title: Shopping for a transplant: when noncompliant patients seek wait listing at multiple hospitals.
abstract: United Network for Organ Sharing policy allows patients to be listed for a transplant at multiple hospitals. This strategy can sometimes lessen the transplant waiting time for patients because waiting times vary geographically. We explore the ethical dilemma of "shopping for a transplant" by presenting the case of a patient with an addictive disorder who was listed for liver transplantation at one hospital on the east coast of the United States and was seeking listing at 2 additional hospitals in midwestern United States, when marijuana use was suspected by 1 of the latter 2 facilities. Although the transplant team at this facility deferred listing the patient, the team's bioethicist posed the concept of a duty to notify the facility where the patient was already listed for transplantation about any confirmed substance abuse, in an effort to prevent a scarce resource from being allocated to an individual who is noncompliant.
authors.affiliation: Department of Bioethics, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Katrina A
authors.initials: KA
authors.lastname: Bramstedt
authors.forename: Judy
authors.initials: J
authors.lastname: Stowe
authors.forename: Margaret
authors.initials: M
authors.lastname: Kotz
mesh_terms: D003219:Confidentiality / Q000941:ethics*; D017007:Duty to Warn / Q000941:ethics; D026689:Ethical Analysis; D020408:Health Insurance Portability and Accountability Act / Q000941:ethics; D006526:Hepatitis C / Q000150:complications / Q000523:psychology / Q000601:surgery; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000523:psychology / Q000601:surgery; D016031:Liver Transplantation / Q000941:ethics* / Q000523:psychology; D008297:Male; D002189:Marijuana Abuse / Q000150:complications / Q000523:psychology; D008875:Middle Aged; D018579:Patient Selection / Q000941:ethics*; D040841:Resource Allocation / Q000941:ethics; D009927:Tissue and Organ Procurement / Q000941:ethics* / Q000458:organization & administration; D016312:Treatment Refusal / Q000941:ethics* / Q000523:psychology / Q000706:statistics & numerical data; D014342:Truth Disclosure / Q000941:ethics; D014481:United States; D014850:Waiting Lists