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Ethical challenges in nephrology: a call for action

Nature Reviews Nephrology volume 16, pages 603–613 (2020)Cite this article

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Abstract

The American Society of Nephrology, the European Renal Association–European Dialysis and Transplant Association and the International Society of Nephrology Joint Working Group on Ethical Issues in Nephrology have identified ten broad areas of ethical concern as priority challenges that require collaborative action. Here, we describe these challenges — equity in access to kidney failure care, avoiding futile dialysis, reducing dialysis costs, shared decision-making in kidney failure care, living donor risk evaluation and decision-making, priority setting in kidney disease prevention and care, the ethical implications of genetic kidney diseases, responsible advocacy for kidney health and management of conflicts of interest — with the aim of highlighting the need for ethical analysis of specific issues, as well as for the development of tools and training to support clinicians who treat patients with kidney disease in practising ethically and contributing to ethical policy-making.

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Fig. 1: Optimizing the utility of treatment outcomes in kidney failure can exacerbate health inequalities.
Fig. 2: Navigating pathways for treatment of kidney failure requires shared decision-making.

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Author information

Authors and Affiliations

  1. School of Medicine, Deakin University, Geelong Waurn Ponds Campus, Geelong, VIC, Australia

    Dominique E. Martin & Dominique E. Martin

  2. University of Sydney at Westmead Hospital, Westmead, NSW, Australia

    David C. H. Harris & David C. H. Harris

  3. George Institute for Global Health, UNSW, New Delhi, India

    Vivekanand Jha & Vivekanand Jha

  4. University of Oxford, Oxford, UK

    Vivekanand Jha & Vivekanand Jha

  5. Manipal Academy of Higher Education, Manipal, India

    Vivekanand Jha & Vivekanand Jha

  6. International Society of Nephrology, Brussels, Belgium

    Luca Segantini & Luca Segantini

  7. European Society for Organ Transplantation – ESOT c/o ESOT, Padova, Italy

    Luca Segantini & Luca Segantini

  8. Renal Division and Department of Medical Humanities and Bioethics, University of Rochester School of Medicine, Rochester, NY, USA

    Richard A. Demme & Richard A. Demme

  9. Nephrology Division, Department of Medicine, University of Rochester School of Medicine, Rochester, NY, USA

    Thu H. Le & Thu H. Le

  10. American Society of Nephrology, Washington, DC, USA

    Laura McCann & Laura McCann

  11. Renal Division, Emory University School of Medicine, Atlanta, GA, USA

    Jeff M. Sands & Jeff M. Sands

  12. Center for Ethics, Emory University, Atlanta, GA, USA

    Gerard Vong, Paul Root Wolpe, Gerard Vong & Paul Root Wolpe

  13. European Renal Association - European Dialysis and Transplant Association, Parma, Italy

    Monica Fontana & Monica Fontana

  14. Manhes Hospital, Nephrology Department GEPIR, Fleury-Mérogis, France

    Gerard M. London & Gerard M. London

  15. University Hospital, Gent, Belgium

    Bert Vanderhaegen & Bert Vanderhaegen

  16. Nephrology Section, Department of Internal Medicine and Pediatrics, University Hospital, Corneel Heymanslaan 10, B9000, Gent, Belgium

    Raymond Vanholder & Raymond Vanholder

Authors
  1. Dominique E. Martin
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  2. David C. H. Harris
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Consortia

ASN-ERA-EDTA-ISN Joint Working Group on Ethical Issues in Nephrology

  • Dominique E. Martin
  • , David C. H. Harris
  • , Vivekanand Jha
  • , Luca Segantini
  • , Richard A. Demme
  • , Thu H. Le
  • , Laura McCann
  • , Jeff M. Sands
  • , Gerard Vong
  • , Paul Root Wolpe
  • , Monica Fontana
  • , Gerard M. London
  • , Bert Vanderhaegen
  •  & Raymond Vanholder

Contributions

Dominique E. Martin, David Harris, Vivekanand Jha, Richard A. Demme, Thu H. Le, Jeff M. Sands, Gerard Vong, Paul Root Wolpe, Gerard M. London, Bert Vanderhaegen and Raymond Vanholder wrote the text. Dominique E. Martin, David Harris, Vivekanand Jha, Luca Segantini, Richard A. Demme, Thu H. Le, Laura McCann, Jeff M. Sands, Gerard Vong, Paul Root Wolpe, Monica Fontana, Gerard M. London, Bert Vanderhaegen and Raymond Vanholder reviewed and/or edited the manuscript before submission. Dominique E. Martin, David Harris, Vivekanand Jha, Richard A. Demme, Thu H. Le, Laura McCann, Jeff M. Sands, Gerard Vong, Paul Root Wolpe, Monica Fontana, Gerard M. London, Bert Vanderhaegen and Raymond Vanholder made substantial contributions to discussions of the content:

Corresponding author

Correspondence to Dominique E. Martin.

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The authors declare no competing interests.

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Nature Reviews Nephrology thanks Bruce Gelb, Alvin Moss and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Martin, D.E., Harris, D.C.H., Jha, V. et al. Ethical challenges in nephrology: a call for action. Nat Rev Nephrol 16, 603–613 (2020). https://doi.org/10.1038/s41581-020-0295-4

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