Ethical Considerations in Pediatric Organ Allocation

Addressing the lack of an ethical framework for pediatric organ allocation, this project aims to provide evidence-based support for prioritizing pediatric candidates. By collaborating with experts and committees, the goal is to establish a permanent framework that respects ethical and clinical judgments, optimizing patient outcomes while ensuring fairness and equity in organ allocation policies.

• Ethical Considerations
• Pediatric Organ Allocation
• Prioritization
• Collaborative Project
• Health Care Needs

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1. Special Ethical Considerations in the Allocation of Human Organs to Pediatric Candidates (Resolution 11) Pediatric Transplantation Committee Eileen Brewer, MD, Chair

2. Problem OPTN has never articulated an ethical framework to support pediatric priority Resource needed to evaluate allocation policy for fairness to pediatric candidates

3. Strategic Plan #2- Increase Access to Transplants Provide ethical basis for pediatric priority in allocation Resource to evaluate policy

4. Background NOTA requires that the OPTN provide for the unique health care needs of children Final Rule requires equitable allocation that achieves best use of organs Neither intended as ethical guidance 2010 General Principles: justice and utility must be balanced in equitable allocation No specific guidance on special populations

5. Goal of the Proposal Provide evidence to support pediatric priority Intended as a resource for Committees, the Board, and the general public to evaluate policy Permanent framework for decision-making Not prescriptive: respects ethical and clinical judgment of others

6. How the Proposal will Achieve its Goal Prudential Lifespan Account Fair Innings Optimize patient survival in system Maximin Principle

7. Collaboration Pediatric-Ethics Joint Subcommittee convened in Jan 2014, led by Chairs Reviewed by both Committees at their in-person meetings Reviewed by Dr. Norman Daniels, author of the Prudential Lifespan Account

8. Communication Plan Publish to website Disseminate through professional networks Develop educational resources and training for Committee members, especially organ-specific and crossover representatives as well as leadership

9. Overall Project Impact Product White Paper Target Population Impact: Board members, Committee members, general public Total IT Implementation Hours 0/10,680 0 0 2000 4000 6000 Total Overall Implementation Hours 175/17,885 175 0 2000 4000 6000

10. Resolution 11 (page 20) RESOLVED, that the white paper entitled Ethical Considerations in Organ Allocation to Pediatric Candidates, as set forth in Exhibit A, is hereby approved, effective November 13, 2014.

11. Questions Eileen Brewer, MD Committee Chair ebrewer@bcm.edu Christine Flavin, MPH Committee Liaison christine.flavin@unos.org