First Ready, First to Go: Ethical Priority-Setting of Allogeneic Stem Cell Transplant at a Major Cancer Centre

Abstract

Medical advancements have now made it possible to provide allogeneic stem cell transplantation (allo-SCTs) to older patients and use stem cells from less well-matched donors. This has resulted in access to a life-saving modality for a greater number of patients with imminent life-threatening illnesses. However, resources have not always kept pace with innovation and expanded volumes. During the summer of 2015 in the province of Ontario, Canada, inadequate resources contributed to a capacity crisis, resulting in extended wait-lists for allo-SCT across the province. This situation presented unique ethical challenges, including the need for ongoing negotiations with health system partners and nimble process management to ensure timely delivery of care. This article reports on the process one organization used to determine how to equitably allocate scarce allo-SCT resources. With the ever-expanding landscape of new and emerging medical technologies, our experience has implications for the ethics of translating other increasingly expensive health technologies to clinical care.

Kicking off the 2020s with Healthcare Policy

“…This issue also features an interprovincial comparison of childhood cancer costs by McBride and colleagues (2020) , which provides valuable insights into variations in care delivery. Zoratti and colleagues (2020) report on a three-province comparison of drug reimbursement recommendations, whereas Bell and colleagues (2020) explore equity in accessing allogeneic stem cell transplant and Antonipillai and colleagues (2020) explore Canadian refugee health policy. This issue also presents a Discussion and Debate article by Khan and colleagues (2020) that draws on international experience to inform biosimilar implementation.…”