Altruistic Desires Are Not the End All and Be All in Organ Donation

A very sad case in Canada is testing the ethics of organ donation at a Canadian hospital. A terminally ill baby was going to be allowed to die naturally and then after cardiac arrest, be an organ donor under the "Non Heart Beating Cadaver Donor Protocol." But the baby didn't die as planned and the donation has been called off, about which the parents are not happy. From the story:

Two-month-old Kaylee has a fatal brain condition called Joubert Syndrome, which has caused a malformation of her brain, leaving her unable to breathe without a machine when she sleeps. With no way to save their child's life and not wanting to see her suffer any longer, Kaylee's parents, Jason Wallace and Crystal Vitelli, wanted to take her off life support and donate her heart to another baby in need.

They thought Tuesday would be their last day with their daughter. Wallace said that Kaylee was expected to fall asleep in the operating room Tuesday evening and then be taken off life support. If she died within two hours, her heart would be removed for a transplant. But doctors called off the surgery when she did not fall asleep as thought.

Wallace said he wants doctors to try again. "If she's going to die, we got to keep trying," he said. "I want my child to pass on because she can't survive, and to save that child." Dr. Jim Wright, chief of surgery at the Hospital for Sick Children, told reporters late Tuesday that Kaylee is no longer a candidate for a heart transplant at this time. He said that is subject to change, however.

We can all sympathize with the parents' anguish and desire that some good come out of their family's tragedy. But more is at stake here than this baby and the hoped-for recipient. If the baby's time has not really yet come, it hasn't yet come. More to the point, the ethics of the entire system must be maintained or the whole system could fall into chaos.

The parents, for example, want their baby's heart to go to a particular child at the same hospital. But it isn't--and shouldn't be--their say. The donation is not to a particular person but to the system, which of necessity utilizes triage, the dispassionate and fair management of which is vital to managing the system and maintaining public confidence:

Wallace and Vitelli have already decided who they would like to receive their baby's heart. Her name is Lillian O'Connor and she is in the neonatal unit in the floor below Kaylee at SickKids...But SickKids says there is no guarantee the heart will go to Lillian. Deciding who will receive the heart depends on who is at the top of the transplant waiting list, based on their urgent medical need...

Medical ethicist Kerry Bowman of Mount Sinai hospital in Toronto told CTV Newsnet that hospital officials are following both legal and ethical protocols. "Obviously they are going to great length to respect protocol," he said Tuesday. "They are respecting two lives here."

We too often hear about hospitals that seem to cut corners in organ transplantation. Now, one is acting ethically and it's is being, in my view, implicitly criticized in this story for not doing what the parents want. But if the emotions of the moment came to control actions in these matters, the entire system would collapse and who received organs would depend on who one knew or being in the right place at the right time--rather than the orderly, if frustrating, current system that strives to provide equal access to treatment. Good for hospital administrators keeping their heads and following the rules--even when it hurt their hearts.