Guiding ethical principles in transplant candidate selection committees: A scoping review protocol.

OBJECTIVE

The goal of this scoping review is to examine the published literature regarding ethical principles that guide solid-organ transplant candidate selection committees. The review will identify the available research and provide recommendations to selection committees.

INTRODUCTION

Transplantation is a field where ethics is involved with almost every juncture of treatment. Organ selection, pathways to donation, organ allocation, and recipient selection are just a few of the myriads of processes that require ethical thoughtfulness. However, the ethical insights involved in the decision-making during these processes are not well elucidated in the literature. An application of an ethical framework(s) to this process could substantially improve the equality of the process.

INCLUSION CRITERIA

This review will include studies focused on transplant candidate selection committees and/or the transplant candidate selection process. It will include full papers and abstracts published in English.

METHODS

PubMED, EMBASE, APA PsycInfo, SCOPUS, and CINAHL databases will be used for the literature search. Only articles published in English between the years 1960 and 2024 will be considered. The review will consist of title/abstract screening followed by full-text screening to determine which articles meet inclusion criteria. Each article will be reviewed by two independent reviewers, with a third stepping in to resolve conflicts in decision. After all articles have been screened, data will be extracted in duplicate from the selected included articles using a template in Covidence created by the study team. Results will then be summarized and presented in narrative summary.

DISCUSSION

An examination of the transplant selection process is due and warranted as selection carries significant weight in determining who receives an organ and, indeed, the stakes are life and death. Yet few studies exist on transplant selection. Ultimately, the problem with selection is how committees can further improve their promise to patients: are they making the right decision and how they define "the right decision." Thus, it is critical to review selection committees for systematic bias and discrimination, especially in a process that depends heavily on individuals utilizing judgment-based reasoning, in order to improve selection and rid it of historic biases. This way, the transplant candidate selection process can foster fairness, thereby instilling increased public trust.