I am a college student currently attending Tennessee State University. I am
faced with a very difficult assignment in my medical ethics class.
Myself and a group of four other students have to present a moral arguement
before the professsor and the entire class.
I was wondering if you could give me your expert opinion on the case we are
arguing, and help us to decide as to why Sandra should recieve the transplant
and James should not.
Here is the case that was put before us:
Sandra is a 20 yr old female with congential heart failure who is
currently on oxygen and is unable to walk ten feet without rest.
Her cardiologist refered her to a transplant team for evauation
(myself and the four other students). Without a transplant in the next year,
Sandra will probably die of cardiac arrest. During her evaluation,
Sandra continually questiones the team about the procedure and after care.
She was concerned about "all that she had to do " and was not sure
"if all that was worth it" since a transplant meant that she would be
unable to finish her college degree immediately. Further, she missed two
of her appointments and often forgot to take her medication.
Her insurance would cover the hospital fees, but medication and follow-up
care/visits probably would not be covered, as Sandra would hit her
insurance expense cap. James is a 45 year old man who had recieved a heart
transplant 10 years ago. Although he has lived a healthy life with the transplant,
the heart graft is beginning to show signs of failure. His health care
providers classify JAmes as very cooperative and appreciative of the work
the transplant team has done for him. He works full time when he fells well,
but recently has bouts of extreme fatigue and dizziness that keep him at
home. James' condition will only continue to get worse. While his insurance
covered his first transplant, the second graft would not be covered fully as another
transplant is considered follow-up care. The team is unable to do both cases for
reduced fees as the hospital charges alone for $300,000 for every transplant.
I would like to extend my early gratitude to you for helping my collegues
and I with our semester assignment. Your speedy reply would be highly
Thanks again Doc. :)
Dear Tamika, thank you for your question. I remember taking medical ethics classes myself in college and these issues are not easy to resolve, but they do occur in modern medical practice. Cardiac transplantation is a difficult issue since there is a limited supply of organs available so it makes sense to only transplant patients with an expected good survival after transplantation, and to transplant patients who would be expected to be medically compliant with their treatments after transplantation (since medical non-compliance can cause the transplanted heart to be rejected and to fail). While we would like to think that financial concerns do not figure into transplantation decisions, the reality of the situation is that transplants are expensive and someone has to pay for them. Sandra sounds to me like an unreliable patient since she has missed her appointments and she has not taken her medication regularly. Additionally, there is some doubt that Sandra would even agree to undergo transplantation at this point. Without proper psychological counseling or testing, I doubt that Sandra would be a good transplant candidate. James, on the other hand, sounds like an ideal patient for transplantation and he has demonstrated that he is reliable and compliant with his medications and treatments. As a physician, I would not consider the financial obligations of the hospital in making my decision regarding who to transplant, but it sounds like the costs to the hospital would be greater for James (at least during the initial hospitalization). Thus, I think James deserves the transplant at this point.
I hope this information is useful. Information provided in the heart forum is for general purposes only. Only your physician can provided specific diagnoses and therapies. Feel free to write back with further questions. Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
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