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Published on: September 6, 2017
Promoting Research with Organ Transplant Patients
Sarah R Lieber1, Thomas D Schiano2,3, Rosamond Rhodes2
1University of North Carolina at Chapel Hill School of Medicine.
Abstract:
Given the numerous questions related to patient selection, surgical technique, and posttransplant care requiring evidence-based answers, transplantation programs should be conducting research with patients waiting to receive an organ and those who have undergone organ transplantation. Yet, there continues to be a dearth of human subjects research in the field of transplantation medicine. Here, we discuss challenges that may deter transplantation programs from engaging in transplant-related research. Taking liver transplantation as our illustrative example, we explain the vulnerabilities of patients with end-stage organ failure and the complex ethical issues of decisional capacity, coercion, and the timing of study enrollment. Ultimately, we argue that all transplant candidates should be invited and encouraged to participate in research. We maintain that clinical care should be provided in the context of active research so that clinicians can further their understanding of transplantation medicine while also providing high-quality patient care. We suggest that early discussion with patients about participating in research and about a research advance directive may help to overcome reluctance about and the ethical challenges of transplantation research with human subjects.
Insights
Transplantation research needs more human subjects to answer critical patient care questions. Encouraging all transplant candidates to join studies, alongside clinical care, can overcome ethical hurdles and advance transplantation medicine.
Area of Science:
- Transplantation Medicine
- Clinical Research Ethics
- Patient Advocacy
Background:
- Numerous questions in transplantation medicine require evidence-based answers.
- There is a significant lack of human subjects research in transplantation.
- Challenges deter transplantation programs from engaging in vital research.
Purpose of the Study:
- To discuss challenges hindering transplantation research.
- To address ethical issues in transplant research, including decisional capacity and coercion.
- To advocate for increased patient participation in transplantation research.
Main Methods:
- Discussion of ethical considerations in transplant research, using liver transplantation as an example.
- Analysis of patient vulnerabilities and enrollment timing.
- Proposal of strategies to encourage research participation.
Main Results:
- Patients with end-stage organ failure present unique vulnerabilities.
- Ethical issues like decisional capacity and coercion complicate research enrollment.
- Early discussions about research participation and advance directives can mitigate challenges.
Conclusions:
- All organ transplant candidates should be invited and encouraged to participate in research.
- Clinical care should be integrated with active research to improve patient outcomes and medical understanding.
- Overcoming reluctance and ethical challenges is crucial for advancing transplantation medicine through human subjects research.
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