Day 2: Medical Ethics Issue Focuses on 'Doing No Harm' to Patients
Luis Fabregas; Andrew Conte, Tribune-Review/Pittsburgh Tribune-Review
With a limited supply of organs, liver transplant surgeons must worker harder to maintain the guiding principle of doing no harm, medical ethicists said.
Give a liver to a patient too soon, and the doctor could cut short the person's life or unnecessarily burden them with having to deal with the complications of organ rejection medicines. Wait too long and the patient could become too sick to truly benefit from transplantation -- or the organ might not be available.
"Risk versus benefit has to be weighed together," said Dr. Eugene Boisaubin, clinical ethicist at the University of Texas Medical School in Houston. "If the total risk of the transplant potentially exceeds the chance of a person's continued health or survival otherwise, that's got to be seriously considered."
Unlike other medical fields where parts like knees or hips come off the shelf, transplantation is complicated by the limited supply of organs. Money makes decisions even more complex because the surgeries mean big business for medical centers.
Transplant programs have financial incentives to perform surgeries on patients who are not as critically ill because they cost less and heal faster. Those patients, however, face a greater risk of dying if they undergo a liver transplant than if they keep waiting.
"You want to never be in a position where, in order to get transplants done or bring business to a program, you're putting patients at more risk than they have to face," said Arthur L. Caplan, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia.
Federal allocation rules further complicate the question of giving livers to patients at the bottom of the waiting list. …