Answers to Questions that Weren’t Asked: The Ethical Complexities of Identifying Misattributed Paternity During the Transplant Evaluation Process

Abstract

Blood typing and Human Leukocyte Antigens (HLA) matching, while playing a vital role in improving allograft survival following organ transplantation, also have the potential to identify circumstances in which paternity or other degrees of genetic relatedness are misattributed. The decision of whether to disclose a finding of misattributed paternity is ethically complex and has been an issue of concern within the transplant community. In this chapter, we will consider the incidental identification of misattributed paternity within the broader context of incidental findings (IFs) in general. We will then review the prevailing arguments for and against disclosure of a finding of misattributed paternity during the transplant evaluation process. We will consider specific ethical complexities of such disclosure that arise within the context of pediatric organ transplantation, complexities that we feel make the disclosure of misattributed paternity ethically inappropriate within that setting. Finally, we will conclude by recommending a model policy to prevent some of these ethical challenges from arising in the clinical setting.