Decisions not to transplant: futility or rationing
Related Experiment Videos
E G Collins1, P B Pfiefer, G Mozdzierz
1Department of Veterans Affairs Edward Hines Jr. VA Hospital, Hines, Illinois, USA.
Insights
Many heart transplant decisions, often cited as futility, may actually be organ rationing. This challenges the criteria for selecting heart transplant recipients, impacting end-stage heart failure treatment.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Ethics
Background:
- Heart transplantation is a vital therapy for end-stage congestive heart failure.
- Increasing demand for heart transplants outstrips organ availability.
- Rigorous screening identifies suitable candidates for heart transplantation.
Purpose of the Study:
- To critically examine the criteria used for refusing heart transplantation.
- To argue that organ rationing, not futility, often underlies transplant refusal decisions.
- To explore the ambiguity between futility and rationing in transplant allocation.
Main Methods:
- Analysis of decision-making processes in heart transplant candidate selection.
- Review of ethical arguments concerning futility and rationing in organ transplantation.
- Conceptual analysis of the distinction between medical benefit and resource allocation.
Main Results:
- Futility arguments in heart transplant refusal are often ambiguous and difficult to define.
- Decisions to refuse transplantation may be influenced by organ scarcity rather than solely by medical futility.
- The distinction between futility and rationing is not always clear in practice.
Conclusions:
- Many refusals of heart transplantation are likely based on organ rationing.
- Re-evaluation of transplant selection criteria is needed to ensure fairness and transparency.
- Ethical frameworks must better address the complexities of organ allocation in the face of scarcity.
Abstract:
Since the 1980s, heart transplantation has become an acceptable treatment therapy for patients with end-stage congestive heart failure. In recent years, the demand for heart transplantation has exceeded the supply of available organs. Potential transplant candidates undergo rigorous screening to determine which patients will be offered transplantation as a treatment option. Heart transplant recipients are selected based on a determination of which patients will experience an improvement in symptomatology, functional class ability, and life expectancy after transplantation. Refusal of transplantation for an individual patient is usually framed in a futility argument: Either transplantation will not benefit the patient or the risks involved in undergoing the transplant are considered to outweigh the benefits. However, futility is an elusive and ambiguous concept. Furthermore, although authors, clinicians, and ethicists argue for the separation of futility and rationing issues, clearly it is not always possible to do so. The purpose of this article is to argue that many decisions to refuse heart transplantation are actually based on the rationing of organs and not on futility.