Abstract
The ethical and medical-legal aspects of transplantation are similar for all solid organ transplants, including lungs. The applicable legislation varies among different geographical locations and cultures, but it is easy to find common basic principles. Many fundamental issues are often handled in a similar way worldwide. Presenting the evolution of the transplant system of one single country (Italy) can help understanding the milestones of this complex topic.
The ascertainment of death is a basic and very delicate concept in the transplant activity and its principles typically determine strong reactions from the public opinion. Every citizen should have the right to be adequately informed and to be able to liberally express a living will for organ donation. The evolving technology and medical knowledge allowed a deeper assessment of the risks connected to organ donation and the possibility of donor-derived diseases. The principle of safety and an appropriate regulatory system should guide all the aspects of the transplant activity.
The allocation of organs needs to provide equal opportunities of receiving a transplant to patients with end-stage organ failure. Patients with respiratory failure display the highest rates of mortality on the waiting list and should therefore be protected by an equitable allocation policy. The ideal system is still under discussion and is different from country to country. The laws of each individual country set the guidelines for granting all these principles of safety and equity.
The issue of responsibility of health care providers is becoming more and more relevant given the increasing requests for malpractice reimburses and files for complaints. Italy still handles both civil and criminal litigations for healthcare malpractice. The interpretation and the management of malpractice within different justice systems and different countries are often very heterogeneous. Transplantation is, by definition, a truly multidisciplinary clinical activity. All the individual components of the health care team share a common responsibility when a patient is injured.
References
Conference of Medical Royal Colleges and their Faculties in the United Kingdom (1976) Diagnosis of brain death, Lancet 2
Decree 2 August 2002 “Criteria and methods for certifying the suitability of organs removed for transplantation (Article 14, paragraph 5, Law 1 April 1999, n. 91)
Decree of 11 April 2008 Updating of the decree of 22 August 1994 n.582 1994 “Regulation containing the procedures for ascertaining and certifying death”. (OJ 12/6/2008)
Decree of the Ministry of Health of 8 April 2000 “Provisions regarding the removal and transplantation of organs and tissues, implementing the provisions relating to the declaration of will of citizens on the donation of organs and tissues for the purpose of transplantation” Official Gazette 15/5/2000 n 89
Egan TM, Edwards LB (2016) Effect of the lung allocation score on lung transplantation in the United States. J Heart Lung Transplant 35(4):433–439
Gianelli CA (2007) The medico legal second opinion. Transplants 2
Gianelli CA, Ventura F (2004) Medicolegal aspects of donor safety evaluation. Transplant Proc 36(3):421–423
Guidelines of the Permanent Conference on State and Regions Relations – 26 November 2003. Agreement between the Minister of Health, the regions and the autonomous provinces of Trento and Bolzano on the document bearing: “Guidelines for assessing the safety of the organ donor”
Guidelines of the Permanent Conference on State and Regions Reports – 1 September 2003 “Guidelines relating to the application of instrumental investigations of cerebral blood flow in particular situations, for the purpose of diagnosing death in subjects suffering from brain lesions”. Latest version 20 February 2009
Law 2 December 1975 644 (Official Gazette 12/19/1975 334)
Law no. 301 of 12 August 1993 “Regulations on corneal sampling and grafts” Official Gazette 17/8/1993 no 192
Law 1 April 1999 n.91 “Provisions on organ and tissue sampling and transplantation” Official Gazette of 15/4/1999 n. 87
Law no.24 of March 8th, 2017 “Dispositions on safety of cure and patients, professional liability of healthcare professionals” (17G00041). Official Gazette 17/103/2017 no.64
Law no.578 of 29 December 1993 “Rules for ascertaining and certifying death” Official Gazette 8/1/1994 no.5
Ministerial Decree 27/10/2004 “Reconstitution of the Permanent Technical Council and Establishment of the National Transplant Safety Commission”
Ministry of Health Decree 22 August 1994 n. 582 “Regulation containing the procedures for ascertaining and certifying death” Official Gazette 19/10/1994 n. 245
Report of the ad hoc committee of the Harvard Medical School to examine the definition of Brain Death (1968) A definition of irreversible coma. JAMA 205:337–340
Rosso L, Palleschi A et al (2016) Lung allocation score: a single-center simulation. Transplant Proc 48:391e394
Transplant Information System. http://www.salute.gov.it/servizio/datisit.jsp (2020)
Venettoni S, Emilio SC, Scalamogna M, Grossi P, Gianelli A et al (2004) Strategies for evaluation of suitable donors: Italian experience. Ann Transplant 9(2):15–16
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Gianelli Castiglione, A. (2023). Ethical and Medical-Legal Aspects of Lung Transplant. In: Bertani, A., Vitulo, P., Grossi, P.A. (eds) Contemporary Lung Transplantation. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-20788-9_7-1
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