have national procurement centers to supervise these activities.…”

Section: Sources Of Organ Donation In the Middle Eastmentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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The Middle Eastern map includes all the Arab countries, Iran, Turkey, Pakistan, and countries of Central Asia. There are common features of organ transplant in these countries such as inadequate preventive medicine, uneven health infrastructure, poor awareness of the medical community and public about the importance of organ donation and transplant, high level of ethnicity, poor government support of organ transplant, and political unrest. In addition, there is inadequate team spirit among transplant physicians, lack of planning for organ procurement and transplant centers, and lack of effective health insurance. Living-donor organ transplant is the most widely practiced type of transplant in the Middle East. Deceased-donor organ donation is not used properly because of continued debate in the medical community about the concept of death according to neurologic criteria (brain death) and inadequate awareness of the public about the importance of organ donation and transplant in many countries in this region. Continuous work is needed to provide solutions to overcome the current obstacles.

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Rationing failure. The ethical lessons of the retransplantation of scarce vital organs

Cited by 92 publications

References 14 publications

Solid-Organ Transplantation in HIV-Infected Patients

Solid-Organ Transplantation in HIV-Infected Patients

Hepatic retransplantation in cholestatic liver disease: Impact of the interval to retransplantation on survival and resource utilization

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