Case Study: Choosing between organ donation recipients
Case StudyL
The hospital ethics committee was discussing an important
and urgent case. A donor heart had become available, but an extremely rare thing
had happened. Two heart-transplant candidates in the hospital were both matches
for the donor heart. One patient was known to the committee as Mr. X, the other
as Ms. Y.
For someone with heart failure, Mr. X had been on the
transplant waiting list a long time. He had been waiting one year and was near
death. Ms. Y had just been placed on the list and could be sustained with
medication for quite some time, possibly until another heart became available.
The answer seemed obvious-give the heart to Mr. X.
A number of the members of the committee did not agree with
this answer. They argued that time on the transplant list should be only one
factor considered. They saw a problem in Mr. X’s medical record.
Mr. X was 64 years old and had suffered from a heart condition
for years. He had had two angioplasties and two bypass operations to correct a
blockage of the heart’s blood vessels. The problem seen by some committee
members was that Mr. X still smoked, ate fatty foods, and was very overweight.
After each procedure, doctors had warned Mr. X that he must change his
life-style, and that if he didn’t, his condition would worsen. He never stopped
smoking, however, and never changed his diet. He said it was too hard.
Research has proven that smoking and high cholesterol are
risk factors for heart problems. Blockage of the coronary arteries is directly
attributed to these two factors. Treatments such as angioplasty (opening the
blood vessels by passing a tube into the arteries) and bypass surgery
(connecting new blood vessels that go around the clogged ones) can correct the
problem, but they are not a total cure. To avoid further problems, patients
must control their diet, stop smoking, and alleviate stress. This, of course,
is not easy. Mr. X appeared not even to try.
The heart was about to be airlifted to the hospital. The
committee had to make their decision very soon.
Questions
1. What
should the committee do?
2. How would
you vote if you were on the committee?
3. In some
cases, transplant operations are not successful, and a second operation is
needed. Should someone be allowed two transplant procedures? Three? Why or why
not?
4. In some
hospitals, alcoholics are not allowed to receive liver transplants. In other
hospitals, they are. Those who see alcoholism as a genetically determined
condition argue that these people cannot help their addiction. Others feel that
these people are responsible and should just stop. Should hospitals deny
transplant livers to alcoholics?
