Problem Statement
Organs are rare and expensive resources. Distributing these resources equitably remains one of the most pressing dilemmas in bioethics. Given that the dying patient did consent to organ donation, the primary ethical dilemmas in this case arise when determining the recipient. The case presents four different options, two of which (Michael and Mario) seem relatively easy to rule out. Mario is an infant who may not be a suitable candidate, and Michael has a history of liver disease due to alcoholism. Emily and Anita, however, both seem equally suitable candidates for the liver.

This case raises several moral questions. If every patient is deemed equally as worthy and valuable, according to ethical principles like equity and justice, then how is it possible to favor one person over the other? The answer to that question would be first to rule out any potential recipient who might reject the organ due to underlying medical conditions or to general incompatibility. In this case, ruling out Michael and Mario is due to their being less likely to successfully adapt to the new organ. It would be tempting to choose an infant based on a raw emotional response, but Mario’s condition might not be resolved with the liver transplant. More research would be needed into the implications of having biliary atresia, to determine whether the infant would have trouble with bile production even with a new liver.

In fact, the only way to really make an informed decision in this case is to eschew any immediate emotional response to the four candidates and consider only the issue of which candidate will maximize the value of the liver. Value in this case is not a financial metric, but is instead related to medical compatibility and the least likely person to develop further complications after the transplant. Above all, this case illustrates the central importance of the ethical principle of justice in medicine. This case also seriously challenges the healthcare team to apply the principle of beneficence equitably. Essentially, the case pits the principle of beneficence against the principle of justice.

Resolution

Technological innovations—including those that have made organ transplants more common and safer--frequently give rise to new ethical dilemmas in medicine (Steinbock, London & Arras, n.d.). This case shows how organ transplants, as beneficial and miraculous as they are, can also become a source of struggle for bioethicists and healthcare workers who contend with difficult choices—many of which are essentially life-and-death matters. The principalist method avoids some of the pitfalls associated with adherence to only one ethical theory like utilitarianism or deontology.

Ethical principles become guiding forces to help people make ethical decisions in cases as troubling as this one, involving who would be the ideal recipient for a precious organ. The primary ethical principles in medicine and healthcare include respect for autonomy, beneficence, and justice. However, confidentiality or nonmaleficence re often included to make four guiding principles that can be applied to difficult situations (“Principlesd of Ethics,” n.d.). These ethical principles are based on values like equity, respect for...…needs to conduct a more thorough examination of the biomarkers that affect the recipient’s ability to tolerate the liver, such as immune health or blood type. The healthcare team also needs to consider the legal parameters, such as whether the recipient list must be followed in a particular order or if recipients are randomly chosen. Likewise, the team needs to assess whether one of the patients needs the transplant sooner than the others, under the principle of beneficence.

If all medical parameters prove equal, the team would subsequently be advised to offer the liver first to Michael only because he has been on the list the longest. To deny Michael the liver would be incompatible with the principles of justice and beneficence. As irksome as it might seem to many members of the team, choosing Michael would allow the institution to better align with its most important values. Recommended course of action is as follows:

· Thoroughly assess all patients to determine whether one is in dire, immediate need of the organ transplant

· Thoroughly assess all patients to determine medical suitability and compatibility with the donor organ

· Offer the donor, if he is cognizant and capable, the option for input into the decision. Confidentiality can be preserved if the donor is given only the basic information and is allowed to consult with the medical team about the ethical issues at stake.

· Consult with Michael, and make sure that he understands that in taking the liver he is denying other candidates the opportunity…