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Deceased Organ Donation Ethical Considerations Organ Allocation Transplant Wait List

Should a 73 year old be given a heart transplant?

That’s the question behind a recent MedBlog article.

The facts are this: Charlie Wilson received a heart in 2007 and just recently died in early 2010. A transplanted heart lasts an average of ten years. The waiting list prioritizes medical need first. Since donor organs are in such short supply and there is no alternative treatment for heart failure, should that heart have been given to someone who, statistically, would’ve ‘used’ it longer?

OPTN (and consequently UNOS, since they are the contractor managing OPTN) is charged with the ‘fair and equitable allocation’ of deceased donor organs. Does this meet the criteria?

What we term a ‘waiting list’ is not a list at all, but a pool of recipients, and each organ offer is treated like a lottery where blood type, HLA, geography and other factors must match up like the numbers on a bingo card. questions like this are not about ‘bumping’ a person from their place on the list, but about QUALITY of matches, putting the transplanted organ with a person who will benefit most from it.

The improvement of anti-rejection medications has allowed surgeons to perform 0/6 HLA transplants, but none of them want to admit that A. the transplant doesn’t last as long and B. the anti-rejection meds have their own side effects, including an increased risk of cancer. Especially in the case of living donor organs (usually kidneys), the surgeons are mostly concerned with ‘healing’ the sick recipient of their kidney failure (when transplants are NOT cures, but another form of treatment) and procuring the fee for TWO surgeries, scheduled at their leisure instead of the middle of the night, holidays or weekends when a deceased organ becomes available.

Despite public perception, living donors suffer short and long-term consequences of their sacrifice, including decreased kidney function, hypertension, increased risk of cardiac issues and kidney failure. When a recipient’s transplant fails, s/he can obtain a new one. A living donor’s maiming is permanent. With the push for more living donations, we then have to ask ourselves – How many healthy people should be compromised for the temporary treatment of one recipient? Is the ratio 2:1, 5:1 – how much less of a person is a living donor than a recipient? (and then there’s the question of the living donors who eventually become recipients themselves – are we simply creating a new, never-ending class of people in need of transplants?)

The reality is that not every person with end-stage renal disease will fare well with a transplant, yet the transplant industry constantly pushes transplant as the treatment of choice. However, a suggestion as simple as prioritizing children by certain UNOS committee members caused the special interest groups of specific kidney-affecting diseases to rebel viciously. Apparently in this situation (as on the Titanic), it really is every person for themselves and to hell with the good of society as a whole.

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