Uploaded by odonate

Organ Transplantation Day 1 powerpoint

pp. 385-388 Textbook
Daily Dilemma
• During a robbery, a 7-11 clerk is shot and
wounded. She returns fire and wounds the
suspect in the leg before they escape
• Hours later, a man known to police to have a
history of robbery arrives in an ER with a bullet in
his leg.
• Police want to compare the bullet to bullets fired
from the shopkeeper’s gun since it is the only
physical evidence from the robbery
• The suspect then refuses treatment. This may
lead to chronic pain and possibly infection, but he
is unlikely to die from the wound.
• Should doctors be required to remove the bullet
safely under local anesthesia in order to use it as
• The 4th Amendment deals with illegal search and
• Medical ethics prohibits involuntary infringements
of bodily integrity on mentally competent patients
• The Supreme Court has actually dealt with this
issue, and they ruled that a “reasonableness”
standard be applied that considered the
seriousness of the operation to retrieve the
evidence as well as the potential evidential value –
this should be done on a case-by-case basis
• In this case, the argument for forcing the
extraction is compelling – the surgery is minor and
the bullet is decisive evidence
• The other issue is whether physicians can be
ordered to perform a procedure that they object
to – for example, some states require doctors to
draw blood to test for alcohol levels in DUIs
whether they want to or not
Ethical Considerations We Will Tackle
Principle of
Respect for Persons
• Are some ways of distributing organs more respectful than others?
Harms and Benefits
• What kinds of harms and benefits may come to people who need organs as a result
of different organ-distribution policies?
• When there are not enough organs for people who need them, how should they be
• What is the fairest way to distribute organs?
• Organ transplantation involves harvesting organs
from live or cadaver donors and transplanting
them into recipients whose organs have failed or
are compromised
• Unsurprisingly, there are more needy recipients
than healthy organs being donated
• Today we are going to study fairness in the
allocation (distribution) of scarce, lifesaving
biomedical resources.
• You will read 3 historical cases regarding
resource allocation.
• Each case describes a historical situation in
which a person or group of people had to decide
how to distribute a scarce, lifesaving medical
• The purpose is to begin to think about fair ways
to allocate scarce biomedical resources.
• Note that the facts have changed since the time
of these historical cases. Penicillin, insulin, and
dialysis machines are no longer scarce. Still,
analysis of these old cases will help you
understand today’s allocation challenges.
The overall ethical question they will be
considering over the next three days is this:
How can scarce resources be most fairly
• Remember the following :
• Scarcity is an issue for many different
resources—medical procedures,
medications, organs for transplant, and
• Scarcity arises whenever need exceeds
• The theme of scarcity and fairness arose in
all three historical cases. After scientists
determined the benefits of the treatments
(insulin, penicillin, and the dialysis machine),
demand for them quickly exceeded the
Case Studies
• Take a few minutes to read the 3 case studies
• They aren’t long, but they are important
• You will be divided into groups of three
• In your groups, first discuss the questions
posed on page 1 of each of the case studies,
then discuss the additional information on the
second page of each case study
• Begin with the insulin case:
• What do you think would have been
the fair way to distribute insulin when
it was in such short supply?
• Now turn to page 2 and see how
Banting distributed the insulin
• What are the pros and cons of how
his method of distributing the insulin?
• Next, consider the penicillin case.
• Guidelines of the Committee on Chemotherapeutic and
Other Agents (COC) were created to determine distribution.
• Is this a fair and equitable way of deciding how to distribute
the limited doses of penicillin?
The COC distributed the penicillin primarily on the basis of how sick the
patient was and secondarily on the basis of advancing scientific
• Is there anything else that the COC should have considered?
Why or why not?
• Now consider the
dialysis committee used
to decide who had
access to dialysis.
• Is it fair to consider one’s
social worth—or value
to society—as a
• Take a 5-minute break
• We are done with the case
• For the rest of this unit, we
will consider only issues
involving the allocation of
organs for organ
• In the United States, the United Network for
Organ Sharing (UNOS) determines organallocation policies.
• You will review past and current policies later in
this unit.
• Let’s first consider livers: livers—like all organs
that are transplanted—are in short supply
• What would a national policy that governs how
to allocate them look like?
• We will carry out a brief activity that conveys
the current situation with liver transplants in
the United States.
• Imagine that all of you are in need of a liver and you are all on the
organ transplant list
• You have all been given a card that will determine your final status in
terms of receiving a liver – do NOT look at it yet!
Predicted %
Actual %
Over the next 12 months, what percent of
you will receive a liver?
Over the next 12 months, what percent of
you will die waiting for a liver?
Over the next 12 months, what percent of
you will still be alive but will not have
received a liver?
Liver Transplants
• We will be examining liver transplants for the
next few classes
• You will need more information about liver
transplants to evaluate allocation policies.
• Gathering the relevant facts and concepts is
always one of the first steps bioethicists take
as they contemplate an ethical question.
• Read the handout: Liver and Liver-Transplant
Fact Sheet
• Use this to complete the assignment titled
The Liver and Liver Transplants—Checking for