Ethical Implications of Multi-Organ Transplants: Addressing Allocation Disparities
This resource explores ethical dilemmas in Multi-Organ Transplants (MOT) and presents solutions to standardize allocation systems and promote equity. Developed through feedback from OPTN committees, it proposes recommendations to enhance transparency, establish standards, and mitigate disadvantages for certain patient subgroups.
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Presentation Transcript
Ethical Implications of Multi-Organ Transplants (MOT) Ethics Committee 1
What problem will this resource solve? Current MOT allocation systems are not standardized across organ type Generates confusion in the community Lack of consistency has potential to create/perpetuate inequity Equity in access to transplant is #2 OPTN strategic goal At the same time Amount of MOT have increased over the past two decades Excluding KP and heart/lung, has doubled in the past six years, from 625 in 2012 to 1,035 in 2017 Need for guidance/clarity 2
How was this resource developed? Throughout 2018, the Committee identified potential ethical dilemmas for current MOT policies Solicited feedback from all 21 OPTN committees Received feedback from members of the following committees: Pediatric, Patient Affairs, Pancreas, Ops & Safety, Minority Affairs, Thoracic 3
What are the proposed solutions? Develop a white paper with recommendations for the OPTN/UNOS Board to consider in addressing MOT allocation 4
Ethical dilemmas addressed Degree of need Monitoring MOT in transplant programs Waitlists and the pulling of organs Fairness to patients awaiting SOT Organ quality Standardized Criteria for MOT Treatment options other than transplantation Relative Futility Prioritization of MOT over SOT (single organ transplant) Impact of adult MOT on pediatric SOT Regionalization Protected Subgroups 5
Recommendations Include: 1. Establish data reporting for MOT outcomes Improve transparency and create standards 2. Consider establishing minimum requirements for MOT Medical urgency important qualifier 3. Consider additional safety net policies for other MOT combinations Don t disadvantage patients who undergo SOT instead of MOT 4. Minimize added harm to subgroups already disadvantaged in access to transplants Children, minority populations, highly sensitized patients 6
How will members implement this resource? Does not require any member action Will be available as a reference on the OPTN website pending approval by the Board of Directors 7
How will the OPTN implement this resource? Will be available through the OPTN website If approved, could serve as reference for the Board of Directors and committees considering future policy changes to MOT 8
Extra Slides 10
Pediatric candidates Focus of paper on adult candidates because the challenges with pediatric candidates may be substantively different for MOT However, Committee solicited and received feedback from Pediatric Committee, which asked for more discussion on pediatrics In response to Pediatric Committee, Ethics Committee added language to Protected Subgroups section discussing the impact on pediatric candidates 11
MOT Increase Excluding KP and heart/lung, MOT has doubled in the past six years, from 625 in 2012 to 1,035 in 2017 The reason for this increase is not readily apparent The Committee considered investigating the reason for this increase, but after discussion, agreed the most relevant and important takeaway for the ethical implications of MOT is the fact of the increase, not the reason for it 12
