Sebelius ordered to make exception on girl's transplant

[applecorped]

My father-in-law needs a lung transplant too. It'll be hilarious if his lung goes to this girl instead.

His lung?

 

[JoeTheJuggler]

His lung?

I suppose that was shorthand for saying the lung that would have gone to him if we had followed the established rules.

 

[daenku32]

I suppose that was shorthand for saying the lung that would have gone to him if we had followed the established rules.

Yeah. His lung is at 20% capacity and dropping. No one would want that.

 

[applecorped]

Got it. Not his lung.

 

[jhunter1163]

I commented to my wife when I saw that the girl had been allowed onto the list, "Here come the lawsuits." The policy needs to be changed, and quickly, or else there'll be so much litigation that the poor docs won't have time to do surgeries.

 

[BenBurch]

We need a mechanical lung. One that can be used long term.

 

[NoahFence]

What's the name of the person who is going to die so that this girl can (maybe) live?

 

[JoeTheJuggler]

Got it. Not his lung.

Meh. It's a defensible grammatical construction. I understood it immediately. (I suspect you did too, but are trying to make a point without saying it straightforwardly.) It would be his (or somebody else's) lung if we followed the normal rules and didn't make an exception.

The way the system is set up, though, that person will never know that the girl got "his" lung (the lung that otherwise would have gone to him).

So instead of one person knowing he's going to die because of this decision to make an exception to the application of the established rules, there will be a lot of people suspecting it.

 

[JoeTheJuggler]

Not quite, this ruling doesn't allow the girl to cut to the front of the line. It removes the "you must be this tall to ride" limit on lung transplants" and she is now allowed to stand in line.

I suppose that's effectively what's going on, but technically, children are in fact on the waiting list for adult lungs. They're just behind adults. So this decision actually let her cut to the front of the line she was already in.

In other words, if we had a donor lung, and there were no compatible adults on the list, the existing rules would NOT require us to throw away the organ rather than try to transplant it into the first child on the list that's a match.

 

[daenku32]

You know. If was in this position, I really wouldn't know what I would want. The whole idea that it's either my life or someone else's, is just sucky. Even in the ideal situation where they had a fridge full of organs to donate I think I would have rather had the people who used to own the organs to have continued living, rather than dying just so that I get in a few more years. And then in the more realistic case where there are only limited number of organs to go around, knowing that someone may have to go and die without one so that I would get to live. I guess I'm just always the guy who wants to wait for the line to, ahem, die down, before I get into one. I figure those willing to stand the wait want them more than me.

 

[applecorped]

I'd pick my daughter over my dad every time, wouldn't you?

 

[catsmate]

I agree with Popehat's take on it, in the form of a update to The Screwtape Letters.

<much snippage>
And so we come to the events of yesterday, when a herd of cattle, your patient among them, lowed so loudly at being shown a picture of a young girl denied an organ transplant that it now appears the girl will receive the cast-off lung, whether or not she was of suitable age to receive the organ, and in disregard of longstanding rules on which others of the vermin based their expectations. You can be sure that not a one of the brutes considered that in "giving" life to the object of his fancy, he was just as surely taking it from another. In the Roman colosseum, the plebs knew full well that their roars condemned Christians to death. In the modern arena, the plebs dupe themselves that their roaring is righteous.

Thanks to seeds planted long ago by the Lowerarchy, we can expect more such harvests in the future. As the number of the humans increases, their competition for finite resources will grow keener. We have taught mankind to believe that such resources should be allocated arbitrarily, to she who is most popular or to he who cries most loudly of his need, rather than according to rules, laws, or anything approaching such rationality as their little minds can muster. The so-called leaders of their societies, whom we have well in hand, will be only too happy to appease the mob.

Finally, I concur with your facile observation that it benefits our cause for the girl get her lung (the death of a child, while pleasing to the senses, does us no good since we probably cannot get her soul), but the disposition of a piece of dead tissue is of no importance in the long run. What matters is we are fast approaching the day when, by showing the humans a picture of a wounded puppy or a homeless kitten, we can provoke in them such squalls of outrage that they will abandon their laws, their morals, and their reason.

Your affectionate uncle,

Screwtape

 

[The Fallen Serpent]

I'd pick my daughter over my dad every time, wouldn't you?

I think most people would. That is the emotional nature of people. Children before adults. Which is the point of such rules. If the science shows that the chance of a child living is significantly low and the chance of an adult living is significantly high, the practical thing to do is to attempt to save the adult. This is a difficult issue in the medical field. I have had doctors describe to me examples of emergency situations where doctors will Code Blue an even brain dead infant for hours while other patients who might actually recover if they received medical attention are ignored and die. The urge to do everything for a dying child is high in most people. All other things being equal, I doubt few would argue against prioritizing children first. However it is rarely the case that all other things are equal and in those instances if the information is available and conclusive it should be followed.


I am not familiar with the science behind this rule so I do not know if it is sound or outdated. I would feel if it is outdated and no longer a proper rule the rule itself should have been suspended instead of just applying this single exemption. As others have said, it sets a bad precedent unless there is a medically sound reason why this one child should receive an exemption but the rule is otherwise correct.

 

[JoeTheJuggler]

I'd pick my daughter over my dad every time, wouldn't you?

Not if the probability of success is greater for my dad than for my daughter. It would be an unethical waste of scarce organ.

The current rules take into account compatibility (tissue typing and such), need (which patient can't likely wait for the next one), and likelihood of a successful outcome (we don't give organs to patients likely to die of something else right away, for example), and finally geography.

You're simply ignoring one important consideration: the likelihood of success. Very few of these operations have even been performed, so far. We're fairly confident though, that the added steps of cutting down the lung (or of compacting it into a smaller space) results in decreased probability of success.

The problem with dealing with the scarcity of organs problem in a lawsuit is that the judge is deciding only the case of the girl before him. He has the luxury of ignoring everyone else waiting for the next available lung. No judge would want to make a decision that would likely be a death sentence on the innocent girl, but that's exactly what the rules MUST do since there are more people in need of organs than available organs. (I just heard today that about 18 people on the waiting list for organ transplants die each day for want of an organ.)

 

[JoeTheJuggler]

You know. If was in this position, I really wouldn't know what I would want. The whole idea that it's either my life or someone else's, is just sucky.

That's very well put. And I think the way to do it is more or less the way we have been doing it: have a set of rules that are applied dispassionately.

I think the way not to do it, is to take each case to court.

I have two big complaints about the status quo, though. One is that the ability to pay should never be a factor in this decision, but the way things are set up (still), it sometimes is. (In some states, for example, Medicaid will pay for transplants, but not in others.) The second is that I would make organ donation an opt-out rather than an opt-in thing. In other words, you've got to sign something to say you refuse to donate your organs. Absent such a document, we should assume you're an organ donor.

[ETA: And I'd be happy to make the legal argument that the public interest in such a policy outweighs the minor burden ("inconvenience" at most) placed on the civil rights of people with a religious or other objection.]

Again, the one good thing I see coming out of this is greater awareness of the horrible reality of the scarcity of donor organs, and a little more public push to encourage people to sign their donor cards.

 

[applecorped]

Mickey Mantle laughs.

 

[The Central Scrutinizer]

FWIW, adult lungs can be used in children. They require either transplanting just a lobe or cutting the lungs down to fit.

It also requires that the child not be a smoker.

 

[JoeTheJuggler]

Mickey Mantle laughs.

Under current rules (barring the intervention of a court ordering an exception be made), he almost certainly wouldn't have gotten his liver transplant. In fact, that sort of celebrity/wealthy person favoritism is something the rules were designed to prevent.

 

[WildCat]

We need a mechanical lung. One that can be used long term.

Or we could just end the shortage of organs by paying the survivor's families for them.

But for some reason it's been OK to pay huge amounts of money to the doctors and hospitals and everyone in the supply chain but not to the estate of the person who actually donates, because that's unethical for some reason. Far better that thousands of people die while on the waiting list.

 

[WildCat]

Under current rules (barring the intervention of a court ordering an exception be made), he almost certainly wouldn't have gotten his liver transplant. In fact, that sort of celebrity/wealthy person favoritism is something the rules were designed to prevent.

When did they change the rules that allow wealthy people like Steve Jobs to register for transplants in multiple areas to greatly increase their chances of a transplant?