title: Is it ethical to prescribe generic immunosuppressive drugs to renal transplant patients?
abstract: OBJECTIVE
  This review was conducted to determine the ethical acceptability of prescribing generic immunosuppressive drugs to renal transplant patients.
  
  
  METHODS
  The literature search was conducted using Pubmed and Google Scholar.
  
  
  RESULTS
  The use of generic immunosuppressive drugs (ISDs) in transplantation is a controversial topic. There is a consensus among transplant societies that clinical data is lacking and that caution should be exercised. The reluctance to use generic ISDs in organ transplantation is partly related to the fact that most are "critical dose drugs", and that either low dosing or overdosing could have serious adverse consequences for both patients and society (i.e., the loss of scarce organs). In this paper, we examine the various ethical issues involved such as distributive justice, physician duties, risks versus benefits, conflict of interest, informed consent, and logistical and economic issues.
  
  
  CONCLUSIONS
  Our analysis was limited by the paucity of clinical data on generic ISDs and the absence of health economics studies to quantify the benefits of prescribing generic ISDs.
  
  
  CONCLUSIONS
  Our study led us to conclude that it would be ethical to prescribe generic ISDs provided certain conditions were met. These include regulatory safeguards to minimize the risks of substitution; education of patients; and further clinical and health economics studies to better inform clinicians, patients and society of the risks and costs related to drug substitution.
authors.affiliation: Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montreal, Quebec H2X 0A9 Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Allard
authors.affiliation: Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montreal, Quebec H2X 0A9 Canada ; Nephrology and Transplantation Division, Centre hospitalier de l'Université de Montréal (CHUM), 1560 Sherbrooke Street East, Montreal, Quebec H2L 4 M1 Canada ; Department of Social and Preventive Medicine, Bioethics Program, School of Public Health, Université de Montréal, Montreal, Canada.
authors.forename: Marie-Chantal
authors.initials: MC
authors.lastname: Fortin
keywords: Ethics; Generic drugs; Immunosuppressive drugs (ISDs); Transplantation