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Hartsock JA, Halverson CME. Lost in translation: the history of the Ebers Papyrus and Dr. Carl H. von Klein. J Med Libr Assoc 2023; 111:844-851. [PMID: 37928112 PMCID: PMC10621680 DOI: 10.5195/jmla.2023.1755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
While the Ebers Papyrus is understood to be one of the oldest and most complete contemporaneous perspectives on Ancient Egyptian healing practices, nothing has yet been said about the biography of its first English-language translator, Dr. Carl H. von Klein. A German immigrant and surgeon in the American Midwest, von Klein spent twenty-some years meticulously translating and annotating the Papyrus, but ultimately his manuscript was destroyed. In this paper, we examine the societal- and personal-scale forces that thwarted his efforts to transform our understanding of the history of medicine.
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Affiliation(s)
- Jane A Hartsock
- , Indiana University Health & Indiana University School of Liberal Arts, Indianapolis, IN
| | - Colin M E Halverson
- , Indiana University Health & Indiana University School of Liberal Arts, Indianapolis, IN
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2
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Schwartz PH, Hartsock JA. Selling Clinical Biospecimens: Guidance for Researchers and Private Industry. J Law Med Ethics 2023; 51:429-436. [PMID: 37655567 DOI: 10.1017/jme.2023.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The recently revised Common Rule requires that donors of biospecimens for research be informed if their specimens might be used for commercial profit. The Common Rule, however, does not apply to sharing or selling de-identified biospecimens that are "leftover" from clinical uses. As a result, many medical researchers remain uncertain of their legal and ethical obligations when a commercial entity expresses interest in these specimens.
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Hartsock JA. The White Coat Cape: An Ethical Analysis of Emerging Therapies to Treat Spinal Muscular Atrophy. Semin Pediatr Neurol 2023; 45:101036. [PMID: 37003633 DOI: 10.1016/j.spen.2023.101036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
The recent emergence of promising therapies to treat neuromuscular diseases such as spinal muscular atrophy raises important questions regarding the ethical permissibility of allowing a parent to refuse these Food and Drug Administration-approved drugs. The 3 most recent drugs targeting spinal muscular atrophy have all been approved since 2019, lack long-term data regarding potential side-effects and long-term benefits, and are costly. Indeed, onasemnogene abeparvovec-xioi (Zolgensma) has been called the most expensive drug in the world. Contemporary analyses of innovative therapies, compassionate use medications, off-label usage, and emerging therapies tend to focus on the importance of informed consent in framing the ethical dimensions of these medications. This manuscript utilizes a narrative framework of "rescue" to explore the competing perspectives of optimistic physicians and parents, who may decline the therapies finding the benefit-burden profile does not weigh in favor of their use. Ultimately, this paper concludes that such refusal should be considered ethically permissible until such time as more long-term data are available for these medications and their cost has decreased substantially.
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Hartsock JA, Head KJ, Kasting ML, Sturm L, Zimet G. Perceptions of the ethical permissibility of strict travel restrictions to mitigate transmission of SARS-CoV-2. Transp Res Interdiscip Perspect 2022; 14:100577. [PMID: 35252841 PMCID: PMC8885284 DOI: 10.1016/j.trip.2022.100577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/21/2022] [Accepted: 02/26/2022] [Indexed: 06/14/2023]
Abstract
Although there has been extensive exploration of public opinion surrounding many non-pharmaceutical interventions (NPIs) aimed at mitigating transmission of SARS-CoV-2 (e.g. mask-wearing and social distancing), there has been less discussion of the public's perception of the ethical appropriateness other NPIs. This paper presents the results of a survey of U.S. adults' opinions of the ethical permissibility of both state-to-state and international travel restrictions to mitigate transmission of SARS-CoV-2. Our research revealed overall high agreement with the ethical permissibility of both state-to-state and international travel restrictions, though we saw significant difference across political party affiliation and conservative/liberal ideologies. Other factors associated with agreement with state-to-state travel restrictions included increasing education, increasing income, and both high and low commitment altruism. When considering international travel restrictions, income, education, and low commitment altruism were associated with increased agreement with the ethical permissibility of international travel restrictions. Ethical analysis and implications are explored.
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Affiliation(s)
- Jane A Hartsock
- Clinical and Organizational Ethics - Indiana University Health Adjunct Assistant Professor, Medical Humanities and Health Studies - Indiana University School of Liberal Arts 1800 N. Capital Ave. Suite E644 Indianapolis IN 46202, United States
| | - Katharine J Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis 450 University Blvd. Indianapolis, IN 46202, United States
| | - Monica L Kasting
- Department of Public Health Purdue University 812 W. State Street, Room 216 West Lafayette, IN 47907, United States
| | - Lynne Sturm
- Associate Professor of Clinical Pediatrics Indiana University School of Medicine 1002 Wishard Boulevard, Suite 3120 Indianapolis IN 46202, United States
| | - Gregory Zimet
- Professor of Pediatrics & Psychiatry Indiana University School of Medicine 410 W. 10 Street, Suite 1001 Indianapolis, IN 46202, United States
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Head KJ, Hartsock JA, Bakas T, Boustani MA, Schroeder M, Fowler NR. Development of Written Materials for Participants in an Alzheimer's Disease and Related Dementias Screening Trial. J Patient Exp 2022; 9:23743735221092573. [PMID: 35434299 PMCID: PMC9009139 DOI: 10.1177/23743735221092573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Given that participants' experiences in clinical trials include a variety of communication touchpoints with clinical trial staff, these communications should be designed in a way that enhances the participant experience by paying attention to the self-determination theoretical concepts of competence, autonomy, and relatedness. In this feature, we argue that clinical trial teams need to consider the importance of how they design their written participant communication materials, and we explain in detail the process our multidisciplinary team took to design written materials for the patient and family caregiver participants in our Alzheimer's disease and related dementias (ADRD) screening trial. This article concludes with suggested guidance and steps for other clinical trial teams.
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Affiliation(s)
- Katharine J Head
- Department of Communication Studies, Indiana University–Purdue University
Indianapolis, Indianapolis, IN, USA
| | - Jane A. Hartsock
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Tamilyn Bakas
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Malaz A Boustani
- Department of Medicine, Indiana University School of
Medicine, Indianapolis, IN, USA
- Indiana University Center for Aging Research, Indianapolis, IN,
USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational
Science Institute, USA
| | | | - Nicole R Fowler
- Department of Medicine, Indiana University School of
Medicine, Indianapolis, IN, USA
- Indiana University Center for Aging Research, Indianapolis, IN,
USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational
Science Institute, USA
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Sturm L, Kasting ML, Head KJ, Hartsock JA, Zimet GD. Influenza vaccination in the time of COVID-19: A national U.S. survey of adults. Vaccine 2021; 39:1921-1928. [PMID: 33715898 PMCID: PMC7931729 DOI: 10.1016/j.vaccine.2021.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 11/24/2022]
Abstract
Introduction Decisions about influenza vaccination for fall-winter 2020 were made against the backdrop of the COVID-19 pandemic. During May 2020, the authors examined intended vaccination in the next 12 months in relationship to demographic variables, healthcare attitudes, and personal COVID-19 experiences for two samples of adults--those who did not receive influenza vaccine during the prior 12 months, and those who did. Methods In May 2020, a cross-sectional online survey was conducted with a national US sample. Participants reported prior influenza vaccination (yes/no during prior 12 months) and anticipated vaccination (yes/no during next 12 months). Covariates included demographic characteristics (e.g., gender, race-ethnicity, political ideology), general beliefs (e.g., benefits of vaccines, altruistic attitudes), and COVID-19 health beliefs and experiences (COVID-19 worry and severity, perception of COVID-19 as a community threat, knowing someone with COVID-19). For each group, hierarchical multivariable logistic regression was conducted with intent to vaccinate as the outcome. Results Among participants (n = 3502), 47% did not receive influenza vaccine in the prior 12 months and 53% had; 25.5% of non-vaccinators and 91.9% of vaccinators intended future vaccination. For non-vaccinators, odds of intending vaccination was associated with race/ethnicity (Hispanics were more likely to intend than white-NH; AOR = 1.74; 95% CI = 1.23–2.4), greater perceived benefits of vaccination (AOR = 2.19; 95% CI = 1.88–2.54), and perception of COVID-19 as a community threat (AOR = 1.91; 95% CI = 1.49–2.45). For vaccinators, odds of intending vaccination was associated with age (AOR = 1.04; 95% CI = 1.03–1.05), race/ethnicity (Black-NH and Other-NH were less likely to intend than white-NH, AOR = 0.60; 95% CI = 0.36–0.999; and AOR = 0.45; 95% CI = 0.24–0.84, respectively), greater perceived benefits of vaccination (AOR = 1.88; 95% CI = 1.45–2.45) and greater perception of collective benefits of vaccines (AOR = 1.48; 95% CI = 1.15–1.90). Conclusions The COVID-19 pandemic may have served as a cue to action for influenza vaccination intention among some prior non-vaccinators whereas intention among prior vaccinators is more related to positive attitudes toward vaccination.
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Affiliation(s)
- Lynne Sturm
- Indiana University School of Medicine, Department of Pediatrics, Suite 3120 Riley Pediatric Care Center, 1002 Wishard Boulevard, Indianapolis, IN 46202, USA.
| | - Monica L Kasting
- Purdue University, Department of Public Health, Matthews Hall 216, 812 W. State Street, West Lafayette, IN 47907, USA.
| | - Katharine J Head
- Indiana University, Purdue University Indianapolis, Department of Communication Studies, 307C Cavanaugh Hall, 425 University Blvd, Indianapolis, IN, 46202 USA.
| | - Jane A Hartsock
- Indiana University Health, 1800 N. Capitol Ave., Noyes Pavilion Suite E644, Indianapolis, IN 46202, USA.
| | - Gregory D Zimet
- Indiana University School of Medicine, Department of Pediatrics, 410 W. 10th Street. Ste 1001, Indianapolis, IN 46202, USA.
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Kasting ML, Head KJ, Hartsock JA, Sturm L, Zimet GD. Public perceptions of the effectiveness of recommended non-pharmaceutical intervention behaviors to mitigate the spread of SARS-CoV-2. PLoS One 2020; 15:e0241662. [PMID: 33147261 PMCID: PMC7641367 DOI: 10.1371/journal.pone.0241662] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/19/2020] [Indexed: 12/15/2022] Open
Abstract
Background The COVID-19 pandemic is an unprecedented public health threat, both in scope and response. With no vaccine available, the public is advised to practice non-pharmaceutical interventions (NPI) including social distancing, mask-wearing, and washing hands. However, little is known about public perceptions of the effectiveness of these measures, and high perceived effectiveness is likely to be critical in order to achieve widespread adoption of NPI. Methods In May 2020, we conducted a cross-sectional survey among U.S. adults (N = 3,474). The primary outcome was a six-item measure assessing perceived effectiveness of recommended behaviors to prevent SARS-CoV-2 infection from 1 (not at all effective) to 5 (extremely effective). The sample was divided into “higher” and “lower” perceived effectiveness groups. Covariates included demographics, healthcare characteristics, and health beliefs. Variables that were significant at p<0.01 in bivariate analyses were entered into a multivariable logistic regression and a best-fit model was created using a cutoff of p<0.01 to stay in the model. Results Mean age was 45.5 years and most participants were non-Hispanic White (63%) and female (52.4%). The high perceived effectiveness group was slightly larger than the low perceived effectiveness group (52.7% vs. 47.3%). Almost all health belief variables were significant in the best-fit regression model. COVID-19-related worry (aOR = 1.82; 95% CI = 1.64–2.02), and perceived threat to physical health (aOR = 1.32; 95% CI = 1.20–1.45) were positively associated with perceived effectiveness while perceived severity of COVID-19 (0.84; 95% CI = 0.73–0.96) and perceived likelihood of infection (0.85; 95% CI = 0.77–0.94) switched directions in the adjusted model and were negatively associated with perceived effectiveness. Conclusions This research indicates people generally believe NPI are effective, but there was variability based on health beliefs and there are mixed rates of engagement in these behaviors. Public health efforts should focus on increasing perceived severity and threat of SARS-CoV-2-related disease, while promoting NPI as effective in reducing threat.
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Affiliation(s)
- Monica L. Kasting
- Department of Public Health, Purdue University, West Lafayette, Indiana, United States of America
- Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana, United States of America
- * E-mail:
| | - Katharine J. Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States of America
| | - Jane A. Hartsock
- Department of Clinical and Organizational Ethics, Indiana University Health, Indianapolis, Indiana, United States of America
- Center for Bioethics, Indiana University, Indianapolis, Indiana, United States of America
- Medical Humanities & Health Studies Program, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States of America
| | - Lynne Sturm
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Gregory D. Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
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Head KJ, Kasting ML, Sturm LA, Hartsock JA, Zimet GD. A National Survey Assessing SARS-CoV-2 Vaccination Intentions: Implications for Future Public Health Communication Efforts. Sci Commun 2020; 42:698-723. [PMID: 38602991 PMCID: PMC7520657 DOI: 10.1177/1075547020960463] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
With SARS-CoV-2 vaccines under development, research is needed to assess intention to vaccinate. We conducted a survey (N = 3,159) with U.S. adults in May 2020 assessing SARS-CoV-2 vaccine intentions, intentions with a provider recommendation, and sociodemographic and psychosocial variables. Participants had high SARS-CoV-2 vaccine intentions (M = 5.23/7-point scale), which increased significantly with a provider recommendation (M = 5.47). Hierarchical linear regression showed that less education and working in health care were associated with lower intent, and liberal political views, altruism, and COVID-19-related health beliefs were associated with higher intent. This work can inform interventions to increase vaccine uptake, ultimately reducing COVID-19-related morbidity and mortality.
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Affiliation(s)
- Katharine J Head
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | | | - Lynne A Sturm
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jane A Hartsock
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Gregory D Zimet
- Indiana University School of Medicine, Indianapolis, IN, USA
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Abstract
As pediatric biobank research grows, additional guidance will be needed about whether researchers should always obtain consent from participants when they reach the legal age of majority. Biobanks struggle with a range of practical and ethical issues related to this question. We propose a framework for the use of anticipatory waivers of consent that is empirically rooted in research that shows that children and adolescents are often developmentally capable of meaningful deliberation about the risks and benefits of participation in research. Accordingly, bright-line legal concepts of majority or competency do not accurately capture the emerging capacity for autonomous decision-making of many pediatric research participants and unnecessarily complicate the issues about contacting participants at the age of majority to obtain consent for the continued or first use of their biospecimens that were obtained during childhood. We believe the proposed framework provides an ethically sound balance between the concern for potential exploitation of vulnerable populations, the impetus for the federal regulations governing research with children, and the need to conduct valuable research in the age of genomic medicine.
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Affiliation(s)
- Jane A Hartsock
- Faculty investigator with the Indiana University Center for Bioethics at the Indiana University School of Medicine and the director of clinical ethics for the Academic Health Center at Indiana University Health
| | - Peter H Schwartz
- Director of the Indiana University Center for Bioethics at the Indiana University School of Medicine and an associate professor of medicine at Indiana University School of Medicine
| | - Amy C Waltz
- Associate director of the Indiana University Human Subjects Office and an adjunct professor at the Indiana University Robert H. McKinney School of Law
| | - Mary A Ott
- Pediatric ethicist at the Indiana University Center for Bioethics at the Indiana University School of Medicine and an associate professor of pediatrics in the Indiana University School of Medicine
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Kirkman AO, Hartsock JA, Torke AM. How The Fault in Our Stars illuminates four themes of the Adolescent End of Life Narrative. Med Humanit 2019; 45:240-246. [PMID: 29804093 DOI: 10.1136/medhum-2017-011400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Abstract
Adolescents who face life-limiting illness have unique developmental features and strong personal preferences around end of life (EOL) care. Understanding and documenting those preferences can be enhanced by practising narrative medicine. This paper aims to identify a new form of narrative, the Adolescent End of Life Narrative, and recognise four central themes. The Adolescent EOL Narrative can be observed in young adult fiction, The Fault in Our Stars, which elucidates the notion that terminally ill adolescents have authentic preferences about their life and death. Attaining narrative competence and appreciating the distinct perspective of the dying adolescent allows medical providers and parents to support the adolescent in achieving a good death. By thinking with the Adolescent EOL Narrative, adults can use Voicing my CHOiCES, an EOL planning guide designed for adolescents, to effectively capture the adolescent's preferences, and the adolescent can make use of this type of narrative to make sense of their lived experience.
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Affiliation(s)
- Anna Obergfell Kirkman
- Legal Affairs, Eskenazi Health, Indianapolis, Indiana, USA
- Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis, IN, USA
| | - Jane A Hartsock
- Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis, IN, USA
- Medical Humanities & Health Studies Program, Indiana University School of Liberal Arts, Indianapolis, Indiana, USA
- Indiana University Center for Bioethics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alexia M Torke
- Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis, IN, USA
- Indiana University Center for Aging Research, Regenstrief Institute Inc, Indianapolis, Indiana, USA
- Division of General Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Hartsock JA. Provider Conscientious Refusal, Medical Malpractice, and the Right to Civil Recourse. Am J Bioeth 2018; 18:66-68. [PMID: 30040568 DOI: 10.1080/15265161.2018.1478020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Hartsock JA, Ivy SS, Helft PR. Liver Allocation to Non-U.S. Citizen Non-U.S. Residents: An Ethical Framework for a Last-in-Line Approach. Am J Transplant 2016; 16:1681-7. [PMID: 26693843 DOI: 10.1111/ajt.13674] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 11/06/2015] [Accepted: 11/22/2015] [Indexed: 01/25/2023]
Abstract
The incidence of non-U.S. citizen non-U.S. resident patients coming to the United States specifically for deceased donor liver transplantation raises compelling ethical questions that require careful consideration. The inclusion of these often financially and/or socially privileged patients in the pool of potential candidates for an absolutely scarce and life-saving liver transplant may exacerbate disparities already existing in deceased donor liver allocation. In addition, their inclusion on organ transplant waiting lists conflicts with recognized ethical principles of justice and reciprocity. Moreover, preliminary data suggest that public awareness of this practice could discourage organ donation, thereby worsening an already profound supply-demand gulf. Finally, U.S. organ allocation policies and statutes are out of step with recently promulgated international transplant guidelines, which prioritize self-sufficiency of organ programs. This article analyzes each of these ethical conflicts within the context of deceased donor liver transplantation and recommends policy changes that align the United States with international practices that discourage this scenario.
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Affiliation(s)
- J A Hartsock
- Indiana University School of Liberal Arts, Indianapolis, IN.,Indiana University Health, Indianapolis, IN.,Charles Warren Fairbanks Center for Medical Ethics, Indianapolis, IN
| | - S S Ivy
- Indiana University Health, Indianapolis, IN.,Charles Warren Fairbanks Center for Medical Ethics, Indianapolis, IN
| | - P R Helft
- Indiana University Health, Indianapolis, IN.,Charles Warren Fairbanks Center for Medical Ethics, Indianapolis, IN.,Indiana University-Purdue University at Indianapolis, Indianapolis, IN.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
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