Pediatrics. 2017 Apr;139(4). pii: e20163471. doi: 10.1542/peds.2016-3471. Epub 2017 Mar 2.

Genomic Contraindications for Heart Transplantation.

Char DS^1,^2,³, Lázaro-Muñoz G^4,⁵, Barnes A⁶, Magnus D², Deem MJ⁷, Lantos JD⁸.

Author information

1: Department of Anesthesiology, and.
2: Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California.
3: Division of Pediatric Cardiac Anesthesia, Stanford University Medical Center, Stanford, California.
4: Center for Genomics and Society, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.
5: Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas.
6: Pediatric Cardiac Transplantation, and.
7: Department of Multidisciplinary Studies, The Center for Genomic Advocacy, Indiana State University, Terre Haute, Indiana.
8: Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri; and jlantos@cmh.edu.

Abstract

Genome sequencing raises new ethical challenges. Decoding the genome produces new forms of diagnostic and prognostic information; however, the information is often difficult to interpret. The connection between most genetic variants and their phenotypic manifestations is not understood. This scenario is particularly true for disorders that are not associated with an autosomal genetic variant. The analytic uncertainty is compounded by moral uncertainty about how, exactly, the results of genomic testing should influence clinical decisions. In this Ethics Rounds, we present a case in which genomic findings seemed to play a role in deciding whether a patient was to be listed as a transplant candidate. We then asked experts in bioethics and cardiology to discuss the implications of such decisions.