Ethical Issues in Organ Transplantation & Allocation
The case study titled “Who will receive the liver?” is concerned with an ethical dilemma regarding the transplantation and allocation of the liver to two patients. Mr. Mann and Mrs. Bay are both suffering from an end-stage liver disease. Mr. Mann, fifty years old, is suffering from alcoholic liver cirrhosis and will die soon if he does not receive the liver transplant. He has no job, he is divorced, and he lives alone. Additionally, Mr. Mann has not been in good terms with his sons who are both married and basically, this means explains why he has been dependent on state funding and probably this is the same reason why he became an alcoholic to the extent of suffering from the disease.
On the other hand we have Mrs. Bay who is suffering from ESLD Hepatitis B though not admitted to any healthcare facility. We can consider Mrs. Bay as a social asset with a community looking up to her and her family due to her involvement in community-based activities. She is a wife and a mother of two young sons all of whom would never imagine of a life without a mother. Her condition is linked to moments in her life when she can hardly move from the bed meaning that she can neither accord love to her family nor provide services to the community that she is fond of.
Both patients require a liver transplant as the treatment for the two conditions. However, we have only one organ hence posing the allocation dilemma. Ethical organ transplant and allocation practices follow a number of frameworks. These include the sickest patient’s framework, social worth principle, utilitarian ethical framework, proximity, and the fairness principle which is based on the first-come, first-served rule. This paper seeks to provide an answer to the case study by assessing the facts presented in the case in light of the above mentioned ethical frameworks.
Based on critical analysis for the facts surrounding this ethical dilemma, I would allocate the liver to Mrs. Bay. She is only 37 years of age as compared to Mr. Mann who is 50 years of age and this means that Mr. Mann has surpassed the qualification age which is 50 years and above in many cases. Secondly, Mrs. Bay ranks ahead of the other candidate in the wait list and thus it would only be fair to follow the protocols in the allocation of the available organ. Thirdly, Mrs. Bay has a community and a family depending upon her with her two sons who would not want to lose their mother and on the other hand we have Mr. Mann who is dependent on the community and the state to fund him in whether in good health or ailing. Lastly, none of the two candidates chose to be their condition but looking deeper into the case, Mr. Mann’s condition is more or less a result of irresponsible alcoholism and given his condition, chances are high that he will relapse to his drinking behavior as soon as he has the opportunity to do so.
One may argue against the above decision especially based on the fact that the success rates for the liver transplant to hepatitis B patients is low. Nevertheless, such an argument ought to be considered weak as it strength gets neutralized by looking at the other side of the story which is that though slim chances, there are still chances of success in the transplant and Mrs. Bay’s condition could be one of those. Furthermore, if the success rate must be considered as a qualification factor, then it must be leveled against the age limit of the recipients and this ultimately eliminates Mr. Mann from the equation. Additionally, the success rate of a liver transplant to a hepatitis B patient can be compared to recidivism in this case in that Mr. Mann will most likely get back to alcoholism and this will contribute to the failure of the transplant. Rationally, the likelihood of recidivism to alcoholism for Mr. Mann is high because he does not promise anything good with regard to his behavior and secondly, his social and economic condition may put him under stress which may push him to drinking.
Other than the above presenting supporting factors, the liver allocation to Mrs. Bay is also supported by four out the six ethical frameworks studied. These ethical frameworks include the utilitarian ethical framework, the fairness principle, the social worth principle, and the sickest patient’s principle. The proximity principle was not considered in the analysis because the location details of the organ and the patients are provided and thus the assumption is that the same distance would be covered. Regarding the best success rate and long-term outcome framework, the allocation to Mrs. Bay may provider slightly lower chances of success but then successful transplant to her would have longer positive outcome based on the fact that Mrs. Bay is 13 years younger than Mr. Mann meaning that she has high chances of living longer than Mr. Mann after the transplant. The above frameworks are discussed below.
The utilitarian ethical framework supports the allocation of the liver to Mrs. Bay in that the allocation would maximize overall utility in the decision. First and foremost we the intrinsic value of human life is constant and hence not a consideration in this case because whichever way the lever falls, a life is at stake. What is important with regard to the utilitarian approach is the issue of the benefits associated with allocating the liver to either of the two. In the case of Mr. Mann, the liver allocation would mean that the state not only covers his hospital bill but also his life after the transplant and in his fast approaching old age since he has no job. Further, the allocation is indirectly an unnecessary cost of irresponsible alcoholism. With Mrs. Bay, the allocation of the liver would mean continued contribution to the state’s gross income as she actively involved in productive activities including employment and community-based activities.
From the social worth principle, the decision is supported by various factors. Firstly, Mrs. Bay has a family and a community looking forward not only to love and companionship but also in constructive community-based activities aimed at improving social welfare. She has a husband and two sons who cannot imagine her infinite absence while looking to the other side we see a man who is divorced and with two uncooperative sons. Instead of contributing to the welfare of the society, Mr. Mann spends time drinking. Though this may sound a little inappropriate, his death may come as a lesson to the community regarding irresponsible drinking behavior but the same cannot be said about the loss of Mrs. Bay. Instead, we can conclude that her loss would be a loss to the entire community hence the loss should be prevented in the best way possible. Lastly, hepatitis B is an infectious virus that can be passed on from one person to the other and thus providing a solution to Mrs. Bay’s condition will also result into protection to the community and people at risk of contracting the virus.
The third ethical framework in support of this decision is the fairness principle which can be summarized together with the sickest patient’s principle. The fairness requires that the allocation of the liver on the first-come, first-serve grounds and in that case, Mrs. Bay deserves the allocation since she was ahead of Mr. Mann on the wait list. On the other hand, the sickest patient’s principle requires that the allocation be made to the person who requires it more urgently which in this case is Mrs. Bay. It is true that she is not admitted in any healthcare facility but then her life involves moments of pain and recovery with the condition getting so bad that she cannot even get out of her bed. If that is not enough, then the criteria may be disqualified based on the fact that both candidates at the end-stage level of the conditions. From analysis of the case facts, it is possible that the probable reason why Mr. Mann was in hospital is that he did not have anybody to take care of him at home and not necessarily because his condition was worse than that of Mrs. Bay.
In conclusion, the allocation of an organ for transplant such as in the case above may present a tough dilemma to the practitioners especially because the intrinsically valuable lives are at stake. Nevertheless, there are qualification factors to look into during the allocation with one of them being the age caps. The ethical theories herein presented also presented a good approach towards solving the dilemma. Based on the analysis, Mrs. Bay deserves the allocation. This decision would be most appropriate as it is supported by most of the theories herein discussed and additionally, the facts about alcoholic liver cirrhosis and hepatitis B also support the decision.