We don't have to wait for "death panels" [Archive] - RetrieverTraining.Net - the RTF

: We don't have to wait for "death panels"

Gerry Clinchy
02-28-2011, 01:38 PM

Technology brings benefits & challenges. Humans get to play God, but without having the wisdom of God.

The number of kidneys available for transplants falls far short of the need, so there is no choice but to ration them. An emotionally difficult proposal to change the first-come-first-served transplant system makes good sense.

There are nearly 90,000 people on waiting lists to receive kidney transplants, and in 2009 there were only some 10,400 kidneys from dead donors to give them. And about 6,300 kidneys were transplanted from living people who donated one of their two kidneys and usually specified the recipient.

Currently the kidneys from dead donors are provided, through an organ procurement and transplantation network, to people who have been waiting the longest. That may seem fair since many transplant candidates wait for years, and some die while waiting.

But the system has serious shortcomings. Some elderly recipients get kidneys that could function far longer than they will live and that could have done more good for a younger recipient. Some younger recipients get kidneys that will fail and will need to be replaced, using up another scarce kidney.

These problems could be eased through a proposal under consideration at the transplant network to better match the likely longevity of the patient with the likely functional life of the kidney.

The patients and kidneys would each be graded separately. About 20 percent of the kidneys predicted to have the longest functional lives would be provided to the youngest and healthiest patients. The other 80 percent of kidneys would go to patients who are no more than 15 years older or younger than the donor.

The approach seems likely to make it harder for elderly people to get a kidney. But when kidneys are already scarce and apt to get scarcer as much of the population ages and sickens it is a rational choice.

02-28-2011, 05:11 PM
The allocation of organs has been a debate since the first successful program was instituted. Another potential source of organs is the HIV positive patients. Of course, the only people who would be considered are other HIV infected patients. Same for Hep C, a common cause of liver failure.

What to do? What would YOU do if you needed a liver to live, and a donor became available that was 75 years old? Do you take it....or wait for a younger liver to possibly become available? "Cold time" also affects transplant success. Better to take an older kidney that's closer to home, than a young one thats a 10-hour trip away? Patients and doctors to a large degree, have had that tough decision taken out of their hands by the guidelines of the UNOS network. As technology advances, the system will need to be modified to meet the needs of patients on that list.

Gerry Clinchy
02-28-2011, 07:51 PM
I agree, Dave, the whole idea of choosing who gets the limited number of organs for the large numbers needing them, is not a decision I'd want to have to make.

I'd feel better about a doctor (or group of doctors) making that decision, though. The doctors are in the best position to know the pros and cons of the organ available & which recipient is the best match with the organ.

03-01-2011, 08:20 AM
Jmtc, but in my limited experience, the 2 kidney patients I knew would have taken any donor organ, be it 17 or 77, to have a "chance" at a "normal" life.
Unfortunately, neither got that opportunity. :(

I agree that I don't think I'd want to be on the panel either.
I see a potential situation where on one hand you've got a Steve Jobs, older but has made huge contributions to society vs a 20 something gangbanger.
Seems an obvious choice, but if you're going to use that time bomb "fairness" as a factor, who knows what could shake down?

Sorry, "Steve", you had your shot at life and yes, you've done some great things, thank you very much. But this other guy has his whole life ahead of him and no one really knows what he might turn out to be.

There are no easy answers and I don't claim to have one. But throwing a subjective, "fairness" into the mix, sets the process up for "social justice", "return on investment" and the whole other 9 yards. Not a pretty picture.

Gerry Clinchy
03-01-2011, 09:04 AM

The hospital says it will let the baby go home. Catch 22. They won't do the tracheotomy, so the baby would be expected to live only minutes after being taken off the life support.

This article also reveals

But the hospital still will not agree to the parents' request to perform a tracheotomy on Joseph, a measure the hospital calls needlessly invasive but the family has said helped their older child who suffered a similar condition live another six months.

Not clear if this is a genetic condition. If so, and if the parents knew it (from their previous child), what about birth control?