ABSTRACT
BACKGROUND: Although altruism is a key principle in our current organ donation and transplantation system, the meanings and implications of the term have been widely debated. Recently, a new type of living organ donation--anonymous and non-directed, also called living altruistic donation (LAD)--has brought the issue into sharper focus. Transplant physicians' views on altruism might influence their attitudes and actions toward living altruistic donors. This study aimed to explore such views among transplant physicians in France and Quebec. FINDINGS: A total of 27 French and 19 Quebec transplant physicians participated in individual, semi-structured interviews between October 2004 and December 2005. The majority of these participants associated altruism with gratuitousness and saw altruistic acts as multiple and varied, ranging from showing consideration to saving a person's life. CONCLUSIONS: The transplant physicians' discourses on altruism were quite diverse, leading us to question the relevance of the concept in organ transplantation and the appropriateness of the term "living altruistic donation."
ABSTRACT
BACKGROUND: The overwhelming scarcity of organs within renal transplantation forces researchers and transplantation teams to seek new ways to increase efficacy. One of the possibilities is the use of personalized medicine, an approach based on quantifiable and scientific factors that determine the global immunological risk of rejection for each patient. Although this approach can improve the efficacy of transplantations, it also poses a number of ethical questions. METHODS: The qualitative research involved 22 semi-structured interviews with nephrologists involved in renal transplantation, with the goal of determining the professionals' views about calculating the global immunological risk and the attendant ethical issues. RESULTS: The results demonstrate a general acceptance of this approach amongst the participants in the study. Knowledge of each patient's immunological risk could improve treatment and the post-graft follow-up. On the other hand, the possibility that patients might be excluded from transplantation poses a significant ethical issue. This approach is not seen as something entirely new, given the fact that medicine is increasingly scientific and evidence-based. Although renal transplantation incorporates scientific data, these physicians believe that there should always be a place for clinical judgment and the physician-patient relationship. CONCLUSIONS: The participants see the benefits of including the calculation of the global immunological risk within transplantation. Such data, being more precise and rigorous, could be of help in their clinical work. However, in spite of the use of such scientific data, a place must be retained for the clinical judgment that allows a physician to make decisions based on medical data, professional expertise and knowledge of the patient. To act in the best interests of the patient is key to whether the calculation of the global immunological risk is employed.
Subject(s)
Decision Making/ethics , Kidney Transplantation/ethics , Kidney Transplantation/immunology , Patient Selection/ethics , Physicians/statistics & numerical data , Precision Medicine/statistics & numerical data , Adult , Aged , Ethics, Clinical , Ethics, Medical , Female , Health Knowledge, Attitudes, Practice , Humans , Interdisciplinary Communication , Judgment , Male , Middle Aged , Precision Medicine/ethics , Precision Medicine/methods , Predictive Value of Tests , Qualitative Research , Quebec , Risk Assessment , Risk Factors , Surveys and Questionnaires , UncertaintyABSTRACT
AIM: To explore the views of physicians on the use of personalized medicine tools to develop a new method for selecting potential recipients of a renal allograft. METHODS: A total of 22 semidirected interviews, using clinical case studies. RESULTS: According to the participants, this method has several possible applications within renal transplantation (individualizing immunosuppressive therapy, help with decision making, and possibly with the selection of patients). It could be more effective than the method presently used. The method must be validated scientifically, and must also involve clinical judgment. CONCLUSION: The use of personalized medicine within transplantation must be in the best interests of the patient. An ethical reflection is necessary in order to focus on the possibility of patients being excluded, as well as on the resolution of the equity/efficacy dilemma. Empirical research has shown itself to be essential for ascertaining the views of the clinicians who will be working with the tools provided by personalized medicine.
ABSTRACT
La medicina personalizada es la última corriente médica del momento y podría imponerse en la práctica médica a partir del 2010. La medicina personalizada se caracteriza por la utilización de datos derivados principalmente de la genómica, con el fin de escoger terapias hechas a la medida para cada paciente. Si bien las grandes corrientes de pensamiento representan, con frecuencia, una revolución con respecto al modo de pensamiento precedente, se insertan, sin embargo, en un continuum que busca establecer la unión entre ciencia y medicina. Los promotores de la medicina personalizada consideran que se logrará la alianza y, al mismo tiempo, garantizará el devenir de una medicina eficaz y segura. A pesar de las grandes promesas de la medicina personalizada y sus próximas aplicaciones en diferentes especialidades médicas como la cardiología y la oncología, es necesario superar numerosos retos y obstáculos para su aplicación real en clínica. También es importante evaluar de manera ética y crítica esta nueva forma de medicina que pretende ser a la vez más científica y más individualizada. De una parte, la refl exiónética obliga a afrontar los retos generalmente asociados a la genómica y a cuestionar realmente el aporte de nuevos datos científicos a la medicina. De otra parte, esta reflexión también obliga a evaluar la paradoja de la medicina personalizada que intenta fundamentarse sobre datos científi cos sólidos, ciertos y generalizables, con el fin de adaptarse a la situación única e incierta de un paciente.
Subject(s)
Bioethics , Medical Care , Medicine , Patients , ScienceABSTRACT
It can be argued that living altruistic donors should remain anonymous and should not express preferences in the selection of organ recipients. This study aimed to describe the views of transplant physicians in France and Québec regarding these issues. A total of 27 French and 19 Québec renal transplant physicians took part in individual, semi-directed interviews. Almost all of the physicians agreed that anonymity is mandatory in living altruistic donation (LAD). Regarding the issue of directed donation, most of the French physicians (78%) were opposed to any form of the practice, compared to only a third of their Québec colleagues (32%). We found that these positions were embedded in their respective cultural, legal and social contexts. These results afford a better understanding of these complex issues in two different cultural contexts, and will be useful in the development of international guidelines for LAD.