You Decide
Christina Dochterman
DeVry University

Author Note
This paper was prepared for Principles of Ethics, ETHC-445-16882, taught by Professor Knox.

MEMORANDUM
Date: 2-8-13

OBJECTIVE: Identify appropriate candidates for transplant.
POLICY: Candidates for transplant surgery will be evaluated according to a standard set of medical, financial and psychosocial criteria, from referral through work-up to listing for transplant with United Network for Organ Sharing (UNOS). Candidates will be accepted or denied for listing based on established absolute or relative exclusion criteria.

PROCEDURE: 1. An application for transplant may be initiated by referrals such as physicians, healthcare facilities or by patient self-referral. (Minimal referral information needed includes: Demographics, complete insurance information, contact numbers, emergency contact, and height and weight)
2. After completing the application, the patient must sign a release of information. A signed recommendation is also needed. The transplant financial coordinator will verify financial reimbursement prior to the scheduling of the transplant.
3. The patient’s medical records and history will be requested. (Minimal referral information needed includes: most recent History and Physical (addresses history of lung disease, cancer and heart disease), most recent labs, psychosocial assessment, and BMI.
4. Obvious medical and psychosocial barriers to transplant will be assessed prior to a work-up. A patient may be excluded from transplant work-up based on established absolute contraindications or evident inability to actively complete evaluation.
A. Absolute Contraindications for transplant include:
1. Active cancer
2. Heart Attack
3. Liver disease
4. Primary etiology of renal disease:
a. Primary oxalosis
b. Primary amyloidosis
5. Alcoholism, or psychosis
6. Symptomatic peripheral vascular disease without evaluation and treatment
7. Life-expectancy less than one year
8. Active tuberculosis
9. Excessive probability mortality
10. Active infection unresponsive to therapy
11. Unacceptable risk of noncompliance with therapy or follow-up
12. Anatomy that makes the risk of transplantation prohibitive
B. Relative Contraindications for transplant include:
1. Cancer in other places in the body
2. BMI > 40
3. Active immunologic renal disease
4. Cardiac disease
a. Inducible ischemia – should be corrected medically or surgically
b. Patients with low ejection fraction will be individualized after cardiac consult. 5. Elevated risk of noncompliance
6. Symptomatic peripheral vascular disease
7. Treated active psychiatric illness (e.g. paranoid schizophrenia)
8. Pulmonary disease
9. Other diseases or factors likely to limit length of life or quality of life even if the transplant is successful.
10. Psychosocial factors (e.g. inability to obtain transportation to follow-up appointments, legal status, criminal history with high probability of re-incarceration, cognitive inability to understand or follow post transplant regimen)
11. Significant gastrointestinal disease
12. Renal disease with significant likelihood of causing allograft loss
13. Active drug use
C. All patients with relative contraindications will be considered by the Transplant Committee on an individual basis. Final determination of status will rest with the committee. Documentation of the information will be maintained in the transplant database and in the patient record. All patients on the active transplant waiting list should have an annual reevaluation consult with the transplant surgeon. Age-specific screening and surveillance appropriate for the particular patient will be required. Both of the lists of diseases in the above bullets A and B were developed based upon access to medical information.
Based upon the Utilitarianism, the memorandum will expedite the process in which patients are selected for transplant. It uses criteria which have been established by many government agencies including the medical community. To support the urgency of the situations, the criteria are very specific but would apply to any and all referrals for transplant. Using Kant’s deontology theory, the criteria is consistent and is based on rationality and fact rather than desire or happiness of individuals. Because I am not a physician and do not have the clinical background to make the determination of who should and shouldn’t qualify for transplant, I have used commonly established standards to solve the dilemma of who should benefit from organ transplantation.