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Patel A, Michelson K, Andrei AC, Pahl E, Gossett JG. Variations in Criteria and Practices for Heart Transplantation Listing Among Pediatric Transplant Cardiologists. Pediatr Cardiol 2019; 40:101-109. [PMID: 30121868 DOI: 10.1007/s00246-018-1965-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 08/12/2018] [Indexed: 11/24/2022]
Abstract
Ethical issues in pediatric heart transplantation (Htx) include resource allocation, benefit, and burden assessment in high-risk recipients, and informed consent. Practice patterns and decision-making was investigated using an internet survey with 47-multiple choice items and vignette-based questions. Of 43 pediatric Htx cardiologists contacted, 28 (65%) responded. Respondents reported that an overall median 1-month survival of 73% (range 50-100%), 1-year survival of 70% (range 50-85%), 5-year survival of 50% (range 40-85%), and 10-year survival of 50% (range 25-85%) was adequate to offer Htx. Based on vignettes presented, 100% of those surveyed would offer Htx to a straightforward 12-year old with end-stage dilated cardiomyopathy and a 7-year old with hypoplastic left heart syndrome with protein losing enteropathy. Thirty percent of physicians would offer Htx to a patient status post a Fontan procedure with mutliple co-morbidities. Seventy-five percent of physicians would offer Htx despite proven non-adherence. Considerable variability exists in the practice patterns of pediatric heart transplant cardiologists with regards to decision-making while evaluating patients for listing. Disagreements among pediatric Htx cardiologists exist when there are concerns for non-adherence and associated multiple co-morbidities. Further work is needed to understand these variations and develop consensus for pediatric Htx organ allocation.
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Affiliation(s)
- Angira Patel
- Northwestern Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Box 21, Chicago, IL, 60611-2991, USA. .,Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Kelly Michelson
- Northwestern Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Box 21, Chicago, IL, 60611-2991, USA.,Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Elfriede Pahl
- Northwestern Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Box 21, Chicago, IL, 60611-2991, USA.,Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jeffrey G Gossett
- University of California San Francisco Benioff Children's Hospitals, San Francisco, CA, USA
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