Heart-Lung Transplantation for Patients With Cystic Fibrosis

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Abstract
It is becoming increasingly clear that scientific or technologic advance in medicine (as in other fields) has the effect of multiplying ethical choices or, from a somewhat different perspective, of heaping new burdens of nuanced judgment on already overburdened clinicians. This is more evident, and more dramatic, in acute than in chronic illness; in the latter, the therapeutic status quo is rarely upset by major breakthroughs. Heart-lung transplantation (HLT) in end-stage cystic fibrosis (CF), however, is an example of what now may provisionally be called a therapeutic breakthrough in a chronic disease, in view of the apparent fact that the transplanted lungs do not redevelop CF. Since the early 1980s, when the first CF HLTs were performed, with encouraging results, clinicians dealing with patients with end-stage CF have been faced with the need to make judgments regarding which patients to recommend as candidates for HLT. The scope of ethical choice