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Counselling variation among physicians regarding intestinal transplant for short bowel syndrome
  1. Christy L Cummings1,
  2. Karen A Diefenbach2,
  3. Mark R Mercurio3
  1. 1Division of Newborn Medicine, Boston Children's Hospital, Harvard School of Medicine, Boston, Massachusetts, USA
  2. 2Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
  3. 3Department of Pediatrics, Program for Biomedical Ethics, Yale University School of Medicine, Pediatric Ethics Program, Yale New Haven Children's Hospital, New Haven, Connecticut, USA
  1. Correspondence to Dr Christy L Cummings, Division of Newborn Medicine, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 437, Boston, MA 02115, USA; Christy.Cummings{at}childrens.harvard.edu

Abstract

Background Intestinal transplant in infants with severe short bowel syndrome (SBS) is an emerging therapy, yet without sufficient long-term data or established guidelines, resulting in possible variation in practice.

Objectives To assess current attitudes and counselling practices among physicians regarding intestinal transplant in infants with SBS, and to determine whether counselling and management vary between subspecialists or centres.

Methods A national sample of practicing paediatric surgeons and neonatologists was surveyed via the American Academy of Paediatrics listserves. Results were analysed by physician subspecialty and again by presence or absence of intestinal transplant at respondent's centre.

Results The survey was completed by 433 respondents, consisting of 363 neonatologists and 70 paediatric surgeons. Fifty-seven respondents (13.2%) practiced at a centre that performed intestinal transplants in children. The vast majority of respondents (91% for preterm, 95% for term neonates) felt that maintaining a neonate with SBS on total parenteral nutrition for intestinal transplant was ethically optional (neither impermissible nor obligatory), and that parents should be given an informed choice whether to pursue that option. However, only 33% indicated they often/always offer intestinal transplant as a treatment option to families in this situation.

Conclusions There is a marked disparity between individual physicians’ beliefs regarding the acceptability of intestinal transplant for severe SBS and their reported practice. Wide variability exists among physicians with respect to their knowledge, beliefs and practice regarding severe SBS, raising concerns about transparency and justice. Survival data prior to transplant, currently unavailable, are essential to rational decision making and informed parental permission.

  • Clinical Ethics
  • Informed Consent
  • Newborns and Minors
  • Technology/Risk Assessment
  • Transplantation

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