Thursday, June 26, 2008

Disclosing organ transplant risks: Now or later?


Patients should weigh overall options, not individual risks, ethicists argue

By JoNel Aleccia
Health writer

Patients awaiting organ transplants should decide in advance whether they’re willing to take substandard kidneys, livers and other organs, including those at risk for infectious diseases such as HIV or hepatitis C.

That’s the conclusion of University of Pennsylvania scientists and ethicists who want to overhaul a piecemeal system they say fails to adequately inform some patients of potential problems while allowing others to "cherry-pick" donors, accepting or rejecting specific organs based on certain risk factors at the time of transplant.

“What they think might be based on fear or bias,” said Art Caplan, director of the Center for Bioethics at the university’s school of medicine and co-author of an article in the latest issue of the New England Journal of Medicine.

But a member of the United Network for Organ Sharing, or UNOS, the nation’s clearinghouse for organ allocation, said that while he supports thoughtful consent, he’s seen no evidence that the current system is flawed.

“This proposal is a solution in search of a problem,” said Dr. Benjamin Hippen, a transplant surgeon on the UNOS ethics committee.

The Pennsylvania authors said the issue was highlighted last year by the case of a Chicago man whose transplanted organs infected four people with HIV and hepatitis C. Although the 38-year-old car crash victim did not test positive for HIV at the time of his death, local officials knew the man had engaged in behaviors that raised his risk of infection. Recipients were not informed of the risks at the time of transplant, and at least one patient now plans to sue the transplant agency and the hospital.

Under the current system, warning patients about potential transplant problems is an "unknown and unregulated" practice that varies widely by region, hospital and even surgeon, the authors said.

"Disclosure is basically driven by a particular organ transplant team in a particular place," Caplan noted.

UNOS policy requires kidney patients to decide in advance whether they'll accept organs from "expanded criteria" donors, those who are older or have a history of high blood pressure or diabetes. After the Chicago incident, UNOS added a requirement that recipients be informed if organs come from certain high-risk donors, including those considered at risk for HIV. Read the full report.

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