Who Lives? Who Dies? Who Decides? And How?

By Lisa Watts

A hospital receives one healthy heart but faces a list of 13 people who need that organ. How do the doctors choose who gets the transplant?

The question is far from a hypothetical one at hospitals and medical centers around the country. Donated organs are a scarce commodity, and the ethical dilemmas over who should be selected to get them are many.

For his Independent Study, Aaron Glasgow '98, a philosophy major with an interest in applied ethics, tackled the question of how to select transplant candidates after hearing a story from his mother. She works as a nurse in a hospital that was letting its kidney dialysis machines go unused because administrators couldn't decide which of its patients should receive the life-saving treatments and which ones would have to wait.

Glasgow approached the question of transplant decisions as an exercise in critical thinking. He researched the topic as much as he could, but he didn't find as much material as he would have with other medical ethics issues such as abortion, cloning, and euthanasia.

Guiding him over the course of weeks of discussion was his adviser, Henry Kreuzman (philosophy).

"We would meet a couple of times a week and go over the stuff that I had read, and he helped me pull out arguments," Glasgow says.

Glasgow first looked at assigning transplant candidates a social value based on what they would contribute to society.

"But I rejected that approach, because it would treat people as a means to an end, and how do you decide what's beneficial to society? It would be hard to develop an unbiased list of social worth," he said.

Then he looked at choosing candidates strictly on medical factors, on their ability to pay, or by random selection, but rejected all of those approaches.

In the end, the philosophy major developed his own two-level system. Patients would first be cleared for transplants based on their willingness to undergo the operation and on the medical benefit that the transplant would offer. An alcoholic, for instance, who had stopped drinking would regain his or her health with a new liver would qualify.

The second tier of this system would then look at the Patient's need balanced by the resources that the transplant would require.

"We would pick those patients that would reap the most medical benefit from the least amount of resources," Glasgow says. "In that way, we would use resources most effectively to save the most lives."

Glasgow, who is going on to law school at Capital University to study bioethics, is satisfied with his system. Two questions that he has resolved in his mind are that age should not be a determinant in transplant decisions, and that we shouldn't use medicine to punish people's behavior.

"Blame has no place at the bedside," he says of treating or not treating drug addicts, prisoners, or alcoholics.

As for age, if he were presented a young child and a 65-year-old who needed the same organ, and all things were equal with them according to his system, then Glasgow says that doctors should flip a coin to choose.

"I don't think people's lives should be devalued as they get older," he says. "Even if they only have five years to go, they're going to value those years just as much as anyone else."