The prompt was "Comment
on the appropriateness of transplanting organs into a patient whose
diagnosis has historically been associated with a poor prognosis."
Transplant ethics (especially concerning patients who may not live long after their transplant) are complicated by benefits and burdens that are difficult to weigh, and the confusion surrounding scarce resources.
A patient considering a transplant should, with his loved ones and his healthcare team, try to determine the potential benefits gained and burdens incurred with the procedure and life after it. Would a several-hour surgery, the associated recovery, and a strict regimen of drugs and behavior modifications overwhelm him? If not, does the procedure treat the disease or alleviate suffering to a degree worthy of these burdens?
Assessing how much the patient will benefit from the transplant includes estimating his prognosis with and without the transplant. Additional years of survival are likely worth a few months of intense suffering and rehabilitation; an additional few months may not be. Patients who have comorbid conditions, who are likely to be noncompliant with post-transplant medication regimens and behaviors, or who are very likely to die shortly in spite of a transplant make decision-making more difficult because the benefits after the procedure are quantitatively smaller, but hard to qualify. Is a moment alive greater than a year alive?
Transplants are also complicated by scare resources: only so many organs are available for the number of patients waiting for relief. Should one person receive a liver before another? Should the youngest on the list be preferred? The healthiest? The sickest? The ones in greatest need?
Finally, decisions must be carefully made on an individual basis. A patient with desires to reconcile with members of his family may value even a few weeks of extra time in life, but a patient who is satisfied with her life may be willing to choose palliative care. Considering a group of patients, a transplant center may prioritize a healthy child, but may move up a man recently placed the ICU if he has a good chance of recovery. This individual approach should always be motivated by the proper goal of medicine: not to blindly prolong life, but to improve it so that in it, persons can achieve their purpose and maintain their dignity.
This goal has its source in a truth that this culture has largely forgotten: the purpose of life is not life itself, but beyond it. It is that highest happiness which, if pursued, makes us clutch life less and look toward virtue and self-sacrifice more.
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