The Desperate Dozen: A Problem of Biomedical Resource Allocation
- Page ID
- 26227
This page is a draft and is under active development.
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)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.