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Topic: Transplantation
December 11, 2014 | Posted By Dan Thompson, MD

The title of the article in the Journal of Medical Ethics asks this question.[1]  The authors from the University of Montreal consider this subject while the topic of “illegal aliens” or foreign nationals (FN’s) has been a hot topic in the United States.  They however attempt to answer the problem from an international perspective.  The FN that we hear about is usually in the country illegally, but may be in the country as a legal non-citizen, visitor, non-permeant resident, refuge claimant, resettled refugee and in rare cases a person detained by the government.

A patient who arrives at the emergency room requiring hemodialysis would likely rapidly be started on renal replacement therapy.  This is an emergency and since this is considered, an emergency there would likely not be a question about the provision of such therapy. What then about transplantation of a kidney?  Is renal transplantation an emergency treatment?  We usually consider transplantation to be a more economical form of treatment of the acute renal failure in the end, but the lack of long term funding for medical care of the FN puts a different spin on the subject. It is not just the procurement of the organ and the surgery but also provision of and management of the immunotherapy necessary to prevent rejection of the kidney and the technology to manage the therapy.   A foreign national that returns to their home country where there is not an infrastructure that can provide the drug therapy or monitoring will reject the kidney. There is a national issue of financing the care and the ethical and national issues of obtaining the organ.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

June 27, 2013 | Posted By Marleen Eijkholt, PhD

Sarah is a 10-y old girl with cystic fibrosis who, until recently, was in desperate need of a lung transplant. The doctors had estimated that Sarah would only have a couple more weeks to live without a transplant. Recent news headlines reported about her quest for this transplant, the success of the operation and, over the weekend, they issued the happy news about her regaining consciousness. Most of this news paralleled comments about the battle to revise the legislation, and underscored antagonism towards policy or policy makers (lawyers and ethicists), as if hindering good medicine. 

In this post I would like to comment on this antagonism, and propose that the policy makers did quite a good job in Sarah’s case. I propose that we need a symbiotic relation between medicine and policy makers. As a clinical ethicist with a background in law, I feel a lot of fear for ‘lawyers’, and prejudice against the idea that law, ethics and medicine can go together. In this post, I seek to outline how they can go together, and how Sarah’s case provides an opportunity for partnership. I must note here, however, that this issue is a minor one given the terrible ordeal of all the involved individuals.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

February 6, 2012 | Posted By Posted By David Lemberg, M.S., D.C.

Women's reproductive rights are not an issue that concerns only women. A well-documented causal chain connects a woman's access to contraception and abortion services, the fertility rate, women's educational levels in a developing nation, and that nation's gross domestic product.

What do these matters have to do with women's reproductive rights? The key point is choice. No availability of reliable birth control methods directly equates to no choice. And as has been forcefully demonstrated recently, the availability of choice is deemed critical to the health and well-being of men and women in all socioeconomic groups. Witness the Susan G. Komen Foundation debacle.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

March 14, 2011 | Posted By Danielle Holley, JD, MS

Recently, the United Network for Organ Sharing (UNOS) issued a report seeking feedback on their new proposed allocation system for kidneys–a complete overhaul of the current system – which seeks to match kidney recipients with deceased donor organs based on age and health.  Click here for report.  It has been evident for a while that the system for allocating kidneys faces many problems—there is an ever-growing wait list with over 100,000 people currently on the list and significantly less donors than are needed.  The looming question, then, is how do we allocate life-saving limited resources?    

The question of allocating scarce resources is often posed as a “priority problem” with several opposing options: (1) giving the scarce resource to the worst off, (2) using an utilitarian argument by focusing on the greatest overall good, or (3) using a first-come, first-served method.  Each of these options presents their own unique benefits and downfalls.  The current system tends to allocate based on first-come, first serve with compatability (but there are numerous stories over the years that note the ineffectivness or blatant violation of this).  The proposed system, however, adopts a more utilitarian argument, focusing on giving priority to those first with longest estimated survivial and then to a recipient within 15 years of the donor organ if the donor organ has a KDPI score of greater than or equal to twenty percent.  The overall goal of the proposed system is to increase the total life span following transplant.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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