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Who Gets the Liver

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Who Gets The Liver? An Ethical Dilemma
Carrie R. Martin, R.N.
N4510 Conceptual Thinking
March 16, 2014

Keeping someone alive by giving them a new organ is a great achievement in medicine.
Unfortunately, demand far outweighs supply when it comes to the organ market. People die daily while waiting on their new organ. The topic of distribution of procured organs brings many ethics questions into focus. The biggest of these in my opinion is deciding who will receive the procured organ. I was given the task of deciding who would receive a liver from a list of four potential recipients in an imaginary scenario. The four patients all have a rare tissue type and it is unlikely that another liver will be available that will match for months or even years. Patient number one is a 65-year-old male with four adult children whose wife depends on him for care of a debilitating illness. His liver was damaged by cirrhosis due to alcoholism. Patient number two is a 35-year-old female who is married with two small children. Her liver damage was caused by a chronic illness. Patient number three is a 21-year-old single male whose liver was damaged by a Tylenol overdose. Patient number four is a 28-year-old female who is married with 5 children under the age of 10. She is an illegal immigrant farm worker whose liver was damaged due to exposure to a chemical that was sprayed on the crops where she works. Very little information was given on each person. The first piece of information that would be a real deciding factor for me that was not mentioned was how compliant each patient would be with medical treatments. Without knowing this, it is very difficult to try to predict outcomes after surgery. So, given the little information that I have, here is how I came up with my decision.
I decided to eliminate patient number one right off the bat. I realize that alcoholism is a disease and that he could be treated for it, but at his age, he has lived a very long life. A 65-year-old is likely not to tolerate surgery as well as the other 3 patients, and not enough information is given about how compliant he would be after surgery. With four adult children, there is likely a solution to be had about the wife’s care.
With the three remaining patients, I began to look at age as a factor. The basic problem with using age as a criterion for organ allocation is that age is generally assumed to indicate a patient's overall status or condition. (Reiser, 1987) We have all seen patients who were 40 and looked 60 and vice versa. I have seen 70-year-olds that could run circles around me. So, I decided to eliminate age as a deciding factor.
When looking at the rest of the available information, it would be easy to think about eliminating patient number four because she is an illegal immigrant, but I believe that we are bound to care for each person we come into contact with the same, regardless of whether we disagree with their situation. So, I am still left with three patients to choose from.
At this point, I wanted to narrow the choices down further. I began to think about modifiable traits in these patients. Patient number three’s situation with the overdose makes me wonder if he will attempt this again. Was the overdose intentional? This is not available in the given information, but I am going to assume so, so I eliminated this patient.
Two patients left, and almost identical situations, except one thing – patient number two is likely to have recurrence of liver failure. Even though it is probably 15 years or better down the road, it is still something that will eventually happen again. This is the big difference between the two; if patient number four gets the liver, she is fixed. There is no guarantee either way, but more than likely now that patient number four knows the cause, she will not be in contact with the pesticide again.
So, my choice is patient number four. Some might disagree with me because she is an illegal immigrant, but as stated previously, I believe we are to care for each person the same regardless of status.
The choice is very difficult to make objectively. I am glad that I am not the one who must decide “Who gets the liver?”.

REFERENCES
Reiser, S. (1987). Ethical aspects of organ transplantation in allocation. Texas Heart Institute
Journal, 14(3), 284-288.…...

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