Dr Alison Weightman1,2,3, Dr Simon Coghlan4, A/Prof Philip Clayton1,2,3
1Adelaide Medical School, Australia, 2Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), , Australia, 3Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, , Australia, 4Centre for Artificial Intelligence and Digital Ethics, School of Computing and Information Systems, University of Melbourne, , Australia
Biography:
Dr Alison Weightman is a clinical nephrologist at the Royal Adelaide Hospital. She has previously completed a Masters in Bioethics with her research thesis investigating Respect for Autonomy in Living Kidney Donation. She is currently undertaking a PhD on Decision Making and Informed Consent for Deceased Donor Kidney Transplants.
Abstract:
In Australia, kidney transplants can occur from donors at increased risk of hepatitis B, hepatitis C and HIV. However consent processes for receiving one of these organs differ by state. In Victoria, potential kidney transplant recipients must complete an additional dedicated consent form to be offered an ‘increased viral risk’ organ. By contrast, in NSW, all patients on the kidney transplant waitlist can be offered an increased viral risk organ with standard consent procedures, that is, with disclosure of pertinent risk related information as part of the normal consent process at the time of offer/transplant. In risk-benefit terms, it is illogical for recipients to issue generic refusals for all of these ‘riskier’ donors: the risk of harm (because of viral transmission from these donors) is low while the likelihood of significant benefit is high. These patients receive earlier transplant offers and are less likely to die on the transplant waiting list. We argue that additional consents for increased viral risk offers, as occurs in Victoria, not only fails to benefit potential recipients but also does not respect their autonomy above and beyond general consent processes. Furthermore, we suggest that additional and separate consenting for increased viral risk organs paradoxically undermines the autonomy of potential recipients. The way in which the ‘increased viral risks’ are highlighted in the Victorian model creates a misleading and disproportionate sense of danger and leads to flawed decision making. We propose abandoning dedicated pre-consents for increased viral risk kidney transplants in favour of standard consent processes.
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