Ethical considerations in composite tissue allotransplantation

Ethical issues posed by the hand transplant program conducted by hand and p lastic surgeons at Jewish and University Hospitals, Louisville, Kentucky, a re examined in this essay. Because a composite tissue allotransplantation ( CTA) is an experimental procedure, it raises issues as to the protection of human subjects. The background for the emergence of medical ethics as a di scipline is indicated and the processes employed by the CTA team in order t o address ethical concerns are discussed. Questions are posed as to the jus tifications for certain procedures and those pertaining to the goals of med icine, informed consent, and patient quality of life. Other issues include benefits versus risks, patient autonomy and medical paternalism or non-male ficence. The Louisville team seems to have dealt conscientiously with all e thical questions that have been posed and has treated the hand recipient wi th competence and continuity of care, No reasons based in ethical concerns have surfaced that would in any way discredit the program. (C) 2000 Wiley-L iss, Inc.