Multistep decision-making Step One: Clarify the conflict Step Two: Identify all stakeholders and values Step Three: Understand the circumstances surrounding the ethical conflict
• Takes utility into account, all possible goods and harms that can be envisioned, considering the quantity and probability of the various outcomes.
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Step Four: Identify the ethical perspectives relevant to the conflict
• Factors to be considered in the application of the principle of utility are patient survival; 2) graft survival; 3) quality of life; 4) availability of alternative treatments; and 5) age.
• Factors to be considered in the application of the principle of justice are 1) medical urgency; 2) likelihood of finding a suitable organ in the future; 3) waiting list time; 4) first versus repeat transplants; 5) age; and 6) geographical fairness.
• Factors to be considered in the application of the principle of respect for autonomy are: 1) the duty to respect decisions of donors or those who refuse to donate organs; 2) the right to refuse an organ; 3) free exchanges among autonomous individuals; 4) allocation by directed donation, and 5) transparency of processes and allocation rules to enable stakeholders to make informed decisions. Five: Identify different options for action Step Six: Select among the options. Step Seven: Share and Implement the