Ethical considerations in pediatric heart transplantation

Abstract

Pediatric heart transplantation as a field has evolved over the last 50 years and is now a widely accepted therapy for children with end-stage heart failure. The major ethical principles that guide equitable allocation of organs include utility, justice, and respect for autonomy. In this chapter, we discuss historical perspectives, current state of the field, and explore how ethical principles guide recipient selection and donor allocation. Additionally, other ethical themes that are discussed include: surgical innovation and informed consent; psychosocial issues in transplantation; quality of life and end of life care; genetic anomalies and developmental delay; and regulatory aspects of organ donation. Finally, we discuss recently published cases related to pediatric heart transplantation that highlight ethical conflicts, offer an ethical analysis, and suggest potential solutions.