Over the years, technology in the field of medicine has evolved to the point where transplants give the patients a 70% to 80% chance of survival for the first year and 50% chance of survival for the next 5 years after the procedure is done. Initially, transplants, especially heart and lung transplants, had been considered experimental and were rarely conducted even in end-stage cardiac disease and thoracic conditions. However, ever since the 1980s, not only have they achieved accepted status they have also been done and redone several times allowing for more experience as well as knowledge in the various transplant procedures (Robertson, 1987). The past 40 years for instance, has allowed for better understanding of organ preservation, well-thought out immune response to the transplanted organ, invention of better immunosuppressive drugs, and individualized immunosuppressive regimen that is used to deal with comorbidities that arise after heart transplantation ( Coglianese et al., 2015) . Organ transplantation has a caveat though, the number of individuals requiring transplants of various organs greatly exceed the number of donors available to lend out these organs. Technically, as much as thousands of people benefit from transplants on a yearly basis, thousands of others are left out and end up either on life-support machines or loosing their lives.
Donor supply is limited in the sense that there is a lot of rules and regulations that need to be followed before an organ is successfully transplanted to any patient. These essentially are medical, social, moral and legal factors that have been set to ensure universal conformity as well as to protect potential donors from illegal harvesting of their organs. As such, this has created a scarcity of organs for transplantation has necessitated the creation of just and fair allocation policies as well as relevant solutions that are ethical in bridging the vast gap present between organ supply and the demand for the same organs (Shafran, 2014). This study aims to look at the how these policies are used to determine how a transplant patient is given preference over the other and what is the society’s standing when it comes to organ allocation for transplant patients.
Delegate your assignment to our experts and they will do the rest.
Methodology
The study took a book research approach in which certain keywords such as organ scarcity, effect of economic privilege in choosing an organ transplant patient, heart and lung transplant policies and ethical and moral guidelines for ensuring fair allocation of organs to patients during transplantation. All of these key words were used in google scholar and a number of research articles were found. However, I could not find any relevant scholarly articles in Omega: Journal of death and dying, death studies and the ADEC Forum Newsletter. Furthermore, I surveyed 10 people who were chosen randomly and did not have to necessarily be experts in the field to give an opinion on the issue. In the survey, I used a short close-ended questionnaire that aimed to give guided response platform for the participants and ensure that relevant answers are obtained.
Findings
Historically, the transplant that is regarded as the instigator of other transplants in the medical field and is as well recognized as the first successful transplant was the kidney transplant that took place in Boston in 1954 and was between identical twins (Shafran, 2014). Thirteen years later, in 1967, the successful heart and liver transplants were done but it was not until the 1980s that transplantation became a prominent conventional therapy for end-stage organ disease. The adoption of organ transplantation as viable means of treatment was mainly due to the discovery of cyclosporine that was vital in immunosuppression and which enabled combatting of graft rejection. Fast forward, by 2000, over 600,000 transplants had been performed globally. This success in organ transplantation changed the fate of many and changed what was once a death sentence for patients in many circumstances to a possibility of meaningful life. However, this transition of transplantation from an untried, experimental intervention into a viable, mainstream treatment option presented new challenges and ethical questions especially with regards to the issue of organ shortage.
The waitlist for organs in the US grew exponentially and by August 22, 2013, the number of people in the waitlist for organs was nearly 120,000. To add salt to the injury, only 11,580 transplants were done between January and May of 2013 a pace that can only make the gap between supply and demand even bigger (Shafran, 2014).
To get a clearer picture on why the distribution of organs require a robust policy that should be updated on a regular basis, we need to look at the history of policy around the allocation of organs. Before transplantation was considered a mainstream treatment, organs were usually allotted to the patients of the surgeon who harvested them. However, as organ transplantation become more mainstream, policies and guidelines were formulated with an aim of prohibiting organ sales. An example of this was in 1984 when the US Congress passed the National Organ Transplantation Act (NOTA) that had the objective of formally addressing and improving organ allocation systems (Shafran, 2014). NOTA led to the establishment of a national registry and creation of an equitable organ allocation policies. However, the NOTA act led to large disparities in waiting time based on geographic location and this once again required policy change that advocated for development of allocation policies focusing on objective medical criteria and medical urgency as opposed to waiting time and geographic location. Therefore, in 1998, the US Department of Health and Human Services published the “Final Rule,”. In 1999, the Institute of Medicine (IOM) reviewed and supported the assertations made by the Final rule and the rule was operationalized in the year 2000. The final rule was tailored to consider the low-income people and ethnic minorities when it came to access to transplantation services, organ donation rates, waiting time for transplant, survival and graft failure rates leading to retransplantation and cost of organ transplantation.
The final rule grounded its policies for distribution in four fundamental ethical principles: equity, justice, beneficence and utility. The principles and objectives of equitable organ allocation explicitly state that organs should be solely be allocated based on medical criteria that is hell-bent on ensuring that equal consideration is given to medical utility that is that there is net medical benefit to all transplant patients while at the same time there is equal distribution of the benefits and burdens among all transplant patients. The rule also gives clear guidelines on heart and lung transplantations in which priority is given on the basis of urgency as opposed to any other factor including waiting time and financial status ( Colvin ‐ Adams et al., 2014) .
Therefore, the research gives a conclusive answer on who is likely to get the heart and lung between the two young males of different economic status. Regardless of the financial background, whoever has the highest pretransplant mortality risk is the one who should get the lung or the heart. This decision is made solely through the ‘final rule’ amendment in the 1984 NOTA act. With regards to the lungs, the pretransplant mortality risk is not the only factor that is considered, the Lung Allocation Score (LAS) also factors in the post-transplant survival.
The survey, yielded the same results with 99% of the participants saying that medical urgency and pre-transplant mortality should be given precedence over other factors. In fact, others said that financial status should not even be in the list of consideration. Moreover, majority (60%) of the participants agreed that the lung allocation score (LAS) was a good assessment in making the decision of who should get a lung transplant and who should not. However, the 40% argued that the LAS could be biased as the criteria for post-transplant survival factored in the financial status of the patient as it required a lot of expensive procedures before the patient could have a good chance at getting a meaningful life.
Organ transplantation is generally a critical decision that presents a formidable ethical challenge to the transplant community. The Hippocratic oath morally binds physicians to treat illness indiscriminately without bias and regard for race, creed, or social or economic standing. Moreover, the rules set by governing bodies do not factor in a circumstance where the both patients have the same pre-transplant mortality risk. Furthermore, with the huge gap in supply and demand of organs, there needs to be more discussion and more continuous policy change so as to ensure justice and equity is observed, In our case, the rich kid and the poor kid should be treated equally; the rich kid should not be overlooked just because he is from a rich family same to the poor kid.
References
Robertson, J. A. (1987). Supply and distribution of hearts for transplantation: legal, ethical, and policy issues. Circulation , 75 (1), 77-87.
Shafran, D., Kodish, E., & Tzakis, A. (2014). Organ shortage: the greatest challenge facing transplant medicine. World journal of surgery , 38 (7), 1650-1657.
Coglianese, E. E., Samsi, M., Liebo, M. J., & Heroux, A. L. (2015). The value of psychosocial factors in patient selection and outcomes after heart transplantation. Current heart failure reports , 12 (1), 42-47.
Colvin ‐ Adams, M., Valapour, M., Hertz, M., Heubner, B., Paulson, K., Dhungel, V., ... & Cherikh, W. S. (2012). Lung and heart allocation in the United States. American Journal of Transplantation , 12 (12), 3213-3234.
