There are different ethical issues in the medical field just as there are in many other fields. Learning how to address them before they arise is critical. The decisions involved in organ procurement and allocation can at times involve ethical dilemmas. The main aim of organ transplanting is to reap medical benefits including saving lives and increasing the quality of life. All the necessary protocols should be observed so that the interests of all the parties involved including the donors, allocators and receivers are considered. There are different individuals how hold different positions regarding what is ethical and whether there are people who are candidates for exceptions.
Mickey Mantle case
As in the case of liver transplant for Mickey Mantle, the system should not make exceptions for “Real Heroes”. Organ allocation should be based on medical utility. Making the choice based on medical utility will ensure that medical benefits such as graft survival, years of life added and quality life years are maximized (Fremgen 2009). When exceptions are made for heroes, it means that medical utility is not put into consideration. Another reason exceptions should not be made is because there is no clarification as to who should be counted as “Real Heroes”. Considerations of social utility and based on perceived social usefulness or value of the recipient is subjective when applied to different people. For example, some people may consider sports figures as heroes while others consider actors and musicians as heroes while to some a fireman who is injured saving lives of others is a hero.
No exceptions should be made because organ allocation should be fair. The concerns of all the patients seeking organs should be considered. Therefore, the new organs should be given to the sickest and the most perfect match whether they are heroes or not. The majority of organs available for allocation are received from ordinary people who gave them to save the lives of the receivers regardless of whether they are heroes or not. It is only fair that the organs are allocated with all fairness and justice as possible. Allowing for exceptions to be made for famous people will result in a system that allows common people to be the least considered even when they are most deserving and will have the best use of the organ.
The Seven-Step Model
1. Determine the facts
The case involved Mickey Mantle a patient who was suffering from liver failure resulting from hepatitis and cirrhosis (Baillie et al. 2012). The problem was serious and even necessitated his admission to the hospital. Liver transplant was advocated as the best form of treatment for Mantle because the level of damage could not be reversed. The goal of the treatment choice was that the transplant would extend his life and give him better quality years. Mantles medical problems lowered his survival rate from about 78 to 60 percent three- year survival. There is an acute shortage of liver organs available for a donation of approximately, 4,000 organs available for about 40,000 people.
2. Define the precise ethical issue
The ethical problem in the Mickey case is whether an exception should have been made to move the patient to the top of the liver organ waiting list because he was a famous person.
3. Identify the major principles, rules, and values
The principles in place were that there be no special treatment when deciding who would receive the liver and only the organ allocation formula was to be followed. One of the values that were observed was that the organ transplant should yield maximum medical utility. The organ should be given to the patient where the medical benefits would be maximized. Patients should be held responsible for the consequences of their decisions. For example, one of the reasons that were causing liver failure in Mickey was cirrhosis where alcoholism is a significant contributor. One of the rules was the locals-first priority scheme where the liver was to be allocated to a patient in the local Organ-Procurement organization waiting list. Mickey was, therefore, competing for the liver with other patients in the Southwest Organ Bank in the Dallas area. Another principle for consideration was that the organ be allocated to the best match who shared most identical characteristics before those with compatible features were considered. The best match is determined by factors such as blood group, height and weight characteristics. Another rule that was in place was that the allocation recognizes the urgency with which the patient required the transplant. The patients in the ICU were given higher priority while those still able to move around and go on with their lives had the least priority.
4. Specify the alternatives
One of the alternatives was to follow all the allocation principles, rules, and values and give Mickey the same treatment that all other patients in need of liver transplants received. Another alternative was to give Mickey special treatment because he was a celebrity figure, a Baseball Hall of Fame center fielder.
5. Compare values and alternatives
The first option of giving Mickey no special treatment would be in agreement with the values of the organ allocation system. The option would also be in line with the principles and the rules that have been put in place. The second alternative would have been contrary to the principle of maximizing medical utility. This is because Mickey had a 60 percent chance of a three-year survival that was significantly less than that of other patients in the list for the same organ. The second alternative would also have violated the values of the system because it would not have been fair. Moving Mickey to the top of the waiting list simply because he was a celebrity would have been an inconsiderate act towards the other patients that were waiting.
6. Assess the consequences
One of the consequences of having no special treatment for Mickey is that he could have waited the average waiting period of 130 days for a liver transplant. The decision might have resulted in the death of the celebrity while still on the waiting list that also happens to other patients. The action would uphold all the principles and rules of the system and increased the level of faith that the public including organ donors had in the system. Another consequence is that the liver would have yielded the most medical benefits because all factors would have been weighed without the fact that he was a celebrity tilting the decision to his favor. A better deserving patient with a higher chance of survival might have received the liver and lived longer than Mickey, who died after only two months following the transplant.
One of the consequences of choosing the second alternative is that there is public concern regarding the principles and values of organ allocation. The system is perceived to operate on favoritism and with little regard for common citizens. Another consequence is that the maximum medical benefits are not realized because a proper criterion would not be followed. Another consequence is that the ethics of the Organ Procurement Organization would have been questioned. Not only would they have given a scarce liver to a recovering alcoholic, they would also have given it to a cancer patient with low survival rate.
7. Make a decision
The most appropriate choice in the Mickey case is the first alternative, which is to give him no special treatment. All the principles, rules, and values should have been upheld eliminating the allegations of speeding up the process for an organ transplant for the celebrity figure.
In conclusion, making exceptions for famous persons and speeding the process of organ transplant is unethical. It violates the primary principles of organ transplanting because it makes it impossible to maximize the medical benefits. Although in the case of Mickey there was no clear evidence of him being moved to the top of the waiting list, there were controversies surrounding the transplant. He was a recovering alcoholic, with cancer, and he received a liver after only 48 hours while the waiting time for other patients is over 100 days. To avoid controversies and negative consequences, the parties involved should use well-developed mechanisms such as the Seven-Step Model to solve such ethical dilemmas.
Fremgen, F. (2009). Medical Law and Ethics (3rd ed.). Upper Saddle River, NJ: Pearson Prentice Hall Publishers.
Baillie, H., Mc Geehan J., Garrett T. & Garrett R. (2012). Health Care Ethics (6th ed.). Upper Saddle River, NJ: Pearson Prentice Hall Publishers.