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Addressing the Ethical Challenges of Providing Kidney Failure Care for Children: A Global Stance

Priya Pais1, Aaron Wightman2,3,4

  • 1Department of Pediatric Nephrology, St. John's Medical College, St. John's National Academy of Health Sciences, Bangalore, India.

Frontiers in Pediatrics
|April 1, 2022
PubMed

Insights

Children with kidney failure need kidney replacement therapy (KRT). Inequitable access to KRT in low-income countries creates ethical challenges and moral distress for families and doctors.

Area of Science:

  • Pediatric Bioethics
  • Global Health
  • Nephrology

Background:

  • Children with kidney failure require kidney replacement therapy (KRT) or conservative care with palliative support.
  • Decision-making for KRT involves parents as surrogate decision-makers and pediatric nephrology teams.
  • Ethical considerations in pediatric KRT are universal, but access disparities are significant.

Purpose of the Study:

  • To discuss ethical challenges in pediatric kidney failure care decision-making from a global perspective.
  • To highlight inequities in access to KRT for children in low- and middle-income countries (LMICs).
  • To explore the impact of these disparities on caregivers and pediatric nephrologists.

Main Methods:

  • Analysis of ethical challenges using a pediatric bioethics framework.
  • Discussion of global disparities in KRT access.
  • Use of case vignettes to illustrate real-world dilemmas.

Main Results:

  • Significant ethical dilemmas arise from inequitable access to KRT in LMICs.
  • Children in LMICs face inadequate access to dialysis, transplantation, and palliative care.
  • Caregiver burdens and moral distress among pediatric nephrologists are exacerbated by these disparities.

Conclusions:

  • Advocacy for improved, affordable kidney failure care for children globally is crucial.
  • Addressing access inequities is paramount to improving outcomes for children with kidney failure.
  • The global pediatric nephrology community must champion equitable KRT access.

Keywords:
advocacydialysisethical challengesglobal inequitykidney transplantlow and middle income countries (LMICs)pediatric kidney failure

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