Dying teenager denied heart transplant because of "trouble with the law"
0Aug 12, '13 by KelRN215, BSN, RNI came across this today and felt it worthy of discussion. A 15 year old who has evidently had poor school performance and some legal troubles is now dying of heart failure and his only hope is a transplant. The hospital that has evaluated him has refused to list him for transplant, citing "non-compliance."
This is a tricky situation- transplant is one of the few situations where things like this can work against someone. We wouldn't refuse to treat a teenager with cancer in the same situation, for example. On the flip side, with limited organs to allocate they have to go to people who will likely have better outcomes.
As a pediatric nurse, I have a bit of a hard time with refusing to list a teenager for transplant because of "non-compliance." What teenager ISN'T non-compliant with at least something in their life? Are only good students and kids who've never been in trouble worthy of saving?
At the same time, I do- of course- realize that we only have one side of the story and that the hospital cannot divulge details to the press because of privacy laws.
3Aug 12, '13 by meanmaryjean, MSN, RNI would say that you are perhaps confusing non-compliance with the patient's legal woes. They are separate entities.
And cancer is different in this manner: chemotherapy drugs and radiation are able to be manufactured. Human organs are not.
6Aug 13, '13 by Been there,done thatDon't think you can compare this teenager to the average teen. He has already had trouble with following the law.
One of the criteria for any transplant is the patient's history of complying with medical directives.His parents are also a factor, they are the legal guardians responsible for his behavior. So far, they are failing to direct him in school and society expectations. Would this responsibility have a good outcome?
13Aug 13, '13 by elkparkI work psychiatric consultation-liaison at a large university medical center with a large, active transplant program, and we do psychiatric evaluations for the transplant service. One of the big psychosocial considerations in evaluating individuals for suitability as transplantation candidates is what kind of a "record" they have of being compliant/successful with following rules, rxs, treatment. Receiving an organ transplant means, in most cases, taking on a lifetime commitment to a strict regimen of multiple medications, follow-up care appointments, and lifestyle restrictions. Transplanting an organ into a person with a hx that suggests the individual is not likely to be compliant with aftercare is just throwing the organ away. Yes, it sounds harsh when you're talking about a particular individual. But, as we all know, behaviors have consequences; we all make choices and we all have to live with them.
0Aug 13, '13 by LadyFree28, BSN, RNI see both sides; I am SURE there is more to the story...
I think that because he runs the risk of going down a VERY slippery slope, they are basing his past behaviors on his future...IF they are basing his "past" actions...WHAT run ins did he have with the law??? Do they expect a showdown with police resulting in a shoot out or eventually putting him in jail for 30 years, hence the "waste" comment?? Is that their "fear"???
It sounds absurd; but whatever his background is, the Drs are making a decision based on that in addition to the criteria.
He may end up getting in the list now that his story is on the Internet...a lawyer may see this and have a field day and scrutinize the doctors, or a petition may go around, or a TON of other showdowns may occur that I refuse to even think about...If anything, I do hope there will be a way to find solution to prolong his life...a internal balloon pump? Valve replacements?
Perhaps a very risky stem cell treatment??
I know, I'm going WAY left, but I'm sure stem cells used to help regenerate failing organ will come around, or it's being done in Switzerland or in South America...
5Aug 13, '13 by KelRN215, BSN, RNQuote from elkparkI know there's a lot that goes into listing someone for transplant but this is a child. He's 15 years old- probably a freshman in high school. I think back to when I was that age. I was a "good" kid, high honors, never in trouble in school but there were plenty of rules I didn't follow and limits that I pushed. I just happened to be really good at lying and not getting caught. My brother, on the other hand, also an honor student, went to a good college, is currently an accountant was arrested once or twice in high school... for throwing a party where there was underage drinking.I work psychiatric consultation-liaison at a large university medical center with a large, active transplant program, and we do psychiatric evaluations for the transplant service. One of the big psychosocial considerations in evaluating individuals for suitability as transplantation candidates is what kind of a "record" they have of being compliant/successful with following rules, rxs, treatment. Receiving an organ transplant means, in most cases, taking on a lifetime commitment to a strict regimen of multiple medications, follow-up care appointments, and lifestyle restrictions. Transplanting an organ into a person with a hx that suggests the individual is not likely to be compliant with aftercare is just throwing the organ away. Yes, it sounds harsh when you're talking about a particular individual. But, as we all know, behaviors have consequences; we all make choices and we all have to live with them.
Teenagers, by their very nature, don't think of the long term consequences of their decisions. No 15 year old boy stops before doing something impulsive and thinks "if, by some cruel twist of fate, I develop heart failure I won't be able to get a heart transplant if I punch this kid in this face so I better not do it". I don't think poor decision making as a teenager necessarily means that one cannot understand that transplant is a situation where compliance is non-negotiable.
I also believe that in many cases, a life threatening diagnosis can truly change a trouble teenager. I've seen it happen before, especially with teenage boys. One of the most compliant teenagers I ever had was a patient who the hospital labeled "non-compliant." He was a heavy pot smoker, involved with a local gang and then came the cancer diagnosis. He'd have died without a stem cell transplant... fortunately his young brother was a perfect match. I remember calling him to follow-up the day after he was discharged from the hospital for the first time following transplant (the hospital stated every time they called "we're very worried about non-compliance with this family") and I asked him if he'd taken his morning meds. He responded "no, because it's not 10:00 yet." It was something like 9:52 but he and his Mom were so on top of their schedule that he took his meds exactly at 10am, 4pm and 10pm. Never once did I- the nurse who saw him in the home- have any concerns about compliance.
19Aug 13, '13 by imintroubleOrgan recipients don't receive their organs in a vacuum. If the 15 yr old gets a heart, someone else will not.
Maybe the question should be, not should he get the heart, but should the kid who does everything right be allowed to die.
I guess it depends on what side of the fence you're standing on.
As an aside, I don't like when families take their fight to the media. It's not fair. It's not fair to the thousands of people who wait patiently for the system to work. Who behave honorably. There can be no faith in the transplant selection process, if it's possible public opinion can influence the choice.Last edit by imintrouble on Aug 13, '13