JoeBlow
Gold Member
- May 27, 2021
- 2,224
- 862
A good long term outcome is only possible if the person gets a heart. Fuck, are you ever stupid.Shared decision making in clinical medicine means that each party brings their expertise to the dialogue when more than one viable option exists. Patients know their values and preferences. Physicians and health-care professionals understand the treatment options and their general benefits and burdens. Health-care professionals offer options to the patient that have some chance of benefit. However, in decisions regarding solid organ transplantation, the transplant team adheres to a higher standard than merely some chance of benefit. The transplant team is the initial steward of the gift of the organ. The gift is made to the community of patients in need and good stewardship (sometimes called the principle of utility)5 requires that the organ is allocated in a way that is likely to result in significant benefit to the recipient. Thus, the transplant team uses its professional expertise to set screening protocols for potential recipients and requirements to promote behaviors that increase the likelihood of successful long-term transplant outcomes. Many of these are well-known such as requiring potential recipients of a liver transplant who suffer from alcohol substance use disorder to complete a treatment program for the disorder or for a cigarette smoker to demonstrate a sustained abstinence from nicotine before he is approved for a lung transplant. Such requirements seem common-sensical and typically generate little controversy.
Two other well-established considerations regarding good stewardship of donated solid organs are worth mentioning. First, traditional medical ethics embraces the principle of nonmaleficence as embodied in the famous dictum, “Primum non nocere.” The physician is obligated to avoid harming the patient and when that is not possible in the course of treatment, to take appropriate steps to ameliorate that harm. Patients who receive SOTs are “harmed” by the physician in the sense that they will be subject to immunosuppression to prevent graft rejection. Being immunocompromised places a patient at increased risk of opportunistic infections. As a result, many transplant programs require the patient to be up to date on a range of vaccinations, such as those for hepatitis A and B, and to receive an annual seasonal flu vaccination. The patient may be required to receive all vaccinations that are proven to be efficacious against infectious threats that would significantly jeopardize the benefit of organ transplantation.