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.
What would you do?
I don't know the legalities of heart transplants at all. That being said, If Mr. X still qualifies for the heart, he has been on the list the longest and will get the heart. Simply speaking, he won't last with out it and she will. His situation is more emergent. Personally, I'd rather give it to someone I know would take their doctor's advice to heart (literally) and eat well and exercise. That's where my personal moral compass is, but I also know that someone could look at me and say the same thing, so who knows how good a judge I am. Mr. X may be trying and I am just not aware. I'd do my best to follow the set protocol, no matter how upset family members may be, and give the heart to MR.X.
ReplyDeleteYes, even though Mr. X clearly was unwilling to change his lifestyle and eating habits to help alleviate his constant ongoing heart problems, he has been on the donor list the longest and should receive the heart transplant. His situation is life or death and that is why he will receive this operation to save his life, even though morally I feel Mrs. Y is more deserving. She has a better chance of survival until a new donor heart becomes available. Mr. X is undeserving of this new heart but he would get my vote on the hospital ethics committee because his situation puts him in critical health if no action is taken to save his life. No matter how I may feel personally about his unhealthy lifestyle choices; life is always worth saving, you shouldn't let someone die if you have a chance to save them.
DeleteI have the same dilemma as you. Technically you should give the hear to patient X since he has been on the waiting list much longer and may pass away soon without it. On the other hand, morally the heart should go to patient Y because you know she will take care of it and change her lifestyle in order to sustain the second chance she was given. Ultimately the heart should be given to X because he will die without it and was first in line.
DeleteI have had the same problem as you. I believe that patient Y deserves the heart more because patient X has been told that if he does not cut weight and stop smoking his heart will not be able to take it. But because patient X has been on the transplant waitlist for longer he should technically get the heart.
DeleteI'm sure that there is an actual answer to this problem involving legalities, but since I do not know what that is, I will give my opinion. I feel that the committee should give the heart to Ms. Y because if given to Mr. X, he will more than likely waste it and end up back in the hospital. And while we never know, meaning maybe after Mr. X got this heart he could turn his life around because he was given a second chance, I don't think he will because he has been in similar situations before. I think the heart should go to Ms. Y even if Mr. X has been waiting longer. Of course, the committee should go with whatever the law says, but that is my opinion.
ReplyDeleteI think the issue here is that what is morally right is conflicting with what is legal. As healthcare professionals it is our duty to follow the law and provide the best care possible. If this means that we have to give a heart to a man that might not do his part in his treatment, then that's what it means.
DeleteI agree with what you are saying about him wasting the heart, seeing that he has multiple chances to turn his life around and probably not have to be in this situation if he would of listened, he would be throwing away a perfectly good heart that could save someones life like Ms. Y's life. Also agreeing with what you said about the legalities it is hard to make an actual decision not knowing the rules behind this.
DeleteI'm not sure who would really get the heart transplant based on this situation, but based on the information given I would give it to Mr. X. I say this because he has been waiting on the list for a long time and it wouldn't be fair to pass him up because he didn't make lifestyle changes. And there is always that chance that he realized that he need to make those changes in order to stay healthy. Also for Ms. Y she was just placed on the list and it doesn't appear that she needed it right away because she can be sustained with medication and maybe another heart will be available for her soon. With that being said I think that Mr. X deserves to get the heart transplant.
ReplyDeleteI would agree with you if there wasn't background into Mr. X case. There needs to be measures taken to give people the chance to live and if someone is in a higher need than someone else then they should get it. But also they need to be a proper candidate for the heart which Mr. X has been carelessly neglecting his part in trying to get better. Even though he might get a new heart to fix all of his problems if he sticks to his lifestyle of smoking and drinking I don't think that there will be much other ending then death or being put back on the transplant list again. But I do agree with not really knowing the way the list would work so I would just have to assume that Mr. X would get the heart since Ms. Y is able to be sustained on pills for the time being until the next heart comes along.
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