At its June 2018 meeting, the OPTN/UNOS Board of Directors approved the publication of an Ethics committee white paper titled Manipulation of the Organ Allocation System Waitlist Priority through the Escalation of Medical Therapies. You can access this paper from the OPTN website.
Some physicians escalate the amount of care they provide to their patients on the waiting list in order to increase the chances of their patient receiving an organ. Many in the transplant community feel that this practice of unnecessarily escalating a patients’ care may be widespread.1,2 They also believe that other physicians may feel compelled to similarly escalate their own patients’ care so that their transplant candidates are not disadvantaged by the unethical practices of others.
Although the OPTN Board had not publically commented on this issue, they requested that the committee conduct an ethical analysis of the issue, particularly pertaining to the escalation of medically unnecessary treatments provided for the sole purpose of increasing a candidate’s waitlist priority.
This paper can guide physicians who may be confronted with this issue by:
- Offering them ways to advocate for their patients while also maintaining ethical responsibilities of stewardship of organs in the overall system
- Giving them a model for how to engage in ethical clinical practice, and
- Clarifying safeguards with the transplant system designed to protect justice and utility in organ allocation.
This paper does NOT propose that we enforce, monitor, or police the way any transplant hospital uses therapeutic interventions. It also does not Intend to dictate how clinicians should provide care to their patients, or suggest what indications for using specific therapeutic interventions should be.