Fable Assignment

Please note: This case study is fictional. It is only to be used to examine one potential ethical problem concerning organ transplantation.


CASE STUDY


Albert Newburg typed the letters o-r-g-a-n-m-a-t-c-h in the Google search bar. He clicked on the first headline he saw, which read “Organ Donor, Organ Transplant, Organ Donor Services| Matching Donors”. This headline was the link for a website called matchingdonors.com. Albert clicked on the topic, “Why should I become a living donor”, and read carefully. He read the sentence, “you don't have to wait until you die to be a heroic organ donor”, and the word HEROIC was imprinted in his mind. Albert frantically searched the website for a person in need of a life-saving organ transplant. He found Becky Mueller and sent an e-mail without hesitation. The e-mail read:

Hello Becky,

My name is Albert Newburg, and I would like to give you one of my kidneys. I am in perfect health, and I match your blood type. My phone number is listed below. Please contact me, so we can get this process started. You need a kidney, and I need to give it to you.

-Albert

The next morning, Becky Mueller opened her e-mail account, and was stunned to find a message from Albert Newburg in her inbox. She stared at the computer screen. What was she going to do? She had been a member of matchingdonors.com for seven months now. She never really thought that anyone would give his or her kidney to a stranger. She was elated to receive Albert’s offer, however she did feel quite apprehensive. She felt that Albert’s message was strange because of the last line “I need to give it to you”. She also questioned why someone would want to go through such an evasive procedure and give up an organ for a stranger. Becky pondered for a moment, and decided to e-mail Albert back.

Becky and Albert exchanged e-mails for a few days. They put a plan together where Albert was to fly into Becky’s hometown and meet with her doctors.

Becky and Albert arrived at the hospital. Like Becky, the doctors immediately noticed that something was off about Albert. He seemed socially awkward and too eager to please people. He kept offering in a nagging manner to help the nurses and doctors with their work. He gave large amounts of money to every homeless or poor looking person he saw. In a small talk conversation with Becky and the doctors, Albert divulged that he wanted to give everything he had away- everything from his money to his house to his organs.

Becky and the doctors were stunned by Albert’s confession. The doctors immediately knew that there could be potential ethical problems concerning Albert’s organ donation because he was clearly not of sound mind. The doctors proceeded to do extensive mental health testing. They discovered that Albert was severely depressed and planned on committing suicide in the near future. The doctors tried to offer Albert some help on this issue, but Albert was insistent on his plans. The surgeon who would be performing Becky’s transplant took Becky aside to tell her the bad news,

“Becky, I’m afraid that we will most likely be unable to perform this transplant due to Albert’s mental state. He is very depressed and not of sound mind. I am not sure that it would be ethical to take his kidney from him even though he is persistent. I will have to consult with the board of ethics, and I will get back to you.”

The surgeon immediately met with the board of ethics and laid out his case.

“We have a man offering to donate his kidney to a woman he found on matchingdonors.com. This man is suicidal. He wants to give everything he has away before leaving Earth. He is not severely mentally handicapped. He has no assistance from family members, friends, or the government. He is just a single man who is severely depressed. I have offered him treatment and tried to convince him not to kill himself. He will not enter any programs, and will continue to live on his own until he kills himself. There is nothing that we can legally do to stop him from committing suicide; it his will. He wants to give up his organ to Ms. Becky Mueller. My question for you today is: Is it ethical to take Albert’s organ even though he is not of sound mind and may not be able to make an informed decision?”

Below is some factual information about the ethical dilemmas of organ transplantation.

 There are 98,056 people currently on the waiting list for a life-saving organ transplant.
 Every day, 16 to 17 people die while waiting for a transplant of a vital organ, such as a heart, liver, kidney, pancreas, lung or bone marrow.
 Because of the lack of available donors in this country, 2,025 kidney patients, 1,347 liver patients, 458 heart patients and 361 lung patients died in 2001 while waiting for life-saving organ transplants
 An estimated 10,000 to 14,000 people who die each year meet the criteria for organ donation, but less than half of that number become actual organ donors.

"25 Facts About Organ Donation and Transplatation." Congressional Kidney Caucus. 9 Dec. 2007 .

 Giving up an organ to someone unknown is a radical form of altruism (The Ethics of Organ Donation by Living Donors), and psychologists question if the person is compensating for low self-esteem, depression, or other psychological problems.


You have now looked at some facts and read a fictional case study that is designed to make you think about the ethical issues concerning organ transplants. Take a look at the following questions.

1. Consider the following and form an opinion on whether or not you believe it would be ethical to for the doctors in the case study to transplant Becky with Albert’s kidney.

Pro Con
He is going to die anyway, so why not put his organs to use and save someone’s life? He is severely depressed, and there is a possibility that he may come out of it.
Other than his depression, Albert is of sound mind. He is a grown man who willingly offered to help someone. Albert is suicidal and not thinking clearly.
Albert refuses to get help and insists on dying. Albert could change his mind.


2. Can you think of any other situations where a doctor would question whether it is ethical to accept a donation? Consider a white man offering his organ to only a person of the white race-is this ethical? What about the people of other ethnicities? Are they not just as deserving?



For more information on organ transplantation, you can look at my blog organethics.blogspot.com, and, of course, you can always conduct your own research online or at the library.

Timed Writing

Project three was a great learning experience because of the different mediums that were used: a letter, a fable, and a blog. The letter was not as effective for me personally because I had a difficult topic to find an opposing view. My letters were pretty much all the same because they were all supportive of my topic. I felt that I was writing the same piece of work over three times. I did, however, appreciate the fable. I felt that it was challenging to gear my ideas to a younger audience. I had to augment my thoughts and rhetoric to make my work understandable to a younger crowd. Lastly, the blog was the tool that I found most effective in project three.
The blog was much more effective than the paper because it allowed the students in our class to work off of each other and exchange innovative ideas between each other. The paper is constrictive because, with the exception of peer-review, there is only an exchange of ideas between the writer and the one reader, the professor. I appreciate the connectedness we, as students, experience through the blog world. We are able to look at our peers’ ideas and learn off of them. If I ever felt stuck in my writing, I was able to review a peer’s work, and gain new ideas and ways of thinking. This was especially helpful when constructing project three.
Overall, I felt that project three was an effective way of culminating our semester. Project three challenged my normal thinking processes and forced me to examine other people’s work and views. I would absolutely suggest using this project in future classes.

Letter to NKF

National Kidney Foundation
30 East 33rd Street
New York, NY 10016

To Whom It May Concern,

I am a student at Eckerd College in St. Petersburg, FL, and I am also a kidney transplant recipient. I have come across your organization through many different avenues; I recently wrote a paper about the ethics of organ transplants, and I looked to your organization for assistance when I needed it. Hereditary Nephritis runs in my family, and has affected six members of my family so far. I know how important it is to educate families facing kidney problems. I would like to volunteer in some way to support the efforts of your organization. Please let me know how I could be of service.

Letter to IAOD

International Association for Organ Donation
P.O. Box 545
Dearborn, Michigan 48121
313.745.2379

To Whom It May Concern,

I am a student at Eckerd College in St. Petersburg, FL, and I am also an organ transplant recipient. I recently wrote a research paper on the ethics of organ transplantation, and I came across your organization's website during my research. I would like to commend your organization for your tremendous efforts in educating communities about the vast need for donations. Your organization stands out because of your goal to educate a diverse group of people. I agree that this is important because of the higher disease prevalence in minority ethnic groups. My only question about your organization is why haven't you dispersed your programs and education across the nation? I read online that you have reached other nations around the world, however it seems that in the United States you have focused on Michigan. I think it would be beneficial to a greater amount of people if you spread your capabilities across the nation. Keep up the great work, and consider reaching communities outside of Michigan.

Letter to COTA

The Children's Organ Transplant Association,
2501 COTA Drive,
Bloomington, IN 47403

To Whom It May Concern,

As an organ transplant recipient, I would like to applaud your organization for assisting children in need of a life-saving transplant. Considering the great absence of medical insurance in this country, I feel that it is imperative for organizations, such as yourself, to find means of funding for transplants. I, myself, faced the common problem of lack of medical insurance and figuring out how I to pay to save my life. Unfortunately, I never came across this organization in my search for help. I would like to propose that you make greater efforts in publicizing your organization. Perhaps you could try to get a news station to air a story, or work on getting more pamphlets and advertising in doctors offices all around the country. I feel that there is so much that your organization can do, and every child or parent of a child should have access to your capabilities.

Peer Review

PEER REVIEW of Arthur's letters:


Hey,

I read all three of your letters, and I think that you ask some great questions. I, personally, knew nothing about the link between the environment and autism, so I am interested, as well. Your paragraphs are good...I would just go back and take a look at the grammar and "effect" should be affect when you're talking about a verb. Overall, great letters!

Comment on Peer Blog

I commented on Cleo's blog, Sexual and Gender Identity Rights Paper.




First of all, let me say that this is an excellent paper. You have great structure, flow, and diction. I read many papers on Professor Kat's blog, and your paper stuck out to me because I felt it was the most informative. You gave multiple statistics, personal stories, quotes from organizations, and historical examples. You did a nice job supporting your ideas.
The one thing that I found to be a little confusing was when you said, "Lastly, it is fundamental to recognize that judging a LGBT based upon general misconceptions, the notion that they are more likely to molest children, and that all LGBTs commit other crimes is completely erroneous"...I was a little confused here because there was no transition from your last paragraph and you had not talked about LGBT's being linked to crime.
Overall, I really enjoyed your paper. I was able to easily understand it. GREAT JOB!!!!

November 28, 2007 8:39 AM

Organization Contacts

International Association for Organ Donation
This is a non-profit organization dedicated to education communities about the shortage of organ supply.
http://www.iaod.org/about-organ-donation.htm


Organ Donation Breakthrough Collaborative
This organization is run by the U.S. Department of Human & Health Services to raise awareness about the shortage of organs, and to put together new strategies in hospitals to increase the number of available organs by 75%.
http://organdonationnow.org/index.cfm?fuseaction=Page.viewPage&pageId=471



The Organ Procurement and Transplantation Network
This network is established by the United States Congress to increase the equal opportunities for organ sharing and to increase the number of available organs.
http://www.optn.org/optn/

The Ethics of Organ Transplantation

Karissa Trombley

Prof. Kat Robinson

Analytical & Persuasive Writing

November 16, 2007

The Ethics of Organ Transplants

The miracle of organ transplantation is not without its flaws. Many controversies surround the process of saving lives, such as when someone meets the standard of death to donate an organ, when a living person is mentally stable enough to give away an organ, and who should receive the organ. The ethical dilemmas of transplantation can be examined through statistical data and real-life examples. On the whole, the ethics of organ transplants are multi-faceted and can be seen through the dead donor rule, the living donor rules, and the allocation rules.

At present, the most controversial ethical dilemma of organ transplantation is brain death: the requirement used for the procurement of organs from cadavers. In order for a non-living patient to donate an organ, he or she must fit a requirement, known as the “dead donor rule” (Ott), in which the patient has reached brain death. The definition of brain death has been developed and altered over time, and many people are questioning if it is time to abandon the term altogether. The first definition is known as whole-brain death, which is defined as “the irreversible cessation of all functions of the entire brain, including the brain stem” (U.S. Uniform Determination of Death Act as quoted in Ott 18). Subsequently, the problem with this definition is the physiological status of the patient. Although the brain is no longer functioning, a heartbeat remains, along with the ability to ingest food and excrete waste. In addition, some scientists question if the brain function is entirely irreversible. Studies show about 20% of brain dead patients show some cerebral activity therefore there may be some function left. If there were cerebral activity remaining in a patient would removing an organ from the patient be ethical? Because of these two deficiencies with the whole-brain definition of brain death, a second definition was created by Veatch. The brain death definition for the dead donor rule is not precise; therefore Veatch adapted the original definition to end confusion that could lead to ethical questions in organ donation.

Hence, Veatch altered the original definition of brain death to say, “the irreversible loss of all ‘higher’ brain functions” (Ott 19). The main difference with this definition is that the human personality must be gone; scientist, Beecher, argues that a person is no longer a person without a personality, without a consciousness, without the ability to judge or remember, and without the ability to be happy (Ott 19). These abilities are all part of cerebral functioning and cognition therefore it can be seen why Veatch’s definition requires total loss of cognitive functioning. Moreover, many scientists and physicians criticize this definition because although a human being is dead, a biological organism is still alive (Ott 20). In addition, even though the brain is dead, the patient may not appear to be dead because he or she could be breathing. Although there have been different ideas about the term “brain death” there is a common consensus that it means the irreversible cessation of all brain activity, including the brain stem. The ethical dilemma concerning the brain death requirement may not be apparent at first glance, however if one looks closely the immense predicament becomes apparent. The brain death requirement for the dead donor rule makes donation from cadavers an ethical problem.

Furthermore, the “dead donor rule” is a legal restraint in organ procurement (Robertson). The United States faces an incredible shortage of resources for organ transplantation, and situations occur where organs could be used if the dead donor rule did not exist. For instance, situations occur where organs could be obtained only from people who are irreversibly comatose or near death. For example, the organs of anencephalic newborns could be given to children with end-stage disease. 2,000-3,000 anencephalic children are born each year (Robertson 69), and many of their parents would love to give their child’s organs to another child. Physicians do not allow the donation of organs from anencephalic newborns because it may be removal of organs before brain-stem function ends may be necessary to ensure the viability of the organs, which means that according to the definition of brain death, the child is not legally dead. Consequently, some people propose that the brain death requirement should be abandoned for situations such as previously mentioned in order to end the debate concerning the ethics of the donation of cadavers. The dilemmas with donation do not end with the deceased; they are also present with the living.

The main ethical question of organ donation by a living donor surrounds the topic of the health of the donor. Physicians worry about the physical and mental health of the donor; should the life of a healthy patient be risked to save the life of sick patient? Additional questions surround each individual type of donation by a living donor, which include directed donation to a loved one, nondirected donation, and directed donation to a stranger. The main problem with directed donation to a loved one, where one willingly gives an organ to a friend or family member, is the pressure to donate. Because the donor holds a close relationship with the recipient, he or she may feel psychological pressure to donate. Sometimes, the donor comes out of the situation feeling coerced. The major issue with nondirected donation to a stranger, giving an organ to a pool for the person on the top of a waiting list, is the psychological health of the donor. Giving up an organ to someone unknown is a radical form of altruism (The Ethics of Organ Donation by Living Donors), and psychologists question if the person is compensating for low self-esteem, depression, or other psychological problems. An example of a donor compensating for mental health issues is the man who wanted to give everything away. This man had psychological problems, and he wanted to give everything he had to other people: his house, his money, even his organs. The man ultimately wanted to commit suicide. In summation, directed donation to a loved one and nondirected donation to a stranger holds great ethical dilemmas because physicians are concerned about the health of the donor, however directed donation to a stranger is the cause for most controversy because the well-being of multiple persons is at stake.

Furthermore, directed donation to a stranger opens the door for the potential of buy and sell. Man potential organ donors and recipients look to a website called matchingdonors.com where people can donate organs to complete strangers. This website has 2100 potential donors and is currently in the process of 12 transplantations, with twenty people awaiting surgery (The Ethics of Organ Donations by Living Donors). The problem with matchingdonors.com is accountability. Just as match.com has millions of people who cannot all be screened for quality, matchingdonors.com has hundreds of people who cannot be held accountable either. The second problem with directed donation is when it is chosen on race, religion, and gender; why should someone with a certain characteristic such as mentioned get priority over someone who does not? An example of this is a Jewish man who saw on the news that a Jewish girl needed a kidney transplant. The man did not know anything about the girl other than the fact that she shared the same faith as he did. The man donated a kidney to the girl on the news solely because she was Jewish, and he wanted to help someone with the same faith. This situation can be seen in one of two ways. It is permissible because the girl was helped and no one was harmed, but on the contrary side many other girls in the country need kidney transplants, too, but they did not receive one because they were not Jewish. The problem with the aforementioned situation is with allocation; when there are hundreds and thousands of people needing transplants with scarce resources who should get first pick? Allocation is the main ethical debate concerning organ transplantation. As such, hospitals have their own strategies for deciding who receives transplants; one such strategy is examining the finances of potential recipients.

As a case in point, doctors deny patients with poor health insurance transplants because hospitals cannot afford the bill (Victory). 37 million people in the United States are uninsured and 26-27 million are underinsured (Evans). Most programs in the United States require assurance of payment before a transplant; however most people cannot guarantee their ability to pay. The ethical quandary surrounding hospitals’ financial strategies is the refusal to transplant dying people by medical professionals based upon finances. Hospitals lose money when people cannot pay for the procedure and aftercare, therefore in order to cover their losses hospitals must charge more to other patients. According to the United Network for Organ Sharing (UNOS), the priority for transplantation goes by the sickest and those who have waited the longest, but also financial standing and ability to pay is often a factor. Those who defend this process assert that not all hospitals turn people away. There are a few hospitals, including Michigan Transplant Center, that offer programs to help pay for the cost of surgery and post-treatment. They offer programs, such as Medicare and Medicaid (with income limits). Even so, most hospitals in the United States allocate organs to those who can afford the bill. Overall, the allocation of organs starts with those who are rich.

On the whole, the problems with organ transplantation expand across technical terms, mental state, and allocation factors. People debate, and have debated for years, whether there should be a requirement for death. If the requirement were abolished more resources would be available, which would help allocation. Allocation is a major part of the ethical dilemmas surrounding transplants. Different people have different ideas about who should be helped first; is it money, race, gender, lifestyle? Who should hold the power to determine who lives and dies? Lastly, issues remain around the living people that willingly choose to donate organs- are they of sound mind? Will their own health be in jeopardy? Organ transplantation is not just a one-step process, rather a long and hard journey that faces questions such as: is the donor dead enough according to medical definitions of brain death to donate; is the living donor of sound mind, or is he or she compensating for mental health issues; should the organs of an anencephalic newborn be given to a child with end-stage disease? Such questions make the process of organ transplantation an ethical game that affects the donors, the recipients, and physicians. If only transplantation could be as beautiful as it sounds, there would not be the vast ethical quandaries that are presented today.

Works Cited

Clouse, Robert G. "Transplants and Organ Substitutions." Ethics. P-Z ed. 3 vols.
Pasadena: Salem P Inc., 1994.

Defanti, C A. "Brain Death.” Encyclopedia of Applied Ethics. A-D ed. 3 vols. San Diego: Academic P, 1998.

Evans, R W. "Money Matters: Should Ability to Pay Ever Be a Consideration in Gaining Access to Transplantation?" The Ethics of Organ Transplants the Current Debate (1998): 231-241.

Perry, David L. "Should Violent Felons Receive Organ Transplants?” Santa Clara University Markkula Center for Applied Ethics. 31 Jan. 2002. Santa Clara University. 30 Oct. 2007 .

Ott, Barbara B. "Defining and Redefining Death." The Ethics of Organ Transplants the Current Debate (1998): 16-23.

Robertson, John A. "Relaxing the Death Standard for Organ Donation in Pediatric Situations." Organ Substitution Technology (1988): 68-77.

Truog, Robert D. "Is It Time to Abandon Brain Death?" The Ethics of Organ Transplants the Current Debate (1998): 24-40.

Truog, Robert D. "The Ethics of Organ Donation by Living Donors.” New England Journal of Medicine 353: (2005). Infotrac Onefile. Eckerd College Library, St. Petersburg. 30 Oct. 2007 .

Victory, Joy. “Need an Organ? It Helps to Be Rich.” ABC Health. 20 Jan. 2006. ABC News. 30 Oct. 2007 .

Ubel, Peter A., Robert M. Arnold, and Arthur L. Caplan. "Rationing Failure: the Ethical Lessons of the Retransplantation of Scarce Vital Organs." The Ethics of Organ Transplants the Current Debate (1998): 260-274.