Ethical Issues in Pediatric VCA

Abstract

There is growing interest in offering vascularized composite allografts (VCAs) to children, particularly upper extremity and face transplants. This review identifies ethical issues that must be addressed as VCA programs consider including more children and adolescents. The primary ethical concern in pediatric VCA is that the potential benefits might not justify the risks. Other issues involve eligibility criteria, informed permission and assent, authorizing donations and procuring VCAs, donor and recipient privacy and confidentiality, oversight and evaluation of transplants, and cost-effectiveness and resource allocation. A final concern is the obligation to avoid unfairly denying children and adolescents access to research participation and the benefits of research findings. While some observers find the uncertainty and risk of harm too great to expand access to VCA in minors, others disagree. Ethical concerns, particularly those related to the risks relative to potential benefits, may be the primary barrier to pediatric VCA. Carefully developed guidance and policy can facilitate the ethical inclusion and exclusion of children and adolescents from VCA protocols.