health | June 09, 2013

Who Decides? Arthur Caplan On The Bioethics Of Transplant Prioritization

Advancements in medical science make it possible to save and prolong lives through transplants. Sadly, as
bioethicist Arthur Caplan points out, there aren't nearly enough organs to go around. The recent case of Sarah Murnaghan, who has end-stage cystic fibrosis, sparked debate in the medical community over the prioritization of much-needed organs. Normally 10 year old Murnaghan is only eligible for transplants from child donors. After her case became terminal, she was placed on the adult transplant list.

Caplan, a prominent health speaker, believes that decisions like this one could set dangerous precedents. The under-12 rule evolved, he explains to NPR, because of the various complications associated with putting an adult organ into a child's body. Moreover, bending the rules for one child could cause others to fight for the same privilege. "And then I can start to see other people saying, 'You know what, I need a liver. I need a heart. Where's a federal judge? Put me on too. Are we going to give organs to people who yell the loudest? Are we going to give organs to people who can organize a publicity campaign?"

According to The National Post, 1,700 people nationwide are on the waiting list for a lung transplant. 31 of them are children under the age of 11. While it's understandable that patients would want to be given the best chance of survival, Caplan points out that "judges or congressmen or bureaucrats" shouldn't be the ones deciding "what to do with organs at the bedside." Caplan says that, generally speaking, the system does a good job of determining who gets first access to transplants based on objective, medical considerations. However, when it comes to life-and-death decisions, individual cases warrant closer attention. That's where Caplan comes in. He is the founder of the Division of Bioethics at New York University Langone Medical Center. Biotechnology is rapidly changing our healthcare system, and our ethical understanding needs to keep up. Caplan provides insight into the quickly changing worlds of medicine, need, ethics, and technology to help us make the best decisions in difficult times.

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