Baseline Ethical Principles and a Framework for Evaluation of Policies: Recommendations From an International Consensus Forum

Dale Gardiner; Andrew McGee; Christy Simpson; Curie Ahn; Aviva Goldberg; Austin Kinsella; Sanjay Nagral; Matthew J Weiss

doi:10.1097/TXD.0000000000001471

Baseline Ethical Principles and a Framework for Evaluation of Policies: Recommendations From an International Consensus Forum

Transplant Direct. 2023 Apr 28;9(5):e1471. doi: 10.1097/TXD.0000000000001471. eCollection 2023 May.

Authors

Dale Gardiner¹, Andrew McGee^{2

3}, Christy Simpson^{2

4

5}, Curie Ahn⁶, Aviva Goldberg⁷, Austin Kinsella⁸, Sanjay Nagral^{9

10}, Matthew J Weiss^{8

11

12}

Affiliations

¹ Medical Directorate, NHS Blood and Transplant, Nottingham, United Kingdom.
² Australian Centre for Health Law Research, QUT, Brisbane, Australia.
³ Faculty of Business and Law, QUT, Brisbane, Australia.
⁴ Department of Bioethics, Dalhousie University, Halifax, Canada.
⁵ Canadian Blood Services, Ottawa, Canada.
⁶ Division of Nephrology, National Medical Center, Seoul, South Korea.
⁷ Department of Pediatric Nephrology, University of Manitoba, Winnipeg, Canada.
⁸ Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada.
⁹ Department of Surgical Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India.
¹⁰ Co-chair: Declaration of Istanbul Custodian Group.
¹¹ Transplant Québec, Montréal, Québec, Canada.
¹² Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, Québec, Québec, Canada.

Abstract

To maintain public trust and integrity in organ and tissue donation and transplantation (OTDT), policymakers, governments, clinical leaders, and decision-makers must ensure that policies proposed to increase donation and transplant activity satisfy baseline ethical principles established by international agreement, declaration, and resolution. This article describes the output of the Baseline Ethical Domain group of an international forum designed to guide stakeholders in considering these aspects of their system.

Methods: This Forum was initiated by Transplant Québec and co-hosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. The domain working group members included administrative, clinical, and academic experts in deceased and living donation ethics and 2 Patient, Family, and Donor partners. Identification of internationally accepted baseline ethical principles was done after literature reviews performed by working group members, and a framework for consideration of existing or novel policies was completed over a series of virtual meetings from March to September 2021. Consensus on the framework was achieved by applying the nominal group technique.

Recommendations: We used the 30 baseline ethical principles described in World Health Organization Guiding Principles, Declaration of Istanbul, and Barcelona Principles to generate an ethical framework-presented graphically as a spiral series of considerations-designed to assist decision makers in incorporating these ethical principles into practice and policy. We did not seek to determine what is ethical but instead described a method of evaluation for policy decisions.

Conclusions: The proposed framework could be applied to new or existing OTDT policy decisions to facilitate the transformation of widely accepted ethical principles into practical evaluations. The framework includes adaptation for local contexts and could be applied broadly internationally.