Heart Transplant Ethics
Case Study Excerpt In this scenario, you are the advanced practice nurse on the transplant committee for Hope Medical Center. All members of the committee have to vote to decide which patient will receive a donor heart. Five other people are on the committee with you:
- The administration member is Wes, the Chief Operating Officer.
- The physician member is Dr. Haswell, Cardiovascular Surgeon and Head of Transplant Services.
- The social services member is Mahalia, who has worked closely with all clients on the transplant list.
- The chaplain member is Pastor Arturo, pastor of a local church and lead chaplain at Hope Medical Center
- The community member is Dr. Bashist, a retired general surgeon who serves on the Board of Directors.
Early this morning, a 17-year-old died following a motorcycle accident. The parents want their son to be an organ donor. The team at Heart of Mercy Hospital prepared and began harvesting organs and notified Hope Medical Center that they have a heart for their patient Bernadine Smith, a 32-year-old with a congenital heart defect who needs a transplant after recently enduring her third pregnancy and delivering a healthy baby boy. At Hope, Bernadine has been prepped for surgery.
Heart Transplant Dilemma
As surgery begins, a member of the organ transplant team is on the way by helicopter to pick up Bernadine’s new heart. After the heart is procured and the team member is on the way back with the heart, Bernadine suffers a massive stroke and dies on the table. Hope Medical Center, having already taken possession of the heart, now has just under an hour to decide who gets the heart. Your first job is to interview the following candidates who are next in line for the heart. First is Helen Adams. Helen is a 65-year-old, single Caucasian female with no children or family. Her health history includes coronary artery disease, history of two-packs-per-day smoker, BMI of 29.
Heart Transplant Dilemma
She has modified her diet and gave up smoking 9 months ago. She currently requires 2 LPM oxygen at all times. She is not a candidate for revascularization. As you interview her she states, “Yeah, I quit smoking months ago. God, I miss it. I know you all keep telling me need a new heart or I’ll be dead in a year, but I think I’d feel weird with someone else’s heart in me. I’ve heard people start to like things they never did before and stuff like that. What if it makes me more like the person I get a heart from, and I don’t like it? I’m just not totally sold on the idea.” Second, you interview Quentin West. Quentin is a 38-year-old African American father of four, His wife has been a stay-at-home mom until recently, when Quentin became unable to work as a result of his inability to perform required duties. His health history includes cardiomyopathy, hypertension, and a BMI of 42. He tells you his BMI was much lower in his 20s, when he played professional football as an offensive lineman. He also says he understands that playing football led to his development of cardiomyopathy. He states that he has seen many of his former teammates and friends die of this condition. He does admit to a history of substance abuse but states that he gave that up before his first child was born.
Heart Transplant Dilemma
After your interviews, you are headed back to speak to the rest of the committee when you are grabbed by a nurse to help with a cardiac arrest coming in by ambulance. When the patient arrives, you receive the following regarding the patient: Earl, a 42-year-old male was snow skiing nearby when he suddenly collapsed. His girlfriend called 911. When emergency services arrived, the patient had a pulse, but the pulse was lost on the way to the hospital; CPR was initiated, and the patient was intubated. The paramedics were able to get a heartbeat back; however, the patient continues to have arrhythmias and apparent low cardiac output. Earl is found to have a history of coronary artery disease, hypertension, heart failure, and previous heart attack resulting from cocaine use. He is stabilized and moved to the ICU on a heart pump with a poor prospective outcome. When you go in to meet with the ethics committee with your update, you discover that the patient from the ER is the son of Earl Hope Eubanks the third, a major donor to the facility and the person for whom the hospital is named. Mr. Eubanks has contacted the facility and pledged to pay for a new pediatric cancer wing to be developed and built .„ but it is certainly inferred that the money will be donated only if the son receives the donor heart. As the committee sets down to discuss who should receive the heart, the following discussion occurs:
Heart Transplant Dilemma
Wes: Thank you all for gathering on such short notice. As you all know, we have a big decision to make and not a lot of time to make it in. just so that we are all on the same page, we have three candidates for the heart that is en route to this facility. I would like to open the floor for comment,
Mahalia: I need to recuse myself. I feel like I am too emotionally involved to make an objective judgement in this case.
Wes: Thank you, Mahaila. I understand that this is certainly a difficult situation. I appreciate your honesty. Does anyone else wish to recuse themselves? Okay, so let’s open the floor for conversation.
Dr. Hasweh: As the surgeon, I want to be clear that neither of the two are great candidates.
Wes: Don’t you mean three candidates? We cannot forget about Mr. Eubanks.
Dr. Hasweh: Wes, we all know about his cocaine abuse. You know that disqualifies him.
Wes: But what if he quit? Your Mr. West also has a history of substance abuse.
Dr. Hasweh: History of, not current use. Let’s do a drug screen on Mr, Eubanks and see if he is still using and interview that girlfriend that was with him.
Heart Transplant Dilemma
Dr. Bashist: 1 personally believe that we should eliminate Ms. Adams. She isn’t even sure she wants a transplant.
Mahalia: I believe that she is just scared. Maybe she doesn’t want to get her hopes up, 11 she is chosen, she can always refuse and then we move on to the next recipient.
Dr. Bashist: But that is a waste of time.
Pastor Arturo: If it was you who needed the heart, I would think you wouldn’t feel it was a waste of time, I understand human nature and can see Mahalla’s points. Ms. Adams is certainly still a valid candidate. She has made strides toward a healthier lifestyle already.
Dr. Hasweh: Ms. Adams may be the best candidate since she has already shown that she can make the required changes,
Mahalia: What about Mr. West? He has a family to support, and he is so young!
Dr. Hasweh: But he has a history of substance abuse and a BMI of 42!
Mahalia: Well your Ms. Adams claims that she “quit smoking,'” but how can we really prove that?
Heart Transplant Dilemma
Wes: I appreciate all of the conversation, but we must not forget about Mr. Eubanks. Even if he comes back positive for substance abuse, imagine all of the good we could do with a children’s cancer wing. That has to play into this decision. The drug screen comes back inconclusive, and Mr. Eubanks’ girlfriend said she didn’t see him do anything drug related, After much more discussion, a vote is held. Wes and Mr. Bashist vote for Mr. Eubanks, and the chaplain and Dr. Hasweh vote for Mr. West. Ms. Adams is removed as a candidate. Mahalia again recuses herself. Your vote decides who gets the heart.
Committee Members
Advanced Practice Nurse: You
Administration: Wes, Chief Operating Officer
Physician: Dr. Hasweh, Cardiovascular Surgeon, Head of Transplant services.
Social Services: Mahlla, worked closely with all clients on the transplant list.
Chaplain: Pastor Arturo, pastor of a local church and a lead chaplain at the facility.
Community Member: Dr. Bahshist, retired general surgeon who serves on the board of directors.
Patients: Helen Adams Quentin West Earl Hope Eubanks IV
Heart Transplant Dilemma
Answer the following questions in a numbered list in your original list:
- Your vote decides who gets the heart. Who would you choose and why?,
- How did health inequality and inequities affect your decision?,
- What ethics would you use to back up your decision?,
- Why did you not choose the other candidates?,
- Was this an easy or a difficult decision for you?,
- Would you want to serve on an ethics committee in the future? why or why not?
In your original response, provide at least two references with in text citation to current literature, and assigned readings to support your assertions. Use APA referencing style.
