The use of personalized medicine for patient selection for renal transplantation: Physicians' views on the clinical and ethical implications

BMC Medical Ethics

Research Article

Marie-Chantal Fortin¹  Hubert Doucet²  Marianne Dion-Labrie²  Marie-Josée Hébert³ 

[1] Centre Hospitalier de l'Université de Montréal (CHUM), Transplant Division, Hôpital Notre-Dame, 1560, Sherbrooke street East, H2L 4 M1, Montreal, Quebec, Canada;Groupe de recherche en bioéthique, Université de Montréal, P.O. Box 6128, H3C 3J7, Downtown Station, Montreal, Quebec, Canada;Shire Chair in Nephrology and Renal Transplantation and Regeneration, Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Hôpital Notre-Dame, 1560, Sherbrooke street East, H2L 2 M1, Montreal, Quebec, Canada;

关键词: Renal Transplantation;    Scientific Data;    Clinical Judgment;    Personalized Medicine;    Ethical Reflection;   

DOI  :  10.1186/1472-6939-11-5

 received in 2009-08-24, accepted in 2010-04-09,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundThe overwhelming scarcity of organs within renal transplantation forces researchers and transplantation teams to seek new ways to increase efficacy. One of the possibilities is the use of personalized medicine, an approach based on quantifiable and scientific factors that determine the global immunological risk of rejection for each patient. Although this approach can improve the efficacy of transplantations, it also poses a number of ethical questions.MethodsThe qualitative research involved 22 semi-structured interviews with nephrologists involved in renal transplantation, with the goal of determining the professionals' views about calculating the global immunological risk and the attendant ethical issues.ResultsThe results demonstrate a general acceptance of this approach amongst the participants in the study. Knowledge of each patient's immunological risk could improve treatment and the post-graft follow-up. On the other hand, the possibility that patients might be excluded from transplantation poses a significant ethical issue. This approach is not seen as something entirely new, given the fact that medicine is increasingly scientific and evidence-based. Although renal transplantation incorporates scientific data, these physicians believe that there should always be a place for clinical judgment and the physician-patient relationship.ConclusionsThe participants see the benefits of including the calculation of the global immunological risk within transplantation. Such data, being more precise and rigorous, could be of help in their clinical work. However, in spite of the use of such scientific data, a place must be retained for the clinical judgment that allows a physician to make decisions based on medical data, professional expertise and knowledge of the patient. To act in the best interests of the patient is key to whether the calculation of the global immunological risk is employed.

【 授权许可】

CC BY   
© Dion-Labrie et al; licensee BioMed Central Ltd. 2010