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In this scenario, you are the advanced practice nurse on the transplant committee for Hope Medical
Center. All members of the committee have to vote to decide which patient will receive a donor heart.
Five other people are on the committee with you:
The administration member is Wes, the Chief Operating Officer.
The physician member is Dr. Hasweh, Cardiovascular Surgeon and Head of Transplant Services.
The social services member is Mahalia, who has worked closely with all clients on the transplant list.
The chaplain member is Pastor Arturo, pastor of a local church and lead chaplain at Hope Medical
Center.
The community member is Dr. Bashist, a retired general surgeon who serves on the Board of Directors.
Early this morning, a 17-year-old died following a motorcycle accident. The parents want their son to be
an organ donor. The team at Heart of Mercy Hospital prepared and began harvesting organs and notified
Hope Medical Center that they have a heart for their patient Bernadine Smith, a 32-year-old with a
congenital heart defect who needs a transplant after recently enduring her third pregnancy and
delivering a healthy baby boy. At Hope, Bernadine has been prepped for surgery. As surgery begins, a
member of the organ transplant team is on the way by helicopter to pick up Bernadine’s new heart. After
the heart is procured and the team member is on the way back with the heart, Bernadine suffers a
massive stroke and dies on the table. Hope Medical Center, having already taken possession of the heart,
now has just under an hour to decide who gets the heart.
Your first job is to interview the following candidates who are next in line for the heart.
First is Helen Adams. Helen is a 65-year-old, single Caucasian female with no children or family. Her
health history includes coronary artery disease, history of two-packs-per-day smoker, BMI of 29. She has
modified her diet and gave up smoking 9 months ago. She currently requires 2 LPM oxygen at all times.
She is not a candidate for revascularization. As you interview her, she states, “Yeah, I quit smoking
months ago. God, I miss it. I know you all keep telling me I need a new heart or I’ll be dead in a year, but I
think I’d feel weird with someone else’s heart in me. I’ve heard people start to like things they never did
before and stuff like that. What if it makes me more like the person I get a heart from, and I don’t like it?
I’m just not totally sold on the idea.”
Second, you interview Quentin West. Quentin is a 38-year-old African American father of four. His wife
has been a stay-at-home mom until recently, when Quentin became unable to work as a result of his
inability to perform required duties. His health history includes cardiomyopathy, hypertension, and a BMI
of 42. He tells you his BMI was much lower in his 20s, when he played professional football as an
offensive lineman. He also says he understands that playing football led to his development of
cardiomyopathy. He states that he has seen many of his former teammates and friends die of this
condition. He does admit to a history of substance abuse but states that he gave that up before his first
child was born.
After your interviews, you are headed back to speak to the rest of the committee when you are grabbed
by a nurse to help with a cardiac arrest coming in by ambulance. When the patient arrives, you receive
the following regarding the patient:
Earl, a 42-year-old male was snow skiing nearby when he suddenly collapsed. His girlfriend called 911.
When emergency services arrived, the patient had a pulse, but the pulse was lost on the way to the
hospital; CPR was initiated, and the patient was intubated. The paramedics were able to get a heartbeat
back; however, the patient continues to have arrhythmias and apparent low cardiac output. Earl is found
to have a history of coronary artery disease, hypertension, heart failure, and previous heart attack
resulting from cocaine use. He is stabilized and moved to the ICU on a heart pump with a poor
prospective outcome.
When you go in to meet with the ethics committee with your update, you discover that the patient from
the ER is the son of Earl Hope Eubanks the third, a major donor to the facility and the person for whom
the hospital is named. Mr. Eubanks has contacted the facility and pledged to pay for a new pediatric
cancer wing to be developed and built … but it is certainly inferred that the money will be donated only
if the son receives the donor heart.
As the committee sets down to discuss who should receive the heart, the following discussion occurs:
Wes: Thank you all for gathering on such short notice. As you all know, we have a big decision to make
and not a lot of time to make it in. Just so that we are all on the same page, we have three candidates for
the heart that is en route to this facility. I would like to open the floor for comment.
Mahalia: I need to recuse myself. I feel like I am too emotionally involved to make an objective
judgement in this case.
Wes: Thank you, Mahalia. I understand that this is certainly a difficult situation. I appreciate your
honesty. Does anyone else wish to recuse themselves? Okay, so let’s open the floor for conversation.
Dr. Hasweh: As the surgeon, I want to be clear that neither of the two are great candidates.
Wes: Don’t you mean three candidates? We cannot forget about Mr. Eubanks.
Dr. Hasweh: Wes, we all know about his cocaine abuse. You know that disqualifies him. Wes: But what if
he quit? Your Mr. West also has a history of substance abuse.
Dr. Hasweh: History of, not current use. Let’s do a drug screen on Mr. Eubanks and see if he is still using
and interview that girlfriend that was with him.
Dr. Bashist: I personally believe that we should eliminate Ms. Adams. She isn’t even sure she wants a
transplant.
Mahalia: I believe that she is just scared. Maybe she doesn’t want to get her hopes up. If she is chosen,
she can always refuse and then we move on to the next recipient.
Dr. Bashist: But that is a waste of time.
Pastor Arturo: If it was you who needed the heart, I would think you wouldn’t feel it was a waste of time.
I understand human nature and can see Mahalia’s points. Ms. Adams is certainly still a valid candidate.
She has made strides toward a healthier lifestyle already.
Dr. Hasweh: Ms. Adams may be the best candidate since she has already shown that she can make the
required changes.
Mahalia: What about Mr. West? He has a family to support, and he is so young!
Dr. Hasweh: But he has a history of substance abuse and a BMI of 42!
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Mahalia: Well your Ms. Adams claims that she “quit smoking,” but how can we really prove that?
Wes: I appreciate all of the conversation, but we must not forget about Mr. Eubanks. Even if he comes
back positive for substance abuse, imagine all of the good we could do with a children’s cancer wing.
That has to play into this decision.
The drug screen comes back inconclusive, and Mr. Eubanks’ girlfriend said she didn’t see him do
anything drug related. After much more discussion, a vote is held. Wes and Mr. Bashist vote for Mr.
Eubanks, and the chaplain and Dr. Hasweh vote for Mr. West. Ms. Adams is removed as a candidate.
Mahalia again recuses herself.
Your vote decides who gets the heart.
after viewing the presentation, nelly responded the following
Hospital Ethics Committe
In this scenario, the hospital ethics committees must consider the ethical principles of beneficence, non-
maleficence, autonomy, and justice in making a decision on who should get the heart transplant.
Beneficence involves promoting the patient's well-being, while non-maleficence ensures that harm is
minimized(Morrison & Furlong, 2018 ). Autonomy respects the patient's right to make decisions about
their own healthcare, and justice ensures fairness in the allocation of scarce resources like
organs(Morrison & Furlong, 2018 ). Other important considerations in deciding who gets an organ
include fairness, justice, social support, accountability and respect of persons(Ethics - General
Considerations in Assessment for Transplant Candidacy - Optn, n.d. ).
Using the above criteria, Helen Adams, the 65-year-old female, should be eliminated from consideration
because she has been deemed to be a poor surgical candidate. She also lacks social support, which is an
important consideration in selecting an organ recipient. Helen Adam’s lack of a social support system
would make it difficult for her to cope with the transplant process and adhere to the post-transplant care
regimen. The ethical principle of respect of a person should be considered since the patient expressed
hesitancy in receiving a donor heart transplant. Earl, the 42-year-old who suffered a heart attack should
be eliminated from consideration due to his recent cocaine use and previous heart attack due to cocaine
use. Care should be taken to ensure that his father’s influence is not a consideration in making a decision
for the sake of justice and fairness.
The number of people on the waiting list for a heart transplant outnumbers the available donor
heart(Ibrahim et al., 2021 ). For this reason, it’s important to consider the overall health of the
candidates to determine if they can withstand the transplantation surgery and the subsequent
immunosuppressive medications. Factors such as age, presence of other medical conditions, and ability
to adhere to post-transplant care are considered. Based on these considerations, the 38-year-old father
of four is the best candidate among the three choices. He is the youngest candidate, who has a past
history of being in top physical health as a football player and seems to have adequate social support
from his wife and children.
Health inequality and inequities were considered in terms of making a moral decision about who would
be the best candidate for the transplant without other considerations such as social status. The ethics
you would use to back up your decision are discussed above. The decision about picking a recipient is a
difficult decision because it’s a life and death issue. I do not mind serving on an ethics committee in the
future because I would consider all the ethical issues involved and make a valuable contribution to the
committee.
respond to nelly by answering the following in 200 word essay
Do you agree or disagree?
What are the perceived flaws in logic?
What ethical principles support your view?
What else would you have liked your peer to consider?
ChatGPT
Hello Nelly, thanks for the informative and interesting post. ssessment raises pertinent ethical
considerations but falls short in fully weighing all aspects. I agree with her dismissal of Helen
Adams due to her poor surgical candidacy and lack of social support. However, ruling out Earl
solely based on his past cocaine use, influenced by his father's donation pledge, may disregard
the principle of justice and fairness. It's crucial to verify current substance abuse and consider
Earl's potential for change and support mechanisms.
Perceived flaws in logic include a rigid disqualification of Earl without assessing his present
condition. While acknowledging the significance of beneficence, non-maleficence, autonomy,
and justice, the analysis lacks a deeper exploration of the candidates' current situations. Ethical
principles supporting my view emphasize fairness in decision-making, focusing on present
circumstances rather than solely past behaviors. Autonomy demands respecting Earl's right to a
fair assessment.
What I would have liked Nelly to consider further is the potential for rehabilitation and support
in Earl's case. Understanding the impact of Earl's father's influence on the decision-making
process is crucial for justice. Additionally, deeper scrutiny into Mr. West's long-term health
prospects, considering his history of cardiomyopathy and substantial BMI, could enrich the
ethical deliberation. Overall, a more nuanced evaluation, considering present health, potential for
change, and equitable treatment, would enhance the ethical foundation of the decision-making
process
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