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How Sick Is Too Sick or Old for an Organ Transplant?

Abstract

Organ transplant politics are an urgent international concern given the rise in individuals living with diabetes, high blood pressure, and hypertension.  However, demand for organs outpaces supply and because of that rationing becomes central to the policies that dictate organ distribution.  For example, in recent years, parents, guardians and others have complained that their children have been denied participation on the U.S. organ transplant list.  Recently a parent, Chrissy Rivera, alleged that a Pennsylvania hospital—the Children’s Hospital of Philadelphia—refused to perform a kidney transplant for her child. She claimed that hospital officials turned down performing the transplant because staff referred to her child as “mentally retarded” and questioned the value of implanting the organ into a child with such severe mental and physical disabilities.  According to her, hospital officials expressed concern about the quality of life benefit to the child as well as whether the family (and later the child) would have the means to sustain the medication regimen necessary to avoid organ rejection.  Inherent in these concerns are financial consideration as anti-rejection medication costs can be exorbitant.

The three year old child, Amelia Rivera, was born with Wolf-Hirschhorn syndrome, a rare genetic disorder that causes seizures, heart defects, potential deafness, immune deficiencies, as well as heightened mental and other physical impairments.  Hospital officials expressed concern about the case on Facebook, noting that because of patient privacy rules, they could not speak publicly about their communications with the Rivera family, but failed to offer anything substantive as to affirm or deny the mother’s statements.

Similarly, quality of life concerns are also raised about the aging and elderly and whether they should be entitled to placement on transplant waitlists.  This paper addresses those concerns and queries what “end of life” means and to what extent age should be a consideration in determining placement on organ transplant lists.

For example, patients considered too sick and too old are kicked off the US transplant waitlist each year.  Moreover, this year, thousands will not be informed that an organ transplant could benefit or save their lives, because they were once in prison, are too poor, do not seem convincing in their ability to regularly take their medications, or simply do not seem to be socially or mentally fit.  Their doctors make these subjective calls and send the patients off to dialysis clinics.

This paper examines public health and legal concerns with regard to transplant policy and aging.  It emphasizes there are no federal or state guidelines or rules that require doctors or hospitals to place all persons who could benefit from an organ on the transplant waitlist.

Michele Goodwin holds the Chancellor’s Professorship at the University of California, Irvine with appointments at the School of Law, School of Public Health, and Department of Gender and Sexuality Studies.   She is the founder and director of the Center for Biotechnology and Global Health Policy and its Reproductive Justice Initiative.  She researches and writes about legal concerns with regard to the human body.  She is an acclaimed bioethicist and prolific author.  Professor Goodwin has published with Forbes, Salon.com, the L.A. Times, Chicago Sun Times, Houston Chronicle, Christian Science Monitor, and the NY Times among others.  She is the author of several highly acclaimed books, including the much anticipated, Policing The Womb, which chronicles how women’s reproduction has become the political scapegoat in Congress and legislatures across the U.S., resulting in the rise of personhood measures, practices that force women to undergo cesarean births under threat of court order, abuse of prosecutorial discretion that results in the criminalization and punishment of pregnant women for falling down steps, refusing bed rest or attempting suicide, and policies that dramatically erode reproductive liberty.

Michele frequently lectures world-wide on issues involving human rights, reproductive justice, bioethics, and health law. She served as a Visiting Professor at the University of Chicago and as a Visiting Scholar at the University of California-Berkeley and Columbia University Law School.