Andrew M. Cameron, MD, PhD, Aruna K. Subramanian, MD, PhD, Mark S. Sulkowski, MD, David L. Thomas, MD, MPH, and Kenrad E. Nelson, MD
The medical and non-medical information that a physician should consider when deciding whether or not to place a patient on the organ transplant waiting list.
Guidelines for proceeding with a plan of care when family members have conflicting opinions about the patient’s wishes and the patient does not speak the same language as her physicians.
Unclear regulations and informal data gathering on immigrants who receive or donate organs can cause mistrust and suspicion of the organ allocation system and affect donation rates.
The organ transplantation system is viewed as one of our most equitable health care services, but poor patients are effectively excluded by policy that denies Medicaid coverage of post-transplant immunosuppressant medication.
Physicians should recognize that patients’ beliefs may cause them to have non-medical explanations for their illnesses and that shared explanations should be negotiated if treatment plans are to be successful.
Physicians should demonstrate compassion when the parent of an ill child asks the physician for his or her personal opinion regarding the parents' choice to continue experimental treatment when the prognosis is not good.
Physicians who treat children with Down's syndrome should ensure that their parents fully understand the children's capabilities and long-term prognosis and counsel them on the appropriate actions to take regarding their children's care.