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Non-financial conflicts of interest: contribution to a surgical dilemma by the European Reference Networks for Rare Diseases



Conflicts of interest can impede both research and medical treatment. The European Reference Networks require their members to deal with financial and non-financial conflicts according to an explicit protocol. In a literature review, we identified relevant interests in paediatric surgery, and drafted such a policy.


We conducted a Pubmed query and identified additional publications based on the content of the papers.


58 titles were identified. According to their abstracts, 10 publications were studied in full text. A scientific taxonomy does not yet exist, but a variety of factors are mentioned. Non-financial conflicts of interest are addressed less accurately and less frequently than financial ones, especially regarding surgical treatment. Since the clinical effect of surgical volume was identified as being relevant, additional 29 respective publications were analysed. This volume-quality relationship causes conflicts of interest for the many surgeons treating a broad spectrum of rare conditions. We present a recommendation that may guide referral of patients requiring complex surgery to centres with a higher volume.


Non-financial conflicts of interest need to be dealt with more accuracy, especially with regard to surgery in rare, complex congenital conditions. The European Reference Networks offer a framework to mitigate these conflicts.

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Correspondence to E. Schmiedeke.

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The authors declare that they have no conflict of interest.

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The patient organisations SoMA and AIMAR and the Pediatric Surgical Clinic of Bremen, Germany, are members of eUROGEN-ERN, the European Reference Network for rare uro- recto-genital diseases, the latter being certified therein for the treatment of patients with anorectal malformations. SoMA is also member of ERNICA-ERN, the European Reference Network for rare inherited and congenital digestive disorders.

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Schmiedeke, E., Schaefer, S., Aminoff, D. et al. Non-financial conflicts of interest: contribution to a surgical dilemma by the European Reference Networks for Rare Diseases. Pediatr Surg Int 35, 999–1004 (2019).

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  • Non-financial conflict of interest
  • Congenital malformation
  • Volume-outcome relationship
  • Patient organisation
  • European Reference Networks
  • Anorectal malformation