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July 21, 1989

Renal Transplantation for Children

JAMA. 1989;262(3):348. doi:10.1001/jama.1989.03430030036011

To the Editor. —  In their commentary, Drs Reinhart and Kemph1 express concern about the proportional benefit of renel transplantation in children. We agree that older children (6 to 7 years and older) should be included in the information and consent process and that their emerging autonomy must be respected. Unpleasant options including no active treatment, as well as the risks, costs, and inconveniences of all possible therapies, should be explored thoroughly. The lure of paternalism or unfair efforts to influence or limit the family's choices must be avoided. At the same time, the pediatrician must be the primary professional advocate for the patient and only secondarily for the family and society.Unfortunately, the commentary by Drs Reinhart and Kemph is seriously inaccurate. While they pose an important question, it is placed in a 20-year-old time frame. Their references to the pediatric transplantation literature are out of date, most