Deciding who should get a heart transplant

Jose asked:

There is a doctor, a janitor, a waiter, a professor, a judge, and a bus driver. They all go to the hospital in need of a heart transplant. There is only one heart available. Who should get the transplant? And who actually gets the transplant.

Answer by Craig Skinner

Who actually gets it?

In the UK this depends on who is a tissue-type match for the organ. If only one of the patients matches, she gets the heart. If more than one match, the patient highest up the transplant waiting list gets it. There is a common waiting list for NHS and private patients (you cant jump the waiting list by paying for the heart). The patient’s occupation (if any) is irrelevant. Likewise social circumstances.

Who should get it ?

The UK setup seems pretty ethical. The ethic is Kantian rather than Consequentialist. Thus, there is no attempt to work out which saved patient would contribute most to overall societal benefit considered in an impartial way. Rather each patient’s life, if not of absolute value in a Kantian sense, is at least considered as of much value to that patient as any other patient’s life is to her.

Some people think other criteria should be relevant. Three examples:

1. Age. Many favour the ‘good innings’ approach (I do) – a young person should get priority over an old one (like me) because she still has much of her life ahead of her, whereas I have already lived most of a natural life span.

2. Dependents. Some favour prioritizing a person with, say, three young children, over a similar person with no children. I don’t favour this.

3. Some assurance that the patient wont ‘waste’ the new organ. Thus, some think unreformed alcoholics should be disfavoured for liver transplants. A famous example was the alcoholic former footballer, George Best, who received a liver transplant for alcoholic liver disease only to ruin his second liver with continued drinking. I’m inclined to say the patient must show evidence of being off the booze before transplant is considered. But I don’t feel strongly about it. If we held off treatment for people whose condition was their own fault we might stop rescuing climbers with broken legs because they insist on risking life and limb; stop treating car accident victims who were speeding, smokers with lung cancer, obesity-related diseases in gluttons, tennis elbow, knee injuries in rugby players and so on.

Answer by Shaun Williamson

This is a complex judgement which will have to be made by the hospital consultants. The first thing is tissue matching. The patient who is the closest biological match for the heart will be the leading candidate because they are likely to get the longest benefit from the transplant.

If more than one patient is a biological match then other factors will have to be considered such as the age of the patient or do they have a family with young children etc.

I don’t know who gets the transplant, I’m not a senior hospital transplant doctor and I don’t have enough information about the patients.

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