https://pubmed.ncbi.nlm.nih.gov/36997027/ Transplant

Am J Transplant. 2023 Mar 28;S1600-6135(23)00360-X.
doi: 10.1016/j.ajt.2023.03.017.Online ahead of print.

An Ethical Analysis of Obesity as a Contraindication to Pediatric Liver Transplant Candidacy

Emily R Berkman 1, Evelyn K Hsu 2, Jonna D Clark 3, Mithya Lewis-Newby 4, André A S Dick 5, Douglas S Diekema 6, Aaron G Wightman 7

Abstract
Childhood obesity is becoming more prevalent in the United States (U.S.) and worldwide, including among children in need of liver transplant. Unlike with heart and kidney failure, end stage liver disease (ESLD) is unique in that no widely available medical technology can re-create the life-sustaining function a failing liver. Therefore, delaying life-saving liver transplant for weight loss, for example, is much harder, if not impossible for many pediatric patients, especially those with acute liver failure. For adults in the U.S., guidelines consider obesity a contraindication to liver transplant. While formal guidelines are lacking in children, many pediatric transplant centers also consider obesity a contraindication to pediatric liver transplant. Variations in practice among pediatric institutions may result in biased and ad hoc decisions that worsen health care inequities. In this paper we define and report the prevalence of childhood obesity among children with ESLD, 2) review existing guidelines for liver transplant in adults with obesity, 3) examine pediatric liver transplant outcomes and 4) discuss the ethical considerations of utilizing obesity as a contraindication to pediatric liver transplant informed by the principles of utility, justice and respect for persons.

Published on: 
Mar-2023

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