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Going through a medical ethics lecture for tomorrow. This was a question posed by the prof. ESRD=end stage renal disease
a. 34 y.o. decorated army veteran with PTSD and ESRD due to agent orange exposure
b. 62 y.o. Nobel laureate candidate working on fossil fuel alternatives (The intuition there is that if he gets the kidney that he is going to figure this problem out)
c. Young mother with hypertension, history of medication noncompliance; good match to the kidney
d. Former IV Drug Abuser (has ESRD) who now leads an exemplary life, donating assets, dedicated to Narcotics Annonymous and has led many others to a life of sobriety.
e. Wealthy patient with Adult polycystic kidney disease who promises to donate assets to non-profit to study kidney disease
f. Longstanding diabetic rancher, on dialysis for 5 years, who wants to return to work on his ranch
g. The 15 y.o. daughter of a visiting ambassador; will return to her native country next year
h. Previous kidney donor to his brother 15 years ago, now with same inherited disease
Who get's it? There is no right or wrong answer, although some answers are better than others.
Not something that I could answer, but very interesting to see what people would think
My guess would be the one who got there first.
Fortunately for the world of medicine I do not, and will not be practicing.
I'm with (C)B(uck)
I think another interesting option would have been a 30 year old in prison for life for murder, but is a perfect match.
That one is easy, no. Let that one die
Ethically, you can certainly make that argument (and I pretty much agree). But prisoners in the US do have a legal right to healthcare.
What if the criminal committed a white collar crime (instead of murder) and was doing 25 years but would get out at the age of 55, and so far has made a lot of progress and has been a perfect inmate, and is still a perfect match?
To me that white collar crime inmate should still be at the bottom of the list. Those inmates are scum like the rest of them
Don't most people have 2? In this case I'd have to vote for whoever needs it most, soonest. Everything else is philosophical speculation. There is always another donor who dies tomorrw, which could be me. It says so on my drivers license:)
Before there was space or time there was rock and roll.
As far as anything I have ever learned you would never give it to someone that takes drugs or does not comply to taking them properly, I wouldn't give it to someone that it would do no good for if it is a disease that is going to kill the new kidney, eff someone not from our country, so to me I guess it would come down to the rich guy or the previous donor IF he doesn't have a disease that will ruin the new kidney as well, I would consider the reformed druggy but you can just never trust a drug addict.
Gold medals aren't really made of gold. They're made of sweat, determination, and a hard-to-find alloy called guts.
last man standing deathmatch
The best answers are C (because she's a perfect match), G (because children get precedence because they'll get the longest use out of them), and H (previous donors get preference)
It's essentially a big algorithm that takes into account the type of organ, urgency (not as important for a kidney transplant because there is dialysis), Tissue match (not as important with liver transplants, but obviously a big consideration), blood type, organ size (big consideration in liver and lung transplants), immune status, time on the list, etc.
The amount of money a recipient has makes no difference. You cannot disadvantage a possible recipient because they are not wealthy (however, they do have to have insurance to pay for the surgery and long term care). You also cannot base it on their societal contributions or merit (although one could certainly argue those points ethically).
Legally, prisoners must be put on the transplant list if they are deemed healthy enough for a transplant, and you must transplant them if an organ matches them. You can certainly make arguments against this, but the supreme court says prisoners are entitled to all healthcare as part of the 8th Amendment.
But the biggest thing I learned tonight:
Organ transplantation surgeries: fascinating
Ethics of organ transplantation: dear lawd make it stop.
If C has a history of medication noncompliance, than shouldn't she be thrown off the list?
I can understand G, but if H has the same degenerative disease as his dying/dead relative, it's still going to kill him later so wouldn't he be ruled out on basis of having an inherited degenerative disease?
Ok this really pisses me off because I quoted the original post with my answer (either B or D based on ethical reasons) and then when I tried to respond to the quote above it edited my original response.
This post has been edited 2 times, most recently by derHawkeye 15 months ago
Sine Missione -- Never be a spectator for unfairness or stupidity, argue for arguments sake; the grave will give plenty of time for silence.
Kind of what I thought on C as well
my choice is who is on the list first, then second, then third. Hippocratic Oath didn't give specifics if I remember correctly
For animals, the entire universe has been neatly divided into things to
(a) mate with
(c) run away from
1, Not every doc take that oath. A lot of schools are moving away from it anyway.
2. It has no real legal binding
3. The "who came first" argument is certainly valid, but doesn't really work in the real world. In the ER, do you see the patient who has been waiting for 45 minutes with a bad stomach ache or tend to the ambulance that just came in with a stab wound?
I actually was in an ER within the last year and a half. Breathing problem out of nowhere. Surprise to me. So was the billing. An ambulance ride from my house is 2 grand plus.
I liked the young doctors, but they were learning too. One of them told me that they threw the book at me because they weren't sure what was going on.
I give them credit for getting some things right but the stay took them a couple of days to figure it out. The 2 grand was peanuts compared to that bill.
Anyway what it comes down to in the case of the kidney is, none of us has a say in those cases. They are decided by insurance companies, hospital admin and lawyers. Count on it.
I should get a Nobel prize a free kidney and some pro bone legal advice for this post, dontcha think? Hardy freaking har.
Walter Payton waited his turn.
Ah, again the voice of reason.
I would have no problem with it going to A,B,G or H.
I understand the ER, I am referring to the donor list. Who is up next?
How did the stomach ache and stab wound get into a donor question??
To me, it is easy. (a) gets the organ - he earned it. Just MO.
Life is hard. It's really hard if you're stupid.
I was just making a case that the relative urgency has to be taken into consideration.
Essentially, it's a big algorithm. They collect a lot of physiologic information about the donor and recipient, but also factor in things like urgency, time on the list, age, previous donor status, etc. But the overall match (blood type, tissue type, etc) is probably the most important thing to ensure a successful transplant. They plug all of that in and the program will calculate who would be the best match for it. Recipients locally get first dibs, then regionally (the country is broken up into about a dozen regions), then nationally.
I will say that things like the income level of the recipient and their merits/lifetime achievements are not part of that algorithm (at least according to that lecture). Whether or not someone agrees with that could certainly be argued.
I should get it. In case I need a spare, it'll already be in there and ready to go. I should get it because I am a used to be drunk, used to be drug abusing hippie type, herniated discs in the lumbar region dude, diabetic, fused disc in the neck, bruised spinal cord, brain damaged, high blood pressured, angioplasty recipient (pre-stint method), hiatal herniated, repaired armed, former USN Spook, college graduate, history nut, story telling, short, fat, red haired, massively farkled, wear 8.5 EEEE shoes (My feet are only called feet because of the position they occury on the ends of my legs), Iowa Hawekeye luvin, horney, 63 year old man who I say deserves a spare kidney. So there Psswwwwtts!
LOOK OUT people! Froggy is foggy and groggy after moving a whole bunch of bags and boxes to my new house today. He's feeling crazy dead.
This post was edited by Froggydegremlin 15 months ago
Froggy gets it.
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