Ethical issues in preemptive transplantation.
Preemptive kidney transplantation is a treatment option for end-stage renal disease that offers better overall prognoses than dialysis. Nevertheless, preemptive transplantation raises several ethical concerns. The paper consists of three sections. The first section outlines general ethical principles. The so-called North-American principles are strongly focused on individual autonomy. Personalism re-elaborates the principles in the framework of philosophical anthropology, emphasizing the respect for life, sociality, solidarity, and responsibility. In the second section, clinical and operational scientific data are presented about preemptive kidney transplantation. In the third section, proposals are made on the basis of general principles and technical-scientific data. Attention is paid particularly to the criteria of utility and justice and to the value of solidarity. Therefore, the working method proposed is triangular: From the two aspects at stake (values and scientific framework), ethical issues are analyzed in search of an acceptable synthesis.
Petrini
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Bioethics Unit, Instituto Superiore di Sanità, Rome, Italy. carlo.petrini@iss.it
D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000941:ethics*; D026684:Personal Autonomy; D051436:Renal Insufficiency, Chronic / Q000601:surgery