How much should lifestyle (non-medical) be considered in transplant situations?

This news story made me consider that question.

Teen suspect who died after Roswell police chase was heart... | www.ajc.com
Cliffnotes - 15yr old boy has a heart condition that will cause his death in 3-6 months.
He is deemed unfit for a new heart. The hospital says he is unlikely to follow the treatment protocol (would be interested in how they ruled on this, was it past behavior on following treatments for his condition, or just supposition based on stereotyping him for age/race/financial reasons). They also say that his previous violence/legal trouble makes him a bad candidate.

Backlash ensues, including accusations of racism.

Hospital changes course, he is given a new heart, and medically appears to be doing well.
Within two years he carjacks a guy, drives the stolen car to an elderly woman's house, robs her, shoots at her multiple times (misses), runs over a pedestrian, and is killed when he wrecks fleeing the police.

FWIW, some have complained about the pictures the news stories have linked to the young man, because they say it represents him as a thug. The counter argument is that the picture of him with the gun pointing at the mirror was his actual main profile pic on Facebook.

To me, hindsight shows the hospital was correct. I would rather have seen that heart go to someone who went to live a long life being a positive member in society. But predicting that outcome is an imperfect exercise. Lots of people who start out in bad circumstances, or get in trouble when young, straighten up. Sometimes an extreme medical situation or life changing gift is part of what does it for them.

But somewhere, there is another family who lost their child before they could get a heart. By existing medical protocol, that child had a better chance of not ending up being a criminal and dead two years later. Every organ that gets donated to save one life keeps someone else further down the list from getting it.



Is it fair to try to predict who will live the better life after the transplant?

Should the medical industry pay attention to a person's previous criminal history and lifestyle and use that to judge who gets finite, but life saving, resources like organs?

Is doing so unfair to the point of racism and/or social injustice, or is it common sense?

 

Good point. Crosby definitely qualifies as an outlier.


My intent is to focus on the behavioral side, not the economic side. Obviously in the real world money talks. And the fact that Crosby had a wealthy benefactor willing to pay his way, plus his fame, definitely influenced his situation. But I don't think many people would say "if you don't have good insurance, or the cash to pay, you should just die". From reading comments on the story in the OP, seeing YT video commentary on it, etc., it seems that a vocal group are saying he never should've gotten a heart in the first place based on criminal behavior though. If Crosby were in that situation today, I'm sure there would be people saying the same for his behavior.

Such a tough thing to weigh who "deserves" a second shot at life.

 

First, this is one incident.

Second, he was a kid at the time, so it would have been difficult to say whether he would grow into a terrible adult.

Third, health care decisions shouldn't disproportionately favour the wealthy.

 

I don't know what protocols the hospital used, but they originally scratched him off the donor list because of his behavior. I'd be interested to see exactly what they weigh, and how heavily. I'd also be interested to know if it was strictly his criminal history, or if he had a history of not following treatment protocols for his condition.


Totally agree on the financial side.


The question is, what SHOULD be included in the decision as to where people belong on the list priority-wise?

Should age matter?
Should family (i.e. children/spouse relying on them for support) matter?
Should previous criminal history matter?
Should the origination of their symptoms matter (drug abuse versus genetics/chance, etc.)?
Should their willingness to follow medical advice/treatments in the past matter?


They have to be prioritized in some way. So what does TFP think the criteria should be?

 

Fact: teenagers do stupid stuff. Fact: teenagers will continue to do stupid stuff until they're in their mid-twenties. This is biological. Now, I'm not saying teenagers are incapable of making good decisions, because they are, but their relative inability, compared to adults, to consider outcomes should be kept in mind. Unlike other age groups, teenagers haven't necessarily settled on any one life path or identity yet, so they possess an incredible ability to change who they are and turn over a new leaf.

Obviously, that didn't happen here, but it could have. I don't see why other teens or other transplant candidates should have to pay the price for that. Additionally, juveniles are juveniles for a reason, and I dislike the trend of treating teens like adults when they do something wrong. They're not adults, period.

 

So, back to my questions in Post #5, what things should be weighed?

 

I would argue that, if medical need is the same and medical chance of success is the same, a 20yr old would be a better candidate than a 65yr old. Just because the odds say that someone 4-5 decades younger would benefit for much longer.

I'd also argue that a 40yr old in prison, serving a life sentence for murder, would not rank as high as a 40yr old with no criminal history that was a single parent of 2-3 school aged children.

I do think that, at some point, more needs considered than just the medical side.

The dilemma is what to include, and how to weigh it. My $.02.

 

I agree that it is heavy stuff.


Just as an example, right now there are slightly more than 100,000 people waiting for a kidney transplant. That is the number of people ruled to have a medical need, with a high probability of success if given one. There are only about 15-16k transplants done each year. In the last five years the waiting list has doubled. Which means we are falling behind, not getting ahead. Other organs have similar stats as far as the waiting lists far exceeding availability. So while we can say we don't want to use anything but medical need as "tie-breakers", the reality is that something IS being used aside from that, out of necessity.

So we must choose, like it or not, and choices are made, fair or not.

I don't pretend to have the answer. But we have a lot of smart people here, and a lot of people here with good common sense and much life experience. So I'm curious what they think should be used to make those tough, life altering choices.

 

More organ donors would remove dilemmas like this. A more comprehensive organ donation program where literally everyone is a potential donor unless they sign a waiver saying they don't want to be one (as opposed to the other way around). That would help some, but...

There needs to be more research done on organ culturing. This has the potential of being an inexpensive and highly successful option for most organs, with less chance of rejection and little to no need for anti-rejection meds.

I don't want to discuss who should be higher on a list, because honestly I feel there should be no list anymore. We are no longer living in the dark ages. The possibilities are there. We just need to prioritize their funding.

 

Organ donor checking in.


I like your idea of having to opt out of donation instead of having to opt in. Good call.

 

I don't think occupation, or potential occupation, should matter by itself.