Ethics

How to assess quality of life in reconstructive transplantation

Quality of life (QoL) assessment continues to play important roles in how we think about ethical effectiveness of health care services. How value is assigned to QoL can lead to conflict among patients, surrogate decision-makers, and physicians.

That’s especially true for vascularized composite allotransplantation (VCA), also called reconstructive transplantation. VCA includes transplants of the hand, face, penis, larynx and uterus, and is primarily conducted to improve a patient’s quality of life, not save their lives. Yet ethical inquiry into the quality of life aspects of VCA is lacking.

The November issue of the AMA Journal of Ethics® (@JournalofEthics) features numerous perspectives on conceptualizing quality of life in reconstructive transplantation and gives you opportunities to earn CME credit.

Articles include:

In Experimental Hand Transplantation, Whose Views About Outcomes Should Matter Most?” Clinician-researchers deeply invested in data gathering are still obliged to respect a patient-subject’s right to stop being in research.

Should a Caregiver’s QoL Be Considered in Decisions About Whether a Patient Has an Experimental Double-Hand Transplant?” Success depends on strong support, rehabilitation, adherence, and social integration.

How Should Surgeons Balance Transplantation Innovation With Acceptance of a Trauma Survivor’s Appearance?” Counseling a patient about reconstructive surgery for a traumatic and disfiguring injury requires special consideration.

How to Help Patients Considering VCA.” VCA candidates need clinicians to help them become familiar with experimental surgery eligibility criteria, prior and possible outcomes, and potential risks and benefits.

Listen and learn

In the journal’s November podcast, Katrina Bramstedt, PhD, an associate professor at Bond University School of Medicine in Queensland, Australia, and an associate editor of the Journal of Bioethical Inquiry, discusses background on hand and face transplants and addresses ethical questions that come up in patients and physicians’ discussions.

Ana Iltis, PhD, is the Carlson Professor of University Studies, a professor of philosophy and the director of the Center for Bioethics, Health and Society at Wake Forest University. In the podcast, she describes what patients and physicians should know about ethical dimensions of uterus transplantation.

Listen to previous episodes of the podcast, “Ethics Talk,” or subscribe in iTunes or other services.

Earn CME  

The AMA Journal of Ethics CME module, “How to Integrate Lived Experience Into Quality-of-Life Assessment in Patients Considering Facial Transplantation,” is designated by the AMA for a maximum of 1 AMA PRA Category 1 Credit™.  

The module is part of the AMA Ed Hub™, an online platform that brings together high-quality CME, maintenance of certification, and educational content—in one place—with relevant learning activities, automated credit tracking and reporting for some states and specialty boards.

Learn more about AMA CME accreditation.  

Submit manuscripts and artwork  

The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. Submit a manuscript for publication. The journal also invites original photographs, graphics, cartoons, drawings and paintings that explore the ethical dimensions of health or health care.  

The AMA Journal of EthicsJohn Conley Art of Medicine Contest for U.S.-based medical students, residents, and fellows is now open.   

A look ahead

Upcoming issues of the AMA Journal of Ethics will focus on governing human genome editing, and on global epidemic containment. Sign up to receive email alerts when new issues are published.