Bioethics and moral decision-making frameworks

¶ … Patient over Seventy Years of Age be given a Liver Transplant?

The woman in question, Mrs. Burgone, needs a liver transplant and has the money to pay for one (they are extremely expensive, costing up to $200,000). However her doctor tells her that "social policy" prevents doctors from conducting liver transplant operations on people 70 years of age or over. Mrs. Burgone argues that she can pay for it herself, to no avail. Then the doctor offers a rather strange justification for his position. He claims that if one older person is given permission to have a transplant -- even if she can afford it -- then "society would have to pay for those who can't afford it, and society can't afford to do that," he argued. That is a strange logic, because in the first place if there is a guideline against anyone 70 or older receiving a liver transplant then that rule should remain in place, no matter whether it is on the taxpayers' dime or the person can pay for it herself. The doctor would have been smarter to just say there are data that show older people are at greater risk than younger people, if that was in fact true.

The Argument -- She Shouldn't be Given a Transplant

For the doctor, he actually had a series of good arguments to use in reply to Mrs. Burgone's wishes to have a liver transplant. For example, professor Paul Flaman of St. Joseph's College at the University of Alberta states that "… a widely used and approved criterion of selection is to give priority to those who have a great need and who are expected to benefit greatly" (www.ualberta.ca). What is Mrs. Burgone's real need? Is she desperately hanging on to life and needs one urgently? Readers don't know that. She does she it is unfair to "condemn someone to pain and a greater risk of death when a way of changing this is available." Also, Flaman writes that ethically, it doesn't make sense to give "a limited number of available" number of organs to those & #8230;. Who are expected to only live marginally longer but suffer much with the transplants, when others would benefit greatly" (Flaman, p. 7). Also, the doctor could have pointed out there is a long list of potential recipients that have been waiting for years, so why would Mrs. Burgone be quickly given a liver when 83 people who truly need a liver -- and have waited years -- to survive are on a list ahead of her? These are all reasons why Mrs. Burgone should be told it is not possible for her to get a liver transplant at this time.

The Argument -- She Could be Given a Transplant

I could not find a prohibition against liver transplants for those 70 or over, but there is a good deal of information in the literature supporting transplants for older people. In the PubMed section of the National Institutes of Health a study of 1,446 "consecutive liver transplant recipients was conducted" and 241 elderly patients (over 60) in that group were compared with younger counterparts. The conclusion: "Low-risk elderly patients fare as well as younger patients after liver transplantation" (Levy, et. al, 2001).

Meanwhile, Dr. Gerald S. Lipshutz, assistant professor of surgery at the David Geffen School of Medicine at the University of California reports the results of the findings at the World Transplant Congress in 2006. In a study of 62 patients (Group I) between the ages of 70-79 that had received liver transplants -- compared with a group of 864 patients getting liver transplants between ages 50-59 (Group II) -- found that "Patients aged 70 years and older… had the same survival rate as patients in their 50s" (Kahn, 2006, p. 1). In fact after 1 year the survival rate was 73.2% for Group I and 76.8% for Group II; after 3 years it was 65.3% to 70.5% respectively; and after 10 years it was 46% to 55.3% (Kahn, p. 1).