Ethical and Medical-Legal Aspects of Lung Transplant

The ethical and medical-legal aspects of transplantation are similar for all solid organ transplants, including lungs. The applicable legislation varies among different geographical locations and cultures, but it is easy to find common basic principles. Many fundamental issues are often handled in a similar way worldwide. Presenting the evolution of the transplant system of one single country (Italy) can help understanding the milestones of this complex topic. The ascertainment of death is a basic and very delicate concept in the transplant activity and its principles typically determine strong reactions from the public opinion. Every citizen should have the right to be adequately informed and to be able to liberally express a living will for organ donation. The evolving technology and medical knowledge allowed a deeper assessment of the risks connected to organ donation and the possibility of donor-derived diseases. The principle of safety and an appropriate regulatory system should guide all the aspects of the transplant activity. The allocation of organs needs to provide equal opportunities of receiving a transplant to patients with end-stage organ failure. Patients with respiratory failure display the highest rates of mortality on the waiting list and should therefore be protected by an equitable allocation policy. The ideal system is still under discussion and is different from country to country. The laws of each individual country set the guidelines for granting all these principles of safety and equity. The issue of responsibility of health care providers is becoming more and more relevant given the increasing requests for malpractice reimburses and files for complaints. Italy still handles both civil and criminal litigations for healthcare malpractice. The interpretation and the management of malpractice within different justice systems and different countries are often very heterogeneous. Transplantation is, by definition, a truly multidisciplinary clinical activity. All the individual components of the health care team share a common responsibility when a patient is injured.