What are your reactions to the following hypothetical case?

A 58-year-old man has been admitted to the emergency room with symptoms of a heart attack. There is an obvious smell of alcohol on his breath, and the man appears to be in poor physical condition. Initial examination indicates that, in addition to his heart condition, his liver and kidney functions are also in distress. Moments later, a 32-year-old woman enters the hospital with symptoms of a heart attack also. Her overall physical condition appears to be excellent. In fact, she is wearing work-out clothing and appears to have experienced her problem during an exercise session. She is accompanied by her husband and two young children. Her husband claims that she has had a heart condition all her life and had been expecting to sign up for a heart transplant in the near future. Then a 25-year-old male motorcyclist enters the ER with a fatal head injury. He is pronounced dead on arrival and is identified as an organ donor on his driver’s license. The medical staff has learned that no other patients in the immediate organ service area need hearts, but that both of these patients need hearts as soon as

possible. They have gathered to determine who gets the donor’s heart.

What would your first questions be? What specific concerns would you have? What do you think are the two most important values to preserve in this case? What advice would you give to the staff and on what basis?

3 Answers

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  • 8 years ago
    Best Answer

    58 year old man: I would do what is necessary to stabilize the patient.

    I would ask about the pain occurring during this time period...if it comes

    and go or remains constant? I would ask if something help to relieve the

    pain, like sitting or leaning forward, etc.

    To the man or his family: How long has been his consumption of

    alcohol? Was he diagnosed as having Cirrhosis of the liver? Was he ever on

    dialysis for his kidneys? Does he go to any specialist doctors for care, like

    a gastroenterologist, cardiologist, nephrologist, urologist, etc?

    Those who are addicted to alcohol are not usually accepted

    to a Transplant Center unless they have been detoxed for a period

    of six months (under doctors care) prior to being evaluated for

    placement on the Transplant list. A Transplant Center could be

    contacted to find out if there are any exceptions to this rule and whether

    or not this rule applies to only certain organ transplants and which ones.

    Another thing to take into consideration...is the fact that the patient,

    if they need a transplant, has to be able to physically withstand

    the long hours of being under and living through the operation itself.

    More testing should be done to see how much damage has been done

    to the heart, liver, and kidneys...this would include blood, film testing

    (ultrasound, Ct scan, Echo, MRI, etc) and also maybe even a liver

    biopsy. The cells of these organs are what does the functions;

    so cell damage or death and how much each of these organs

    can still do the necessary functions, would have to be determined.

    For the woman: I would see that she is also stabilized.

    I would ask the same pain questions as above.

    I would ask her if her doctors have referred her to a Transplant Center

    to be evaluated for the transplant list? Since her physical condition

    appears to be excellant...it is highly unlikely that she would need

    a transplant right away. More testing would have to be done to be

    sure she definitely had a heart attack: Blood work, EKG, Holter monitor,

    Pet scan, etc. If the doctor hasn't already referred her to the

    Transplant Center, then she may need to be now...depending on

    how much heart damage there may be.

    You stated that both of these patients need hearts as soon as possible.

    Then UNOS...United network of organ sharing would have to be

    contacted. It is more likely that the woman would receive the heart

    before the gentleman since there may be an alcohol detox rule

    involved. However, most people are placed on the transplant list

    according to how much time they may have left to live without

    having a transplant...so it would be the one who may die the soonest...

    which would probably be the man (without testing this would be hard

    to determine)

    Not all hospitals are Transplant Centers...he/she would have to be

    lifelighted to the nearest Transplant Centers that do heart transplants

    Motorcyclist: Testing would have to be done to be sure of compatible blood

    type. In some countries, it would have to be determined if the patient

    (by signing the donor card) has told the family...as some family members

    can revoke him being a donor and also determine when the organ will

    be taken (like when he is brain dead or his heart stops beating).

    He also may list only that certain organs be donated.

    The Transplant doctors would be testing to see if he is a compatible

    donor to the recipients...so this may rule out one of those needing the

    transplant or both. Also, Transplant surgeons have a right to refuse an

    organ (if they do not believe it is suitable to transplant..past medical

    history of the donor or if they find something wrong with the organ

    itself)

    Hope this information would of been of some help to you.

    Best wishes.

    Source(s): caregiver to a liver transplant patient
  • 8 years ago

    For this hypothetical case, I am assuming that both patients were tested and determined to need a heart transplant as your last few sentences state. I guess the real question is who gets this much needed heart. The woman would get it because she would benefit most from the donated organ. I also assume that both patients are a match to this donated heart. You would need to find out if alcohol abuse was a problem for the man and the reason his liver and kidneys are having problems. Once that is established, he would be disqualified to receive a transplant until he completes a number or required conditions to receive a transplant and being an alcoholic. But that is not the only reason he would not get the organ.

    He also would be at high risk for not surviving the surgery even if he could qualify to receive the transplant. The prognosis for him would be poor for long term survival. The woman is healthy other than this heart condition and surviving the surgery would not be a problem. She would be very low risk and would benefit more from it in the long run. She would most likely not only survive the surgery, but would take good care of her new heart and live a long, full and happy life. Even if the man would survive the heart surgery, he would have liver and kidney failure to follow which are also life threatening. He most likely would not take good care of his donated organ or stay healthy from it. The woman gets the organ or all levels. They are not going to give someone a heart that also has other serious medical problems so the man is denied the transplant.

    Source(s): liver transplant recipient and nurse
  • rob p
    Lv 4
    8 years ago

    Well in a do or die situation, the girl gets the heart of course. In the ER everyone is treated equally but still rational decisions have to be made in a crunch-time episode.

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