Case Discussion for Organ Donation

00:00 Let's conclude our discussion of the Ethics of Organ Donation with the following case presentation.

00:07 The case before you was a 56-year-old male of considerable financial means who is in need of a liver transplant in order to preserve his life.

00:17 Given his influence in financial wealth, he is able to maneuver to be listed on several transplant registries in an effort to obtain an organ as soon as possible.

00:28 Do you see the potential ethical pitfalls involved here? Because of this patient's financial means, he is able to block equal access by moving to the front of the transplant list and furthermore violates the principle of being listed only on one registry by crossing into multiple registries. Let's continue with the case.

00:50 The patient and his family learned of a young man who is from a poor family and suffers a significant motor vehicle crash and his cardiac status is deemed non-survivable in the ICU.

01:04 The patient and his intermediaries offer the family of this young man a significant financial incentive in order to designate the liver to this given gentleman for transplantation.

01:15 Once again, very shaky ethical ground here. I think we would agree.

01:19 The maneuvering to speak to a family at this time is inappropriate by the patient especially during a time of grief like this.

01:28 Furthermore, this seems to be a clear case of organ trade or of buying and selling organs and then thirdly this could be perceived as a case where the rich are exploiting the poor in order to gain an advantage.

01:41 As this case proceeds, the transplant team becomes aware of this and approaches the treating ICU physician for organ harvest.

01:49 The physician despite some concerns about the ethical propriety of what is going on does agree perhaps due to the influence of the patient to proceed with the process of organ harvest and therefore orders the staff that works under them to move forward with setting up the operating room and moving forward with the case.

02:09 Well, as we discussed earlier, any time there is significant ethical reservations, there is a mandate not to proceed with the case despite how much influence or financial wealth a given individual may have.

02:21 Also it is very clearly a broach of ethics to force others to participate when there may be reservations on their part as well.

02:30 So what were the errors that were made in this case? Well, there are several.

02:34 Firstly, being listed on multiple registries has been deemed unethical and blocking equal access to organs.

02:41 Secondly, paying or trading for an organ has been deemed unethical in creating undue influence and prohibiting access.

02:49 Thirdly, any member of the transplanting team is strictly prohibited from approaching any potential donor's family or the patient's care team due to a perceived or actual conflict of interest.

03:02 And finally, any treating physician or healthcare team member who detects impropriety in the process is ethically obligated not to proceed and not to compel any others to do so.