Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
Department of Family Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ.
Transplantation. 2022 Sep 1;106(9):1754-1762. doi: 10.1097/TP.0000000000004144. Epub 2022 Apr 27.
Clinical trials of kidney xenotransplantation are being considered in the United States. Before this novel procedure can take place, investigators will have to obtain approval from the institutional review board. The consent form that will be used for such a trial and that will receive approval from the institutional review board will be complex. Informed consent-the process by which a research participant provides his/her permission to participate in a clinical trial-is a staple of the research process and most commonly is in the form of a physical document. In the case of a novel procedure with uncertain benefits and risks and a participant population in acute need of a transplant, the consent process is crucial. These complexities may raise several ethical considerations for the initial pig kidney xenotransplantation recipients in the United States that will require adaptations of the required elements of the informed consent process by the US Department of Human and Health Services. The ethical issues include (1) a subject's ability to withdraw from the trial, (2) restrictions on their reproductive rights, and (3) the possibility of the need for quarantine if there is a perceived risk of xenozoonosis. This article aims to discuss ethical considerations that may challenge the general required elements of the informed consent form stipulated by the 45 Code of Federal Regulations 46 of the US Department of Health and Human Services and to suggest recommendations for deliberation.
在美国,正在考虑进行肾脏异种移植的临床试验。在进行这种新程序之前,研究人员必须获得机构审查委员会的批准。用于此类试验并将获得机构审查委员会批准的同意书将非常复杂。知情同意——即研究参与者提供其参与临床试验的许可的过程——是研究过程的重要组成部分,通常采用书面文件的形式。对于具有不确定益处和风险且参与者群体急需移植的新型程序,同意过程至关重要。这些复杂性可能会给美国最初的猪肾异种移植接受者带来一些伦理考虑,这将需要美国人类和健康服务部对知情同意过程的必要要素进行调整。伦理问题包括(1)受试者退出试验的能力,(2)对其生殖权利的限制,以及(3)如果存在动物传染病风险,需要隔离的可能性。本文旨在讨论可能挑战美国卫生与公众服务部 45 联邦法规第 46 条规定的知情同意书一般必要要素的伦理考虑因素,并提出审议建议。