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Ethical Issues in Pediatric VCA

  • Vascularized Composite Allografts (L Cendales and R Barth, Section Editors)
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Abstract

Purpose of Review

There is growing interest in offering vascularized composite allografts (VCAs) to children, particularly upper extremity and face transplants. This review identifies ethical issues that must be addressed as VCA programs consider including more children and adolescents.

Recent Findings

The primary ethical concern in pediatric VCA is that the potential benefits might not justify the risks. Other issues involve eligibility criteria, informed permission and assent, authorizing donations and procuring VCAs, donor and recipient privacy and confidentiality, oversight and evaluation of transplants, and cost-effectiveness and resource allocation. A final concern is the obligation to avoid unfairly denying children and adolescents access to research participation and the benefits of research findings. While some observers find the uncertainty and risk of harm too great to expand access to VCA in minors, others disagree.

Summary

Ethical concerns, particularly those related to the risks relative to potential benefits, may be the primary barrier to pediatric VCA. Carefully developed guidance and policy can facilitate the ethical inclusion and exclusion of children and adolescents from VCA protocols.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance, ••Of major importance

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Acknowledgements

I would like to thank Hailey Cleek for assisting in the research for this paper and the Eudaimonia Institute at Wake Forest University for supporting her time.

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  1. Center for Bioethics, Health and Society and Department of Philosophy, Wake Forest University, 1834 Wake Forest Rd., Winston-Salem, NC, 27106, USA

    Ana S. Iltis

  2. Department of History of Medicine, National History, and Cultural Studies, I.M. Sechenov First Moscow State Medical University, Moscow, Russia

    Ana S. Iltis

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Iltis, A.S. Ethical Issues in Pediatric VCA. Curr Transpl Rep 4, 311–319 (2017). https://doi.org/10.1007/s40472-017-0170-9

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