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Ethical issues associated with solid organ transplantation and substance use: a scoping review

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Abstract

While solid organ transplantation for patients with substance use issues has attracted ethical discussion, a typology of the ethics themes has not been articulated in the literature. We conducted a scoping review of peer-reviewed literature on solid organ transplantation and substance use published between January 1997 and April 2016. We aimed to identify and develop a typology of the main ethical themes discussed in this literature and to identify gaps worthy of future research. Seventy articles met inclusion criteria and underwent inductive content analysis. Four main ethical themes were identified: (1) personal responsibility; (2) utility; (3) moral character; and (4) fairness. Each theme had multiple sub-themes and there was substantial overlap between themes. This scoping review identified a disproportionate emphasis in the literature regarding personal responsibility, which was referenced by each of the other themes, and a narrow focus on alcohol and liver. We recommend future research further investigate these connections between ethical themes and focus on ethical issues associated with transplants from organ groups other than liver for patients who use substances other than alcohol.

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(Adapted from Moher et al. 2009)

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Funding

Funding was provided by State Government of Victoria (Operational Infrastructure Program), University of Toronto (Fellowship in Clinical and Organizational Bioethics) and University Health Network (Salary Support).

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Authors and Affiliations

  1. Joint Centre for Bioethics, University of Toronto, 155 College Street, Suite 754, Toronto, ON, M5T 1P8, Canada

    Lauren Notini & Daniel Z. Buchman

  2. Melbourne Law School, The University of Melbourne, 185 Pelham Street, Carlton, VIC, 3053, Australia

    Lauren Notini

  3. Biomedical Ethics Research Group, Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia

    Lauren Notini

  4. University Health Network, Toronto, ON, Canada

    Denitsa Vasileva

  5. Library and Information Services, University Health Network, Toronto, ON, Canada

    Ani Orchanian-Cheff

  6. Bioethics Department, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada

    Daniel Z. Buchman

  7. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Daniel Z. Buchman

  8. Krembil Research Institute, Toronto, ON, Canada

    Daniel Z. Buchman

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  1. Lauren Notini
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Participated in the research design: DZB, LN, AO-C. Participated in the writing of the paper: LN, DZB, DV, AO-C. Participated in the performance of the research: LN, DV, DZB, AO-C. Participated in the data analysis: LN, DV, DZB.

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Correspondence to Daniel Z. Buchman.

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Notini, L., Vasileva, D., Orchanian-Cheff, A. et al. Ethical issues associated with solid organ transplantation and substance use: a scoping review. Monash Bioeth. Rev. 37, 111–135 (2019). https://doi.org/10.1007/s40592-019-00100-1

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