RESUMEN
Compassion fatigue is the result of repeated vicarious trauma from caring for those who have suffered. Although not well-researched in pediatric nephrology to date, there is reason to believe that it is a real and sustained threat to the pediatric nephrology workforce. Interventions aimed at individuals, the profession, and the organizations in which pediatric nephrologists work can create spaces to discuss and ameliorate compassion fatigue. This will result in better care for patients, more stable pediatric nephrology divisions and a stronger, more resilient pediatric nephrology workforce.
RESUMEN
In this article, I review the ethical issues that arise in the allocation of deceased-donor organs to children and young adults. By analyzing the public media cases of Sarah Murnaghan, Amelia Rivera, and Riley Hancey, I assess whether public appeals to challenge inclusion and exclusion criteria for organ transplantation are ethical and under which circumstances. The issues of pediatric allocation with limited evidence and candidacy affected by factors such as intellectual disability and marijuana use are specifically discussed. Finally, I suggest that ethical public advocacy can coexist with well-evidenced transplant allocation if and when certain conditions (morally defensible criteria, expert evidence, nonprioritization of the poster child, and greater advocacy for organ transplantation in general) are met.
Asunto(s)
Donación Directa de Tejido/ética , Asignación de Recursos para la Atención de Salud/ética , Defensa del Paciente/ética , Asignación de Recursos/ética , Factores de Edad , Niño , Preescolar , Fibrosis Quística/cirugía , Donación Directa de Tejido/legislación & jurisprudencia , Femenino , Asignación de Recursos para la Atención de Salud/legislación & jurisprudencia , Asignación de Recursos para la Atención de Salud/organización & administración , Historia del Siglo XXI , Humanos , Discapacidad Intelectual , Trasplante de Riñón , Trasplante de Pulmón/ética , Trasplante de Pulmón/legislación & jurisprudencia , Masculino , Redes Sociales en Línea , Padres , Defensa del Paciente/legislación & jurisprudencia , Neumonía/cirugía , Prejuicio , Opinión Pública , Asignación de Recursos/legislación & jurisprudencia , Asignación de Recursos/organización & administración , Trastornos Relacionados con Sustancias , Obtención de Tejidos y Órganos/ética , Obtención de Tejidos y Órganos/organización & administración , Listas de Espera , Síndrome de Wolf-Hirschhorn/cirugía , Adulto JovenRESUMEN
Children with multiple comorbidities, including neurodevelopmental delay, can develop end-stage kidney disease (ESKD). When and if these children should be eligible for kidney transplantation is an area of debate within the pediatric nephrology community and the public. Discussions focus on expected survival and quality of life posttransplant, as well as resource allocation decisions, as donor kidneys remain a limited resource. This paper focuses on the evidence available regarding outcomes in this population and the ethical issues that should be considered. The authors offer a framework for transplant teams evaluating children with comorbidities for kidney transplant, focusing on the benefits and burdens that transplantation can be expected to achieve.
Asunto(s)
Comorbilidad , Trasplante de Riñón , Selección de Paciente , Receptores de Trasplantes , Niño , HumanosRESUMEN
Current U.S. legislation restricts reimbursement for organ transplantation for nondocumented residents, which makes it difficult for many immigrants, including children, to access the transplants they need. In this article, we offer moral, economic, and legal reasons that nondocumented immigrants deserve the same access to kidney transplantation as do legal residents. We argue that the current reasoning for such a ban is based on unjustified fears and unsupported assumptions, which are not a solid basis for determining eligibility for lifesaving therapy for the neediest members of our society.