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Ethical guidelines for organ transplantation from deceased donors submission

Submission ID: 
4
This submission reflects the views of
Organisation Name: 
Royal Children's Hospital, Melbourne Department Nephrology
Please identify the best term to describe the Organisation: 
Hospital – public
Personal Details
Submission - Option 1. Online submission
Specific Comments: 
3.2.1 Eligibility for transplantation

The comments below are based n the perspective of a paediatric nephrology transplantation unit.

  1. We feel this is a good document and generally endorse it.
  2. We acknowledge there is specific comment on paediatric transplantation, but this is quite limited (p14) and is focused on consent and autonomy of the mature minor, with an illustrative case (p19). We feel this is a strength of the document.
  3. There is acknowledgement of the need to avoid discrimination against any individual based on age or disability (p10, 15), but this is not discussed in great detail.
  4. In our experience, there has been a major shift in the ethical dilemmas facing paediatric nephrologists and a significant area of controversy remains the approach to the severely disabled child with a reasonable life expectancy. A typical example would be a child with cerebral palsy, wheel-chair bound, verbal language delay, incontinent, neurologically stable and perceived by the parents to have a good quality of life with anticipated survival into/ beyond early adulthood. Perhaps teenage child on in-centre haemodialysis for whom transplantation would offer accepted health and financial benefits over dialysis, but also further benefits to quality of life for the whole family, more family-based care and markedly reduced burden of travel/ dialysis attendance.

We would recommend a case illustrating this type of example and corroborating the statement regarding non-discrimination in this instance implying that this child would be a candidate for transplantation. However, the ultimate decision for acceptance for listing must be made by a multidisciplinary team which may include involvement of a clinical ethics committee.

Page reviewed: 8 April, 2016