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Decision-making in the face of end-stage organ failure: high-risk transplantation and end-of-life care

Journal title
Current opinion in organ transplantation
Publication year
Dipchand, A. I.

PURPOSE OF REVIEW: Pediatric solid organ transplantation numbers have been increasing over the years. Research and the medical literature tends to focus on advancing the field and innovation – which often leads to higher risk and more complex procedures. How do we decide when it is too much – too much risk; too much uncertainty? Who makes that decision? Literature is scarce and usually focuses on end-of-life decision-making. This article does not purport to have the answers, but will highlight the depth and breadth of points that must be taken into consideration. RECENT FINDINGS: There are many factors that contribute to the decision-making in the context of high-risk solid organ transplantation in children. Focus needs to include quality of life in the pediatric context, in addition to survival. End-of-life discussions should be included early in the process. Societal factors must be considered in an era of donor organ shortages. Shared decision-making should be the approach. SUMMARY: The key guiding principle is to make a decision about what is best for a child requiring a high-risk transplant based not only on survival, but also on an acceptable quality of life on the background of optimal utilization of a scarce societal resource.

Research abstracts