Biliary atresia in Uganda: Current ethical challenges and advancement of public policy.

IF 2.3 3区 医学 Q2 SURGERY World Journal of Surgery Pub Date : 2024-10-01 Epub Date: 2024-04-01 DOI:10.1002/wjs.12166
Nasser Kakembo, J Isaac Loy, Tamara N Fitzgerald, Ryan M Antiel
{"title":"Biliary atresia in Uganda: Current ethical challenges and advancement of public policy.","authors":"Nasser Kakembo, J Isaac Loy, Tamara N Fitzgerald, Ryan M Antiel","doi":"10.1002/wjs.12166","DOIUrl":null,"url":null,"abstract":"<p><p>Biliary atresia is a progressive cholangiopathy in neonates, which often results in liver failure. In high-income countries, initial treatment requires prompt diagnosis followed by Kasai portoenterostomy. For those with a late diagnosis, or those in whom Kasai portoenterostomy fails, liver transplantation is the only lifesaving treatment. Unfortunately, in low- and middle-income countries, timely diagnosis is a challenge and liver transplantation is rarely accessible. Here, we discuss the ethical dilemmas surrounding treatment of babies with biliary atresia in Uganda. Issues that require careful consideration include: risk of catastrophic health expenditure to families, ethical dilemmas of transplant tourism, medical risks of maintaining the transplant in a low-resourced health system, and difficult decisions encountered by the surgeon caring for these patients. Four distinct models of the patient-physician relationship are applied to biliary atresia in Uganda. These models describe differences in patient and physician roles, and patient values and autonomy. Solid organ transplantation is a rapidly evolving segment of healthcare in Uganda and ongoing policy advancements may shift ethical considerations in the future.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/wjs.12166","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/4/1 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0

Abstract

Biliary atresia is a progressive cholangiopathy in neonates, which often results in liver failure. In high-income countries, initial treatment requires prompt diagnosis followed by Kasai portoenterostomy. For those with a late diagnosis, or those in whom Kasai portoenterostomy fails, liver transplantation is the only lifesaving treatment. Unfortunately, in low- and middle-income countries, timely diagnosis is a challenge and liver transplantation is rarely accessible. Here, we discuss the ethical dilemmas surrounding treatment of babies with biliary atresia in Uganda. Issues that require careful consideration include: risk of catastrophic health expenditure to families, ethical dilemmas of transplant tourism, medical risks of maintaining the transplant in a low-resourced health system, and difficult decisions encountered by the surgeon caring for these patients. Four distinct models of the patient-physician relationship are applied to biliary atresia in Uganda. These models describe differences in patient and physician roles, and patient values and autonomy. Solid organ transplantation is a rapidly evolving segment of healthcare in Uganda and ongoing policy advancements may shift ethical considerations in the future.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
乌干达的胆道闭锁:当前的伦理挑战与公共政策的推进。
胆道闭锁是新生儿的一种进行性胆管病变,通常会导致肝功能衰竭。在高收入国家,初期治疗需要及时诊断,然后进行葛西肠管造口术。对于那些诊断较晚或卡萨伊肠管造口术失败的患者,肝移植是唯一能挽救生命的治疗方法。遗憾的是,在中低收入国家,及时诊断是一项挑战,肝移植手术也很少能实现。在此,我们将讨论在乌干达治疗胆道闭锁婴儿的伦理难题。需要慎重考虑的问题包括:家庭灾难性医疗支出的风险、移植旅游的伦理困境、在资源匮乏的医疗系统中维持移植的医疗风险,以及照顾这些患者的外科医生所遇到的艰难抉择。乌干达的胆道闭锁病例采用了四种不同的医患关系模式。这些模式描述了病人和医生角色的差异,以及病人的价值观和自主权。在乌干达,实体器官移植是快速发展的医疗保健领域,不断推进的政策可能会改变未来的伦理考虑。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
World Journal of Surgery
World Journal of Surgery 医学-外科
CiteScore
5.10
自引率
3.80%
发文量
460
审稿时长
3 months
期刊介绍: World Journal of Surgery is the official publication of the International Society of Surgery/Societe Internationale de Chirurgie (iss-sic.com). Under the editorship of Dr. Julie Ann Sosa, World Journal of Surgery provides an in-depth, international forum for the most authoritative information on major clinical problems in the fields of clinical and experimental surgery, surgical education, and socioeconomic aspects of surgical care. Contributions are reviewed and selected by a group of distinguished surgeons from across the world who make up the Editorial Board.
期刊最新文献
Safety of thyroidectomy as day care surgery at a rural setting in Eastern Uganda. Reduction in perforated appendicitis incidence between rural and urban populations after introducing social health insurance in Vietnam: A population-based study. Author's reply: Is routine histopathological analysis of hemorrhoidectomy specimens necessary? A systematic review and meta-analysis. The utility of alcohol saliva test strips compared to the breathalyzer in trauma patients in a resource-limited setting. Author's reply: Impact of surgical specialization on emergency upper gastrointestinal surgery outcomes: A systematic review and meta-analysis.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1