The AST Statement on Ethics in Organ Transplantation by the AST Patient Care and Education Committee and endorsed by the American Society for Histocompatability and Immunogenetics, International Liver Transplantation Society, North American Transplant Coordinator's Organization, Association of Organ Procurement Organizations, and the South Eastern Organ Procurement Foundation.

Members of these endorsing organizations recognize a set of ethical principles that relate to the process of organ donation and transplantation. The moral situations presented by individual medical cases are complex. The following principles are set forth as guidelines to assist transplant professionals to make ethical decisions in consultation with patients, families, and other health care professionals.

1. One must respect individuals as persons.
2. One must adhere to the principles of equity in the allocation of a precious resource
3. One must strive for the highest quality of care.
4. One must recognize one's own rights and responsibilities as a health care provider.

1. One must respect individuals as persons.
   Patients have a right to autonomy. The health care provider must respect an individual's personal, philosophical, and religious beliefs in making treatment decisions. The expressed wishes of competent, adult patients should respect.

   Similarly in the case of minors or incapacitated patients the parents' or guardians' wishes must be respected. The patient's well-being is the goal.

   The medical care of the donor is a crucial factor in transplant decisions. All decisions to donate must be made freely and without coercion or exploitation of any sort including financial or otherwise. Living donors, families and friends of living or cadaver donors should not profit financially nor should they be financially disadvantaged from donation.

   To respect a person's dignity and free choice, donors must not be viewed primarily as a resource for transplants. A person should not be produced or created through sexual conjugation, cloning or any other means for the sole purpose of tissue or organ donation.

   Patients must be kept fully informed about the risks and benefits of all procedures.
   The privacy and confidentiality of patients and donors must be respected.

2. One must adhere to the principles of equity in the allocation of a precious resource.
   Medical criteria must be the determining factors in transplant decisions. A patient should not be excluded from consideration for a transplant solely on the basis of gender, race, ethnicity, religion, mental capacity, social status or financial background. The probability of the success of the proposed transplant must be evaluated on a case-by-case basis.

   Fairness dictates that just allocation of scarce organs takes into account the probability of successful transplants. Fairness does not dictate a numerical equality in transplants among various groups and locales, but transplant professionals should strive toward a goal of making transplants equally available despite the recipients' backgrounds and locations.

   Public education should encourage organ donation, to make transplants more available to all potential recipients.

3. One must strive for the highest quality of care.
   Within the context of limited individual and societal resources, transplant professionals should strive to deliver optimal care for each individual patient.

   Cadaver, living-related, and living-unrelated transplants are endorsed. New methods of transplantation should be attempted only after careful prior consideration of potential risks and benefits with appropriate assurance of patient safety and well-being.

   The care of potential cadaver donors must not be compromised with a view to the possible transplant. In the case of cadaver donation, standard procedures concerning determination of death or the withdrawal of treatment must be followed by the potential donor's own physicians.

4. One must recognize the rights and responsibilities as a health care provider.
   No health care provider should be required to participate in any medical procedure that would violate his or her ethical or religious principles.

   Transplantation is a complex and dynamic endeavor. Health care providers involved in transplantation have a moral obligation to remain current and competent.

   Organizations that endorse this ethics statement should avoid those investments and other financial relationships that could place them in possible conflicts of interest between quality of patient care or integrity of research on the one hand and significant financial gain on the other.

   Organizations that endorse this ethics statement support their membership in pursuing these ethical principles.

   Members of these organizations will not be asked to participate in any activity, which violates these principles. Individuals acting on behalf of these organizations will not be directed to pursue activities that violate these principles. These principles will be employed in all education, scientific and legislative endeavors.

Adopted by Board of Directors on January 15, 1999.
Revised February, 2001
Revised October, 2002

APPENDIX A

Informed consent statement concerning the potential risks prior to receiving an organ transplant

Prior to receiving an organ transplant, the transplant team needs to inform patients and/or their legal guardians of potential risks associated with transplantation and its attendant immunosuppressive therapy. These risks include but are not limited to:

• Operative and technical complication
• Organ transplant dysfunction, failure and rejection
• Death
• Infection
• Cancer and hematological side effects
• Metabolic complications such as the development of diabetes mellitus and hyperlipidemia, weight gain and bone disease
• Hypertension and fluid retention
• Cardiovascular disease
• Impaired kidney disease and electrolyte disturbances
• Dermatological complications such as hirsutism, alopecia, acne, rashes and warts
• Gastrointestinal complications
• Recurrence of underlying disease process
• Risks to unborn children, reproductive impairment and complication of pregnancy
• Sexual dysfunction
• Risks as yet undetermined

Furthermore, it is incumbent upon the transplant team to ensure that potential recipients fully comprehend these risks and complications and have sufficient opportunity to ask questions before transplantation.

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