The use of personalized medicine for patient selection for renal transplantation: physicians' views on the clinical and ethical implications.
BACKGROUND
The overwhelming scarcity of organs within renal transplantation forces researchers and transplantation teams to seek new ways to increase efficacy. One of the possibilities is the use of personalized medicine, an approach based on quantifiable and scientific factors that determine the global immunological risk of rejection for each patient. Although this approach can improve the efficacy of transplantations, it also poses a number of ethical questions.


METHODS
The qualitative research involved 22 semi-structured interviews with nephrologists involved in renal transplantation, with the goal of determining the professionals' views about calculating the global immunological risk and the attendant ethical issues.


RESULTS
The results demonstrate a general acceptance of this approach amongst the participants in the study. Knowledge of each patient's immunological risk could improve treatment and the post-graft follow-up. On the other hand, the possibility that patients might be excluded from transplantation poses a significant ethical issue. This approach is not seen as something entirely new, given the fact that medicine is increasingly scientific and evidence-based. Although renal transplantation incorporates scientific data, these physicians believe that there should always be a place for clinical judgment and the physician-patient relationship.


CONCLUSIONS
The participants see the benefits of including the calculation of the global immunological risk within transplantation. Such data, being more precise and rigorous, could be of help in their clinical work. However, in spite of the use of such scientific data, a place must be retained for the clinical judgment that allows a physician to make decisions based on medical data, professional expertise and knowledge of the patient. To act in the best interests of the patient is key to whether the calculation of the global immunological risk is employed.
Dion-Labrie
Marianne
M
Groupe de recherche en bioéthique, Université de Montréal, P,O, Box 6128, Downtown Station, Montreal, Quebec H3C3J7, Canada. marianne.dion-labrie@umontreal.ca
Fortin
Marie-Chantal
MC
Hébert
Marie-Josée
MJ
Doucet
Hubert
H
D000328:Adult; D000368:Aged; D003657:Decision Making / Q000941:ethics*; D026690:Ethics, Clinical; D004992:Ethics, Medical; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033183:Interdisciplinary Communication; D007600:Judgment; D016030:Kidney Transplantation / Q000941:ethics* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection / Q000941:ethics*; D010820:Physicians / Q000706:statistics & numerical data*; D057285:Precision Medicine / Q000941:ethics / Q000379:methods / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D036301:Qualitative Research; D011792:Quebec; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D035501:Uncertainty