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Biology LibreTexts

The Desperate Dozen: A Problem of Biomedical Resource Allocation

  • Page ID
    26227
  • The list below shows a dozen candidates waiting for a heart transplantation. Assume that on the average there is one transplantable heart per month for candidate pool.


    Your Task: Rank the candidates in order for the next heart, which has just become available. Describe the ethical foundation upon which your priority selections are made and explain its application to each ranking you make.

     

    Person & Age Critical Need Relative Immunology
    “Match"
    Resulting Quality
    of Health
    Estimated # of
    yrs to Death
    Ability to Pay Comment & Rank
    Surgeon, 62

    95

    80 45 4 99  
    Mechanic, 25 60 60 85 5 25  
    Mother of six, 36 50 90 70 13 90  
    Politician, 44 75 50 60 10 80  
    Famous Singer, 30 80 80 70 25 92  
    Writer, 56 60 95 60 15 40  
    Criminal, 31 70 90 97 35 60  
    Your Mother, 55 90 90 30 8 50  
    Astronaut, 32 75 70 60 20 60  
    Autistic Child, 14 60 80 75 18 75  
    Scientist, 34 80 60 70 12 50  
    You, - 75 80 50 4 45  
    Evaluation scales 100 = Immediate
    90 = 1 week
    80 = 2 wks.
    70 =1 month
    60 =2 mths.
    50 = 4 mths
    100 = Perfect
    90 = Excellent
    80 = Very good
    70 = Satisfactory
    60 = Marginal
    50 = Risky
    90 = Marathon runner
    80=Active
    70=Normal
    60=Ambulatory only
    50=Disabled, weak
    <40=Bedridden
      Number is % of costs patient can pay by self or
    insurance
     

     

    Further discussion

    Would your rankings change if:
    A) Mother of 6 was homeless, on Medicaid
    B) Auto mechanic was a registered sex offender
    C) Your mother has early Alzheimer’s symptoms
    D) Politician has views that were different from your own
    E) Research scientist specializes in immunology
    F) Singer has donated thousands of dollars to charities

    Adjust your ranks according to this new information. Use a different color to indicate changes made from your first list.

     

    Final Task

    Based on your tanks and discussion with your team, develop a unified ethical basis for making biomedical decisions about transplants with consideration to limited resources. Your plan should address how transplant committees should decide who gets hearts first and why some might be placed at the end of the line. You can write this as a paragraph or a bulleted list that shows how these decisions will be made.