ABSTRACT
The National Organ Transplant Act stipulates that deceased donor organs should be justly and wisely allocated based on sound medical criteria. Allocation schemes are consistent across the country, and specific policies are publicly vetted. Patient selection criteria are largely in the hands of individual organ transplant programs, and consistent standards are less evident. This has been particularly apparent for patients with developmental disabilities (DDs). In response to concerns regarding the fairness of transplant evaluations for patients with DDs, we developed a transplant centerwide policy using a multidisciplinary, community-based approach. This publication details the particular policy of our center. All patients should receive individualized assessments using consistent standards; disability should be neither a relative nor an absolute contraindication to transplantation. External review can increase trust in the selection process. Patients in persistent vegetative states should not be listed for transplantation.
Subject(s)
Developmental Disabilities/physiopathology , Organ Transplantation/methods , Patient Selection , Tissue and Organ Procurement , Child , Humans , Intelligence Tests , Organ Transplantation/ethics , Prognosis , Waiting ListsABSTRACT
High-risk (carcinogenic) genotype human papillomavirus (HPV) infections can be associated with significant morbidity in the immunocompromised solid organ transplant (SOT) recipient. Immunosuppression-associated persistent infection can predispose to the development of rapidly progressive high-grade squamous intraepithelial lesions (HSIL) in this population. We present a case report of an adolescent bilateral lung transplant recipient who developed HSIL of the esophagus, cervix, and skin secondary to HPV. This review highlights the unique developmental needs of the sexually active adolescent SOT recipient and reviews guidelines for HPV-related screening and education of this population.
Subject(s)
Lung Transplantation/adverse effects , Papillomaviridae/physiology , Papillomavirus Infections/virology , Postoperative Complications , Squamous Intraepithelial Lesions of the Cervix/diagnosis , Cervix Uteri/virology , Esophagus/virology , Female , Genotype , Humans , Immunocompromised Host , Skin/virology , Transplant Recipients , Young AdultABSTRACT
An intervention model has been developed which teaches family members, in partnership with social workers, to obtain and monitor services for their chronically ill elderly relatives. The research site is a Boston teaching hospital with a patient population that is ethnically and racially diverse. Initial results of the study reveal that case management is easily accepted by most families, and the partnership between the family member and social worker enhances the delivery of needed services.
