Vol.:(0123456789) HEC Forum (2019) 31:49–62 https://doi.org/10.1007/s10730-018-9364-5 1 3 An Ethical Framework for the Care of Patients with Prolonged Hospitalization Following Lung Transplantation Andrew M. Courtwright 1,2  · Emily Rubin 3  · Ellen M. Robinson 2,4  · Souheil El‑Chemaly 5  · Daniela Lamas 5  · Joshua M. Diamond 1  · Hilary J. Goldberg 5 Published online: 19 September 2018 © Springer Nature B.V. 2018 Abstract The lung allocation score system in the United States and several European countries gives more weight to risk of death without transplantation than to survival following transplantation. As a result, centers transplant sicker patients, leading to increased length of initial hospitalization. The care of patients who have accumulated func- tional defcits or additional organ dysfunction during their prolonged stay can be ethically complex. Disagreement occurs between the transplant team, patients and families, and non-transplant health care professionals over the burdens of ongoing intensive intervention. These cases highlight important ethical issues in organ trans- plantation, including the nature and requirements of transplant informed consent, the limits of physician prognostication, patient autonomy and decision-making capacity following transplant, obligations to organ donors and to other potential recipients, and the impact of program metrics on individualized recipient care. We outline gen- eral ethical principles for the care of lung transplant recipients with prolonged hos- pitalization and give regulatory, research, and patient-centered recommendations for these cases. Keywords Critical illness · Informed consent · Organ allocation · Survival · Transplantation * Andrew M. Courtwright Andrew.Courtwright@uphs.upenn.edu 1 Pulmonary and Critical Care Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA 2 Institute for Patient Care, Massachusetts General Hospital, Boston, MA, USA 3 Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA 4 Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, MA, USA 5 Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, USA