1.03- Organ Transplantation

Biomedical Technology II

Pre-Module Work

• We are going to study fairness in the allocation (distribution) of scarce, lifesaving biomedical resources

• Read one historical case• Answer the questions on the case handouts• We need to start to think about fair ways to

allocate the resources• The facts that you will read about have changed

since the time of these cases. For example: Penicillin, insulin, and dialysis are no longer scarce resources.

DAY 1Historical Cases- Learning from Past

Allocation Experiences

What is the ethical question????

Activity Groups of 3

• Brief each of your team mates about the case you read

– What was the resource? Why was it valuable? and its outcome (How was the resource allocated?)

Insulin Case

What do you think would have been the fair way to distribute insulin when it was in such

short supply?

Insulin Case

What are the pros and cons of how Fredrick Banting distributed the insulin?

Dialysis Committee Decision

Is it fair to consider one’s social worth—or value to society—as a criterion?

Penicillin Case

What about the guidelines of the Committee on Chemotherapeutic and Other Agents used?

Is there anything else that the COC should have considered? Why or why not?

Activity: Allocating Organs for Transplantation- What are the

Relevant Facts?

UNOS

United Network for Organ Sharing

Let’s Start……..

You are patients awaiting liver transplants.

You will soon find out what your situation is as a patient.

What do you think?

Question Predicted Actual

Over the next 12 months, what percent of you will receive a liver- 10%, 35%, or 55%?

Over the next 12 months, what percent of you will die while waiting for a liver- 10%, 35%, or 55%?

Over the next 12 months, what percent of you will still be alive but will not have received a liver- 10%, 35%, 0r 55%?

Need More Information?

• Master 3.5: Liver and Liver-Transplant Fact Sheet

• Master 3.6: The Liver and Liver

• Transplants—Checking for Understanding.

HOMEWORK ASSIGNMENT

• Complete questions on Master 3.6

DAY 2

Identifying Stakeholders and Taking Ethical Considerations into Account

Activity: Checking Understanding

• Choose a partner

• Compare answers on your homework questions

• Do you have any questions about the homework?

Activity:Liver Transplant Case Studies

• Partner up

• You will read about 4 patients who are waiting for a liver transplant

• One liver has become available and all the patients’ immune system would accept the liver

Activity: Identifying Allocation Criteria and Relevant Facts

• With your partner, you will use the case studies to identify the criteria you believe should be included in a fair policy for allocating livers for transplantation

• You are part of a committee that is advising a doctor about which of the four patients should get the liver. What would be most fair? Be prepared to explain and back up your decision.

• The ethical question at hand is,

HOW CAN SCARCE RESOURCES BE MOST FAIRLY DISTRIBUTED?

Activity continued

• You will now receive Master 3.8 which will give you more information about each patient.

• You now will be able to connect the criteria, the relevant facts, and the case studies.

• Prioritize based on whoever is the sickest and state the facts you used to determine this

• Prioritize based on whoever will live the longest after transplantation and state the facts you used to determine this

Homework Assignment

• Complete Master 3.9: Identifying Allocation Criteria and the Relevant Facts

• Criteria– Will likely live longest

– Is sickest

– Is youngest

– Is most valuable to society

– Is least responsible for liver disease

– Wins a random lottery

– Waited longest for a liver

Day 3: Bell Ringer

• Are there other people besides the patients who are stakeholders in this decision?

Activity continued

• Do you think the current policy is fair and why?

• With respect to fairness, is the current policy an improvement over the past policy? Why or why not?

Activity: Understanding Past and Current UNOS Policies

Pre-1998 UNOS Liver-Allocation Policy Facts 1 & 2

A) Which ethical criteria were given priority in this policy?

B) Which ethical criteria was not included?

C) Do you think the past UNOS policy was fair?

Activity continued

Current UNOS Liver-Allocation Policy Facts 1 & 2

A) Which ethical criteria was given priority in this policy?

B) Which ethical criteria was not included in this policy?

C) How are the current and past policies similar and how are they different?

In closing……

• The goal is not consensus instead it is well supported decision making.