Transplantation offers hope to patients with organ failure. As in all patient-physician relationships, the physician’s primary concern must be the well-being of the patient. However, organ transplantation is also unique in that it involves two patients, donor and recipient, both of whose interests must be protected. Concern for the patient should always take precedence over advancing scientific knowledge.
Physicians who participate in transplantation of organs from deceased donors should:
- Avoid actual or perceived conflicts of interest by ensuring that:
- To the greatest extent possible that the health care professionals who provide care at the end of life are not directly involved in retrieving or transplanting organs from the deceased donor. Physicians should encourage health care institutions to distinguish the roles of health care professionals who solicit or coordinate organ transplantation from those who provide care at the time of death.
- No member of the transplant team has any role in the decision to withdraw treatment or the pronouncement of death.
- Ensure that death is determined by a physician not associated with the transplant team and in accordance with accepted clinical and ethical standards.
- Ensure that transplant procedures are undertaken only by physicians who have the requisite medical knowledge and expertise and are carried out in adequately equipped medical facilities.
- Ensure that the prospective recipient (or the recipient’s authorized surrogate if the individual lacks decision-making capacity) is fully informed about the procedure and has given voluntary consent in keeping with ethics guidance.
- Except in situations of directed donation, ensure that organs for transplantation are allocated to recipients on the basis of ethically sound criteria, including but not limited to likelihood of benefit, urgency of need, change in quality of life, duration of benefit, and, in certain cases, amount of resources required for successful treatment.
- Ensure that organs for transplantation are treated as a national, rather than a local or regional, resource.
- Refrain from placing transplant candidates on the waiting lists of multiple local transplant centers, but rather place candidates on a single waiting list for each type of organ.
AMA Principles of Medical Ethics: I,III,V
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