Ethical dichotomies in organ transplantation. A time for bridge building

General Hospital Psychiatry
O S Surman, A B Cosimi

Abstract

Rapid advances of the past 15 years have resolved many of the technical and immunologic limitations to organ transplantation. With the success rates that can now be achieved, there is increased attention to the limited supply of donor organs and to cost considerations, the remaining obstacles to wide application of organ transplantation. Competition for organs and for funding demands greater focus on patient selection and resource allocation. As Charles Taylor, philosopher and political scientist, has written, ethical formulations inevitably conflict when each is taken to its logical end point. In the 1960s, a life boat ethics framework predominated for selection of transplant recipients. The opposing egalitarian framework of recent decades has allowed for enrollment of older transplant recipients and those with histories of substance abuse. In the United States, alcoholic liver disease has been the most common indication for orthotopic liver transplantation since 1987. Among those awaiting transplantation, urgency has been a priority over time waiting. But many potential transplant candidates who are young and who appear relatively stable die while waiting. Despite the shortage of cadaveric organs, physicians and ethicists hav...Continue Reading

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Citations

Oct 2, 2003·The British Journal of Psychiatry : the Journal of Mental Science·Ajaykumar V Pawar, Sean A Spence
Feb 24, 2001·Progress in Transplantation : Official Publication, North American Transplant Coordinators Organization ... [et Al.]·J A Nell, M C Corley
Mar 10, 2001·Progress in Transplantation : Official Publication, North American Transplant Coordinators Organization ... [et Al.]·M A DewR L Kormos
Mar 2, 2002·Progress in Transplantation : Official Publication, North American Transplant Coordinators Organization ... [et Al.]·J S HanrahanP K Mohanty
Sep 18, 1998·The Joint Commission Journal on Quality Improvement·H D HadjistavropoulosG Bartlett

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