TY - JOUR
T1 - The Ethics of Hand Transplantation
T2 - A Systematic Review
AU - Cooney, Carisa M.
AU - Siotos, Charalampos
AU - Aston, Jeffrey W.
AU - Bello, Ricardo J.
AU - Seal, Stella M.
AU - Cooney, Damon S.
AU - Shores, Jaimie
AU - Brandacher, Gerald
AU - Lee, W P Andrew
N1 - Publisher Copyright:
© 2018 American Society for Surgery of the Hand
PY - 2018/1
Y1 - 2018/1
N2 - Purpose We conducted a systematic review to document ethical concerns regarding human upper extremity (UE) allotransplantation and how these concerns have changed over time. Methods We performed a systematic review of 5 databases to find manuscripts addressing ethical concerns related to UE allotransplantation. Inclusion criteria were papers that were on the topic of UE allotransplantation, and related ethical concerns, written in English. We extracted and categorized ethical themes under the 4 principles of bioethics: Autonomy, Beneficence, Nonmaleficence, and Justice. We assessed theme frequency by publication year using Joinpoint regression, analyzing temporal trends, and estimating annual percent change. Results We identified 474 citations; 49 articles were included in the final analysis. Publication years were 1998 to 2015 (mean, 3 publications/y; range, 0–7 publications/y). Nonmaleficence was most often addressed (46 of 49 papers; 94%) followed by autonomy (36 of 49; 74%), beneficence (35 of 49; 71%), and justice (31 of 49; 63%). Of the 14 most common themes, only “Need for More Research/Data” (nonmaleficence) demonstrated a significant increase from 1998 to 2002. Conclusions Upper extremity transplantation is an appealing reconstructive option for patients and physicians. Its life-enhancing (vs life-saving) nature and requirement for long-term immunosuppression have generated much ethical debate. Availability of human data has influenced ethical concerns over time. Our results indicate that discussion of ethical issues in the literature increased following publication of UE transplants and outcomes as well as after meetings of national societies and policy decisions by regulatory agencies. Clinical relevance Because UE transplantation is not a life-saving procedure, much ethical debate has accompanied its evolution. It is important for UE surgeons considering referring patients for evaluation to be aware of this discussion to fully educate patients and help them make informed treatment decisions.
AB - Purpose We conducted a systematic review to document ethical concerns regarding human upper extremity (UE) allotransplantation and how these concerns have changed over time. Methods We performed a systematic review of 5 databases to find manuscripts addressing ethical concerns related to UE allotransplantation. Inclusion criteria were papers that were on the topic of UE allotransplantation, and related ethical concerns, written in English. We extracted and categorized ethical themes under the 4 principles of bioethics: Autonomy, Beneficence, Nonmaleficence, and Justice. We assessed theme frequency by publication year using Joinpoint regression, analyzing temporal trends, and estimating annual percent change. Results We identified 474 citations; 49 articles were included in the final analysis. Publication years were 1998 to 2015 (mean, 3 publications/y; range, 0–7 publications/y). Nonmaleficence was most often addressed (46 of 49 papers; 94%) followed by autonomy (36 of 49; 74%), beneficence (35 of 49; 71%), and justice (31 of 49; 63%). Of the 14 most common themes, only “Need for More Research/Data” (nonmaleficence) demonstrated a significant increase from 1998 to 2002. Conclusions Upper extremity transplantation is an appealing reconstructive option for patients and physicians. Its life-enhancing (vs life-saving) nature and requirement for long-term immunosuppression have generated much ethical debate. Availability of human data has influenced ethical concerns over time. Our results indicate that discussion of ethical issues in the literature increased following publication of UE transplants and outcomes as well as after meetings of national societies and policy decisions by regulatory agencies. Clinical relevance Because UE transplantation is not a life-saving procedure, much ethical debate has accompanied its evolution. It is important for UE surgeons considering referring patients for evaluation to be aware of this discussion to fully educate patients and help them make informed treatment decisions.
KW - Ethics
KW - VCA
KW - composite tissue allotransplantation
KW - hand transplantation
KW - upper extremity allotransplantation
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U2 - 10.1016/j.jhsa.2017.08.004
DO - 10.1016/j.jhsa.2017.08.004
M3 - Article
C2 - 28985978
AN - SCOPUS:85030563512
SN - 0363-5023
VL - 43
SP - 84.e1-84.e15
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
IS - 1
ER -