Ethical Debate: Organ Transplants

wv_nurse 2003 · Feb 22, 2003

In my opinion (my opinion only) people come to the US for transplants because we are felt to have the most experience, the best qualified physicians, and perhaps better success (no I can't back this up with statistics--just speaking on thought). I also think that because we are the "land of opportunity" and have an open door boarder--they stand a better chance here than in their native countries because we base transplant priority on NEED, not money (although I am not convinced this is entirely true--but its what we say)--just my thoughts

Sally_ICURN · Feb 22, 2003

This will forever be an ethical discussion and I can only see this thread getting very very ugly and so, as a cardiothoracic and transplant RN, I'm staying away from this "debate" out of respect for my BP rising to the point of my head exploding if I get involved. I will say however, educate yourselves with facts, not just word of mouth from people who maybe don't know much about transplant:

http://www.unos.org/

and from UNOS specifically regarding policies and bylaws including "aliens":

http://www.unos.org/policiesandbylaws/policies.asp?whatWeDo=true

http://www.organdonor.gov/translink.htm

"Fifteen Americans die each day while waiting for an organ to become available. More than 75,000 men, women, and children now wait for a transplant to replace a failing kidney, heart, liver, lung or pancreas. Every 16 minutes, another person joins the waiting list.

Thousands more wait for tissue transplants, desperately need marrow to stay alive, and require blood transfusions. The facts are just astounding! Someone dies every 96 minutes because there aren't enough organs to go around. Sixty percent of the U.S. population is eligible to donate blood, however, only five percent do. And, only 25 to 35 percent of those who need a marrow transplant will find a match among their family members."

The statement "...another person joins the waiting list" does not differentiate between citizens vs non-citizens of the US.

http://www.ask.hrsa.gov/Organ.cfm

http://www.transweb.org/reference/articles/gallup_survey/gallup_index.html

We are making the survey results available to enable
researchers, educators, and practitioners to better
understand the issues and attitudes underlying the organ
donor shortage. This information can provide insight into
the informational needs of families faced with the option of
donation, and can contribute to the design of effective
public and professional education programs.

Right now, its sunny and almost 70 at 11:30am here in CA. Must---go---play---in---my---garden..... :cool:

P_RN, ADN, RN · Feb 22, 2003

http://216.239.51.100/search?q=cache:8y8GqaA85rAC:http://www.unos.org/PoliciesandBylaws/policies/pdfs/policy_18.pdf+organ+donors+foreign+recipients&hl=en&ie=UTF-8

I hope that link works.

According to UNOS (United Network of Organ Sharing) there is a 5% cap on the number of alien recipients for each facility. I did not know that aliens were placed on the same list as citizens. There is a clause in policy that states that immigration status does not limit and that immigrants shall not be charged any differently from citizens.

I'm still not sure how I feel.

Q. · Feb 22, 2003

Originally posted by P_RN
[According to UNOS (United Network of Organ Sharing) there is a 5% cap on the number of alien recipients for each facility. I did not know that aliens were placed on the same list as citizens. There is a clause in policy that states that immigration status does not limit and that immigrants shall not be charged any differently from citizens.
I'm still not sure how I feel. [/b]

I don't agree with it, and not because I think foreigners should die, but because my best friend's dad died waiting for a liver. In all practicality, that liver could have gone to an illegal alien who was more grave than her dad. Tell me, how is that right? How?

hoolahan, ASN, RN · Feb 22, 2003

I wholeheartedly support aliens getting organs, as long as their country also is aware of donating, and we can be on their lists too.

Think of it the other way around, suppose an American was waiting for a new heart, and Mexico had someone w a perfect match, and was close enough to get the heart to the recipient in a viable time frame, how would you feel then??

I think the list should be internationalized to the extent that it can be due to viability.

Besides, before we toot our own horn, shouldn't we question why IV drug users can get a second kidney after they continue to abuse drugs and then the first lidney transplant fails?? Ot what about an alcoholic who gets a liver transplant and continues to drink?? To be that is a bigger travesty than to be certain the recipient truly respects the gift that is being given regardless of where they come from.

MishlB · Feb 22, 2003

Originally posted by roxannekkb
To mish1--I can't understand why you don't think setting up better healthcare in other countries will help the problem. If Mexico, for example, had a good transplant program, the family of Jesica would not have had to pay smugglers to get them across the border, and then go and live illegally in another country. They could have stayed in their own home, near their family and friends, and given Jesica the care she needs in familar surroundings. The same would go for anyone else in any other nation where healthcare is lacking. It's bad enough having a chronic and life threatening illness, but it's worse when you need to travel to get help--help you may not even be able to pay for.

As far as the "mistake" that was made, yes, it was tragic, but she may well have rejected her organs even if they were matched. And the brain damage she suffered may well have been the result of the surgery. She could have ended up like this even if the correct organs had been transplanted initially. I have worked with liver transplantation in infants and children, and many of them died, even with matched organs.

The ethics of giving one person six organs, foreigner or citizen, also comes into play. Six people might have been given a chance of life, but instead, six organs have been used for this one person. I am not saying right or wrong, but it is a subject which has come up and is being debated. In fact, heart and lung transplants are in and of themselves controversial, because 3 organs go to one person, and organs are a very scarce resource.

In an ideal world, better healthcare in every country would be wonderful...yes IF Mexico had a better system, but the truth is they don't, and many other countries don't. Healthcare SHOULD NOT be based on whether someone is a citizen of this country, and it is true that many die while waiting for a transplant, but does that mean that a non-US citizen has no right if they come up on the list?? I guess I don't understand that mentality. "Sorry, you are not born in the US, you must die." And yes, I realize organs are rejected, and these surgeries are risky, but to make the comment, "As far as the "mistake" that was made, yes, it was tragic, but she may well have rejected her organs even if they were matched" is ridiculous. THEY WERE THE WRONG TYPE!! I would say that adds a little problem in addition to the risks already present, wouldn't you?!! Are you saying this because she is from Mexico? The basic fact here is comments are being made about who DESERVES the organs more...a US citizen or not. And the fact that you can justify giving one person a better chance over another by where they were born is frightening to me. Smells like discrimination to me. I for one do not base my nursing care on these factors.

baseline · Feb 22, 2003

I think we help other countries a bit too much. And are appreciated very little in the long run. But...I guess that is what makes us Americans.

MishlB · Feb 22, 2003

Originally posted by Susy K
I don't agree with it, and not because I think foreigners should die, but because my best friend's dad died waiting for a liver. In all practicality, that liver could have gone to an illegal alien who was more grave than her dad. Tell me, how is that right? How?

You say foreigner like it's a dirty word. Lists are based on who is the sickest. You don't agree with that? I am sorry for your friend's Dad, but what about that other person, they are somebody's dad, son, daughter, mother. Because they are not born here does not make them less than human. How is it right to rearrange a situation to meet only your needs? Do you also feel that someone with millions of dollars should have an advantage? I guess if you were the millionaire, you would want it that way, right?

MishlB · Feb 22, 2003

Originally posted by baseline
I think we help other countries a bit too much. And are appreciated very little in the long run. But...I guess that is what makes us Americans.

Yes we help other countries, but at what price? There is usually a motive to our kindness. Whether it be oil exports or military land use. Our country has a long history of discrimination for our own benefit...remember the Japanese, Chinese, Africans? The list goes on and on.....

Q. · Feb 22, 2003

Originally posted by MishlB
You say foreigner like it's a dirty word.

No, I say foreigner to differentiate b/t citizens and non-citizens. Is there a better, more pleasing term you'd like me to use?

You are bringing way too many variables into this discussion: money, sickness, etc.

I agree with lists to be based on who is most critical - that is not the problem here that was presented. The QUESTION was whether we should allow people from all over creation come and use organs. It's not about them deserving to die. It's about - can I go to Russia and get their organs? Is there an international organ registry? Am I eligible for organs from Mexico, Canada, UK?? If that answer is yes - then this whole discussion is moot.

baseline · Feb 22, 2003

Originally posted by MishlB
Yes we help other countries, but at what price? There is usually a motive to our kindness. Whether it be oil exports or military land use. Our country has a long history of discrimination for our own benefit...remember the Japanese, Chinese, Africans? The list goes on and on.....

Now THAT's a two way street running fast!!!!!!

MishlB · Feb 22, 2003

It's just the facts. Sorry I got all fired up. Not meant to pick on anyone in particular...just a subject near and dear to my heart.