[Heaneisismich]

Not sure if this is the right forum, or whether it should be down below in one of the others.
just watched ABC evening news where they had a news clip about a bill currently being discussed which would change the organ transplant way from the current (for kidneys at least) giving it to who's been waiting the longest, to where instead it would be given to whom would get the most out of it.
Basically if i have 2 kidneys to give, and 3 people waiting

a 14 yr old kid who damaged hers in an auto accident which has also left her in a wheel chair
a 24 yr old who lost his due to some other accident
or a 49 yr old mother of 4 who llost hers due to other aspects (maybe her family has a history of it), but has been waiting 7 yrs longer than the other 2 combined..

BY the way they are looking at changing it, both those young'uns would get preference for it over the 49 yr old.
Some people already see this with heart transplants (no for over 70s), liver (as the news story said, 65 or older not normally looked at), and i think lung. BUT unfortunately i have yet to see any site with info other than for kidney.

So are you for this or against this??

[steansathtpos]

I can see both sides of the coin in this situation.

Heads: Should the surgeons waste time performing this procedure on someone who may later reject this kidney anyway thus causing the patient to be back at square one?

Tails: First come first servered regardless of the chances of "kidney utilization". There are people who have been on the waiting list forever.

It is such a double edged sword. I say keep it the way it is.. First come, first served.. The gov't shouldn't dabble in this one.

[nuabuncarnigo]

I could be wrong, but I believe that other factors are already taken into account, not just waiting time (overall immune condition, support systems, risk of non-compliance, medical history, other diseases, etc). As you say, perhaps it's different for kidneys, but taking nothing into consideration other than waiting time is a mistake.

Let the trained medical professionals make the call and do what they're trained to do. The government has little place in this. Leave it as is, waiting time tempered by any mitigating factors. Besides, some might argue that the 49 year old mother of 4 recipient would actually be a better use of the organ since it affects not only her but her family's wellbeing. Giving an organ to the "one who would get the most use out of it" could be interpreted in so many ways, anywhere from utilitarianism to "give it to the youngest".

[CDCL7WKJ]

Corpsman and Proud Organ Donor here. I'm a "give it to the kids" kinda guy. Its a given that patients are screened for compatibility but after all that and the choice is Mother vs Kid. Kid wins.

[irridgita]

Man, this is a great topic for the bar...

It's like the old "values clarification" exercises they used to do...playing lifeboat!!

You could make an argument for giving it to the one who is going to die the soonest (i.e. Triage care)...

My first inclination is the whole "who is going to get the most out of it"...of course that would leave the 49 yr old mother to probably NEVER get a new kidney because there will always be some young'un that needs it.

Sheesh...that is tough question that requires a lot more thought than I've given it so far....I'm gonna go with Triage for right now. Whoever is sickest, gets it...all other variables being equal.

[Qrhzbadu]

Man, this is a great topic for the bar...

It's like the old "values clarification" exercises they used to do...playing lifeboat!!

You could make an argument for giving it to the one who is going to die the soonest (i.e. Triage care)...

My first inclination is the whole "who is going to get the most out of it"...of course that would leave the 49 yr old mother to probably NEVER get a new kidney because there will always be some young'un that needs it.

Sheesh...that is tough question that requires a lot more thought than I've given it so far....I'm gonna go with Triage for right now. Whoever is sickest, gets it...all other variables being equal.

Man I wish medicine was that simple. Just remember to screen out expectant.

[68AttendGem]

Just remember to screen out expectant.

I don't know what that means.

[vqIo7X2U]

Man, this is a great topic for the bar...

It's like the old "values clarification" exercises they used to do...playing lifeboat!!

You could make an argument for giving it to the one who is going to die the soonest (i.e. Triage care)...

My first inclination is the whole "who is going to get the most out of it"...of course that would leave the 49 yr old mother to probably NEVER get a new kidney because there will always be some young'un that needs it.

Sheesh...that is tough question that requires a lot more thought than I've given it so far....I'm gonna go with Triage for right now. Whoever is sickest, gets it...all other variables being equal.

I can go with that.

And even the sickest person may be that way simply because of the diseased organ. The 49 year old may essentially be cured with a new kidney. If the same would be true for the young'un, then they're both in the same boat following a transplant.... I guess I'm wondering why the youngest should automatically get it (according to some). Yes, in theory, they have a long life ahead of them. But the 49 mother could have far more at stake than the kid.

But, yes, this would be a sadistically perfect question for the bar.

[HarryMet]

And they said there would be no death panels or rationing...indeed.

[vvxtiopmx]

And they said there would be no death panels or rationing...indeed.

Has there ever been a time when everyone who needed an organ got one?

[GVsdJZ2H]

I don't know what that means.

in triage it means about to die, e.g. sickest-est

[InsManKV]

in triage it means about to die, e.g. sickest-est

Oh, okay...yeah, I would agree that there is a point of no return...that should be screened out.

[FloareTraurne]

Clever way to try and re-direct the discussion when it stops suiting your narrative. Has there ever been a time when 100% of all in need of a transplant got them? No, nor will there ever. But that isn't the question now is it.

The question is one of changing from first come first serve to a eugenically based system that assigns organs based on the perception of "worth" a person has. I'd thrown in any number of quotes (Margaret Sanger comes to mind) but let's honestly think this through shall we...

How would we determine "worth" in some bizarre system in which a "hot or not" equation were applied to organ transplants? We know historically that such choices were defined along racial lines (ie, think of the Doc that invented blood transfusions and bled to death because the "black" hospital was farther away than the "white" hosipital). We know today, what with genetic-modeling, some parents would seek certain attributes in their prospective embryos. So rest assured, if "worth" is applied to transplants it will be precisely criteria like these that factor into the equation at the expense of percieved "undesirables"...which might include you in that number.

Who determines that "worth"? What determines that "worth"? I know that in this bizarre suicide cult we live in we continually design ways to devalue life but seriously, how do you quantify someone's "worth" as a life?

Is first come first serve sterile and cold? Yes. But realistically it is the only way to ensure anything approaching fairness with a subject like this.

[Wrencytet]

Clever way to try and re-direct the discussion when it stops suiting your narrative.

What narrative is that?

Has there ever been a time when 100% of all in need of a transplant got them? No, nor will there ever. But that isn't the question now is it. So, in other words...we have ALWAYS rationed care and always will...and your implication that "rationing" and "death panels" is something new is deceptive at best.

So, the question then is...HOW shall it be rationed. Not that we are all of sudden rationing care and holding death panels...

The question is one of changing from first come first serve to a eugenically based system that assigns organs based on the perception of "worth" a person has. I'd thrown in any number of quotes (Margaret Sanger comes to mind) but let's honestly think this through shall we...

How would we determine "worth" in some bizarre system in which a "hot or not" equation were applied to organ transplants? We know historically that such choices were defined along racial lines (ie, think of the Doc that invented blood transfusions and bled to death because the "black" hospital was farther away than the "white" hosipital). We know today, what with genetic-modeling, some parents would seek certain attributes in their prospective embryos. So rest assured, if "worth" is applied to transplants it will be precisely criteria like these that factor into the equation at the expense of percieved "undesirables"...which might include you in that number.

Who determines that "worth"? What determines that "worth"? I know that in this bizarre suicide cult we live in we continually design ways to devalue life but seriously, how do you quantify someone's "worth" as a life?

Is first come first serve sterile and cold? Yes. But realistically it is the only way to ensure anything approaching fairness with a subject like this. Is it the only way?

What's wrong with...sickest first? What is so unfair about that?

Is it "fair" to give the organ to an 89 year old man in a hospice who has been waiting for 12 years, but could probably go another 4...and let an 11 year old who has 3 months to live die? That doesn't sound "fair" to me...

Is "first come, first serve" fair if you show up to the ER having a heart attack and 30 people with sprained ankles and tummy aches are ahead of you?

Who appointed that death panel anyway?

[markkisil]

Good question, who does appoint that panel then and make that determination? And who sets forth the criteria? Do you honestly trust some board of bureaucrats to be good at this? Apply the TSA model to organ transplantion and tell me it will work out just fine.

But then again, it'll be easy to figure out for the extreme cases - 89 year old that weights 900lbs and drinks a fifth of vodka each day versus a 12 year old. But what about the harder cases? 49 year old mother of 2 and divorced once versus 47 father of one married since age 26? Do we choose to kill the mom or the dad? Hmmmm. Who's got a degree? Who makes more each year that we can tax? But wait, we need to have a study to ensure that distribution of organs is equitable across every possible hyphenated prefix we can place before the "American" identifier in one's ethnicity unless we want a crowd in the streets chanting "no justice no peace" and "hey hey ho ho there is where the catchy slogan goes". Back to the extreme cases, did I mention the 89 year old was a genius professor at an Ivy League school in their engineering department while the 12 year old has been comatose since a car accident happened 8 years ago? Maybe none of these people qualify because there's a 34 year old marathon runner that just popped up in better health than anyone else on the list. The 34 year old is also a Hollywood celeb we've loved since she was a child star on Disney. So who do we assign death then? Answer quick because Mr. Reaper is waiting. Oh, by the way, where do you factor in on the list?

Can't you remove your blinders for long enough to figure out what kind of road this leads to? Evidently not. Nobody said 100% of transplant requests are staffed. And I'm saying we need not go down the path of appointing some organization to gerrymander decisions as to who does and doesn't get a body part. The current system is a cold, sterile method of choosing but far more valid than some agency tucked away out of sight out of mind screwing it up.

[Zvssxstw]

By the way...the sprained ankle/heart attack analogy fails. If people need a transplant we already know they are equally sick (ie, they die if they don't get it). What we're discussing is, the worth of an individual and how that will be determined in this grand suicide cult in which we live.

[SM9WI8oI]

Good question, who does appoint that panel then and make that determination? And who sets forth the criteria? Do you honestly trust some board of bureaucrats to be good at this? Apply the TSA model to organ transplantion and tell me it will work out just fine.

But then again, it'll be easy to figure out for the extreme cases - 89 year old that weights 900lbs and drinks a fifth of vodka each day versus a 12 year old. But what about the harder cases? 49 year old mother of 2 and divorced once versus 47 father of one married since age 26? Do we choose to kill the mom or the dad? Hmmmm. Who's got a degree? Who makes more each year that we can tax? But wait, we need to have a study to ensure that distribution of organs is equitable across every possible hyphenated prefix we can place before the "American" identifier in one's ethnicity unless we want a crowd in the streets chanting "no justice no peace" and "hey hey ho ho there is where the catchy slogan goes". Back to the extreme cases, did I mention the 89 year old was a genius professor at an Ivy League school in their engineering department while the 12 year old has been comatose since a car accident happened 8 years ago? Maybe none of these people qualify because there's a 34 year old marathon runner that just popped up in better health than anyone else on the list. The 34 year old is also a Hollywood celeb we've loved since she was a child star on Disney. So who do we assign death then? Answer quick because Mr. Reaper is waiting. Oh, by the way, where do you factor in on the list?

Seems like you are arguing against me...but you are arguing against points I'm not making.

While the whole values clarification stuff is interesting...I agree that it opens up a whole can of worms regarding ethics...this is what the old "lifeboat" exercises used to do....i.e. you have sinking ship with 20 people, lifeboat only holds 15, who do you keep, etc. I do NOT in any way think we should get into the business of assigned the value of one life over another, interesting as that may be.

Can't you remove your blinders for long enough to figure out what kind of road this leads to? Evidently not. Well, if you could remove you blinders long enough to read what I actually wrote and not what you have assigned to me...you would probably see that you are arguing against something I"m not saying.

Nobody said 100% of transplant requests are staffed. And I'm saying we need not go down the path of appointing some organization to gerrymander decisions as to who does and doesn't get a body part. I agree with that...but I don't agree that "first come, first serve" is the "only fair way to do it"...that there may be another more fair way...and it's worth looking into. I did NOT say that the youngest should get it.

The current system is a cold, sterile method of choosing but far more valid than some agency tucked away out of sight out of mind screwing it up. ...and no one is suggesting some agency should exist. Well, not me anyway.

[Adimos]

By the way...the sprained ankle/heart attack analogy fails. If people need a transplant we already know they are equally sick (ie, they die if they don't get it). What we're discussing is, the worth of an individual and how that will be determined in this grand suicide cult in which we live.

BTW, not everyone who needs a transplant is equally sick.

[squeerisott]

If we're going to determine who is and isn't worth a transplant then it is inevitable that some organization or agency be developed to administer and oversee the process. Just like everything else that goes on in society there will be some entity that oversees it. These determinations won't happen magically out of thin air after all nor is genie gonna pop from her bottle and wiggle her nose and pick for us.

Still haven't told me how we determine who is worth more than who in assigning the transplants. Let's say we've got two 19 year old knock out gorgeous freshman cheerleaders from State University. Both need the same transplant in order to survive. Who gets the organ first? Hmmmm, one has a GPA of 3.92 and the other 3.8. Does that factor in? Then again, one was a drunk in high school and still smokes and statistically that reduces her life expectancy. Does that factor in? One has a history of heart disease. Do we bring that into the final equation? Do we commit both to Mr Reaper in favor of the 23 year old man who never went to college, was homeless before the police found him sick and living under a bridge thus beginning his medical excursion? Or do we kill off the 23 year old?

We can't even get simple stuff like issuing driver's licenses correctly (recent scandal in CA). Who are we to think some board of experts is gonna get this right? I can see the headlines a decade from now:

"Transplant Board Chair Says No Bribes for Kidneys"

"Study finds women less likely to get lung transplants"

Not to mention the scandal that will ignite when it is discovered that "deserving" patients are deliberately overlooked by the board in favor of the obviously terminal (ie, the 89 year old that weighs 900 lbs and subsists on a diet of vodka and Krispy Kreme). How do we know this? Because it happens every single day in every other thing some gaggle of we know better bureaucrats attempt to manage! They can't even run Megan's Law correctly for heaven's sake. You're going to trust them to give you a spot in line when your gear gets casrep'd?

[replicajoy]

If we're going to determine who is and isn't worth a transplant then it is inevitable that some organization or agency be developed to administer and oversee the process. Just like everything else that goes on in society there will be some entity that oversees it. These determinations won't happen magically out of thin air after all nor is genie gonna pop from her bottle and wiggle her nose and pick for us.

Still haven't told me how we determine who is worth more than who in assigning the transplants.

Why should I tell you that when I never claimed we should make any such determination? I suggested we provide the organ to the sickest first...same way they triage patients in an ER.

Let's say we've got two 19 year old knock out gorgeous freshman cheerleaders from State University. Both need the same transplant in order to survive. Who gets the organ first? Hmmmm, one has a GPA of 3.92 and the other 3.8. Does that factor in? Then again, one was a drunk in high school and still smokes and statistically that reduces her life expectancy. Does that factor in? One has a history of heart disease. Do we bring that into the final equation? Do we commit both to Mr Reaper in favor of the 23 year old man who never went to college, was homeless before the police found him sick and living under a bridge thus beginning his medical excursion? Or do we kill off the 23 year old? Are they Republican or Democrat?

We can't even get simple stuff like issuing driver's licenses correctly (recent scandal in CA). Who are we to think some board of experts is gonna get this right? I can see the headlines a decade from now:

"Transplant Board Chair Says No Bribes for Kidneys"

"Study finds women less likely to get lung transplants"

Not to mention the scandal that will ignite when it is discovered that "deserving" patients are deliberately overlooked by the board in favor of the obviously terminal (ie, the 89 year old that weighs 900 lbs and subsists on a diet of vodka and Krispy Kreme). How do we know this? Because it happens every single day in every other thing some gaggle of we know better bureaucrats attempt to manage! They can't even run Megan's Law correctly for heaven's sake. You're going to trust them to give you a spot in line when your gear gets casrep'd? I agree that if ever such an agency existed to make value judgements on different people...that it would be an ethical mess and be disastrous...why do you keep arguing against points I'm not making?