17-year-old girl organ transplant survey

[Yogi Bear]

Please answer questions in pairs.

INSTRUCTIONS:
In total, you'll make 5 choices since answers 1/2, 3/4, 5/6, 7/8, and 9/10 are opposites (whether or not nationality is considered) of same question (A,B,C,D,E). Choose either 1 or 2, 3 or 4, 5 or 6, 7 or 8, 9 or 10 for a total of 5 answers to questions A, B, C, D, and E.

Please try to answer ALL 5 questions, QA, QB, QC, QD, and QE. Don't leave any blank! Nearly twice as many people have voted for the "ignore nationality" questions compared to the "consider nationality" questions.

QUESTION A: If we were to ignore nationality, based on all the facts you've considered, should the girl have received the 2nd organ transplant?
1) Yes, the girl should receive 2nd transplant (IGNORE nationality)
2) No, the girl should NOT have received 2nd transplant (IGNORE nationality)

QUESTION B: If we were to consider the fact that the girl was an illegal immigrant (not us citizen/permanent resident) based on all the facts you've considered, should the girl have received the 2nd organ transplant?
3) Yes, the girl should receive 2nd transplant (consider nationality)
4) No, the girl should NOT have received 2nd transplant (consider nationality)


QUESTION C: If we were to consider the fact that the girl was an illegal immigrant (not us citizen/permanent resident) based on all the facts you've considered, would you have given her the 1st transplant?
5) Yes, the girl should receive the 1st transplant (consider nationality)
6) No, the girl should NOT have recevied the 1st transplant (consider nationality)

QUESTION D: If we were to ignore nationality, based on all the facts you've considered, should the family sue Duke and/or doctor(s) involved?
7) Yes, the family should sue Duke and/or doctor(s) involved (IGNORE nationality)
8) No, the family soould NOT sue Duke and/or docotor(s) involved (IGNORE nationality)

QUESTION E: If we were to consider the fact that the girl was an illegal immigrant (not us citizen/permanent resident) based on all the facts you've considered, should the family sue Duke and/or doctor(s) involved?
9) Yes, the family should sue Duke and/or doctor(s) involved (consider nationality)
10) No, the family should NOT sue Duke and/or doctor(s) involved (consider nationality)

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[Street Philosopher]

i just used up my daily quota of intellectual activity answering those questions.

 

[Yogi Bear]

For clarification,

Choose either 1 or 2, 3 or 4, 5 or 6, 7 or 8, 9 or 10. In total, you'll make 5 choices since questions 1/2, 3/4, 5/6, 7/8, and 9/10 are opposites of same sub-question. (their are 5 sub-questions since this poll didn't allow multiple questions for some reason).

Looks like not everyone who voted chose to answer all of the sub-questions.

 

[Deuce 007 MD]

Even w/clarification I was still confused. I thought I would never see anything harder then mcat verbal, now I have.

 

[wolferman]

My answers were very different when I ignored nationality versus considering it. Great poll Yogi! Assuming people fill it out correctly, it'll be interesting to see how nationality effects the turnout.

 

[Yogi Bear]

Originally posted by Deuce 007 MD
Even w/clarification I was still confused. I thought I would never see anything harder then mcat verbal, now I have.

lol...yeah... very dififcult to create a poll when the poll feature doesn't allow for separate questions. we used to be able to create several questions, each w/ their own answers. now, its just 1 question w/ multiple answers.

u can tell if people skipped questions since the sum of responses of 1&2 = 3&4 = 5&6 = 7&8 = 9&10.

 

[Moneyless]

I dunno... this poll was a bit confusing for me...

 

[Yogi Bear]

Originally posted by Moneyless
I dunno... this poll was a bit confusing for me...

ok...just fixed the instructions a bit to make it clearer for everyone.

 

[wolferman]

Just from the prelimnary results thus far, it seems like when you consider nationality, most believe that one transplant is reasonable but two is stretching it. Interesting....

 

[Polar girl]

Originally posted by wolferman
Just from the prelimnary results thus far, it seems like when you consider nationality, most believe that one transplant is reasonable but two is stretching it. Interesting....

That seems weird to me. If people think she should have had the first even though illegal, it seems like the second would be a given, considering the second was only needed because the first was messed up and almost killed her.

I voted the reverse of the trend. I thought the second was very appropriate, whereas the first not as much so.

 

[Yogi Bear]

Originally posted by Polar girl
That seems weird to me. If people think she should have had the first even though illegal, it seems like the second would be a given, considering the second was only needed because the first was messed up and almost killed her.

I voted the reverse of the trend. I thought the second was very appropriate, whereas the first not as much so.

i think the sticking point in the second one was that that her kidney damage and the long waiting time, the changes of sucess was really low. and cuz this was an organ transplants, this could have been used for multiple people. i.e. three people could have been saved from 1 hear, and 2 lobes of the lung. did she get both lobes or just one?

 

[cg1]

Polar girl,

I totally agree with you.

Regardless if Jessica should or should not have been given the 1st transplant, she was done an injustice by Duke. They actually put her life in danger because of that 1st transplant.

The girl wasn't "lucky" that they decided to give her that 1st transplant ...because they ended up f#ck!ng it up. She *would* have been lucky if they hadn't botched it, but they did. A more drastic example would be if you got the very top plastic surgeon in the country to give fix a deformed cleft lip. If you were put to the top of the line and given the operation, you'd probably feel *really* lucky. Then, after they botch it up and you are on death's door...how lucky do you feel? Did they do you a "favor"? Ummmm, thanks, but no thanks for that kind of favor. Granted this case is different, but if Duke hadn't dropped the ball, that poor girl would not be 1 breath away from dying (as she unfortunately is as we speak).

Therefore, she deserved that 2nd transplant, as most people would see it, to right the wrong that was done to her by the sloppy medical system that was at Duke.

Of course, Duke doesn't see it that way. They were just scrambling around in CYA mode trying to keep her alive so they wouldn't look bad/get sued. How can I make such a harsh statement like that? It's simple. Because I'd bet anyone a million bucks that if that patient were any OTHER transplant case (in which Duke wasn't liable), they would've said:
"Sorry, but you're not healthy enough for a 2nd transplant right now. Go away." This is what they do every single day (turn people away who aren't healthy enough for a tranpslant).

Originally posted by Polar girl
That seems weird to me. If people think she should have had the first even though illegal, it seems like the second would be a given, considering the second was only needed because the first was messed up and almost killed her.

I voted the reverse of the trend. I thought the second was very appropriate, whereas the first not as much so.

 

[Tuesday Weld]

This is so horrible! They're showing a still photo of the little girl lying in bed, looking lifeless, with her mother hovering over her with an anguished look on her face.

if that patient were any OTHER transplant case (in which Duke wasn't liable), they would've said:
"Sorry, but you're not healthy enough for a 2nd transplant right now. Go away." This is what they do every single day (turn people away who aren't healthy enough for a tranpslant).

In fact, it came out in the news only after she was declared brain dead that the blood stopped going to her brain after the first surgerical mishap - not after the second operation. Unfortunately, the damage was already so extensive that she didn't have much hope of recovery with a second transplant even before that second operation took place.

 

[womansurg]

Oops, I didn't read the directions. Well, screwed up on that test (god, it's just like real life...)

I understand people's indignation about a non-resident being allocated sparse, life saving resources which would otherwise be used on citizens. In the case of this heart/lung set however, it sounds as though the first set of organs were rejected by two other transplant surgeons in the Duke system, so they were more-or-less second hand organs which no one wanted to use otherwise.

As to the second transplant: inappropriate due to the general medical condition of the child at the time of transplant (stroke, renal failure, shock). Those organs were truly wasted.

 

[Yogi Bear]

it's interesting how only about 2/3 who voted answered the "consider immigration status" questions compared to those who answered the "ignore immigration status" questions.

 

[Gradient Echo]

Originally posted by womansurg
Oops, I didn't read the directions. Well, screwed up on that test (god, it's just like real life...)

I understand people's indignation about a non-resident being allocated sparse, life saving resources which would otherwise be used on citizens. In the case of this heart/lung set however, it sounds as though the first set of organs were rejected by two other transplant surgeons in the Duke system, so they were more-or-less second hand organs which no one wanted to use otherwise.

As to the second transplant: inappropriate due to the general medical condition of the child at the time of transplant (stroke, renal failure, shock). Those organs were truly wasted.

womansurg,

isnt there someone outside of Duke that could have used those organs? By bypassing the UNOS list, one of the critical safety checks (the UNOS computer match algorithm) was compromised.

UNOS should have looked at their list and realized that there was no other patient match to the organ set at Duke. Red flags should have been raised. But ultimately its the surgeons' fault.

 

[CatsAreKillers]

The news just declared that she died.

In fact, it came out in the news only after she was declared brain dead that the blood stopped going to her brain after the first surgerical mishap - not after the second operation. Unfortunately, the damage was already so extensive that she didn't have much hope of recovery with a second transplant even before that second operation took place.

I am seriously starting to regard Duke as being less than ethical.

Not only did they not practice due diligence in taking on the responsibility of transplanting people's organs without having a proper system in place to catch errors, but they knew going into the second transplant that, excuse the phrase, they were throwing those organs down the drain.

The only reason they put that second set of organs into Jessica's body was because it would have been even worse press had they not given her a second set; so at least Duke could proclaim "well, we tried".

That's unforgiveable considering that other potential transplant recipients may die because of this chain of events.

 

[dynx]

They might as well have thrown the second set of organs in the trash can. It was a stupid decision. In an attempt to cover their asses these doctors did more harm than they did in the original mistake. The first error was excusable...mistakes do happen and nobody is perfect. The second mistake was a deliberate decision to save face at the expense of other potential organ recipients lives. I don't give a damn about her nationality...She was here and in need so in my opinion she deserved the first transplant. And again regardless of nationality she should have never gotten the second set of organs. I Don't mean to insult people but if you wouldn't have had the heart or the balls to make the tough decision in this case to deny her the second organ transplant then you should reconsider your career in medicine. By putting the 2nd organs in a girl they KNEW was going to die these doctors willingly cost up to three people there lives.

 

[Nirvana]

Very well said.

Originally posted by dynx
They might as well have thrown the second set of organs in the trash can. It was a stupid decision. In an attempt to cover their asses these doctors did more harm than they did in the original mistake. The first error was excusable...mistakes do happen and nobody is perfect. The second mistake was a deliberate decision to save face at the expense of other potential organ recipients lives. I don't give a damn about her nationality...She was here and in need so in my opinion she deserved the first transplant. And again regardless of nationality she should have never gotten the second set of organs. I Don't mean to insult people but if you wouldn't have had the heart or the balls to make the tough decision in this case to deny her the second organ transplant then you should reconsider your career in medicine. By putting the 2nd organs in a girl they KNEW was going to die these doctors willingly cost up to three people there lives.

 

[turbomech7]

Very well said indeed!

Originally posted by dynx
They might as well have thrown the second set of organs in the trash can. It was a stupid decision. In an attempt to cover their asses these doctors did more harm than they did in the original mistake. The first error was excusable...mistakes do happen and nobody is perfect. The second mistake was a deliberate decision to save face at the expense of other potential organ recipients lives. I don't give a damn about her nationality...She was here and in need so in my opinion she deserved the first transplant. And again regardless of nationality she should have never gotten the second set of organs. I Don't mean to insult people but if you wouldn't have had the heart or the balls to make the tough decision in this case to deny her the second organ transplant then you should reconsider your career in medicine. By putting the 2nd organs in a girl they KNEW was going to die these doctors willingly cost up to three people there lives.

 

[omores]

Originally posted by cg1
[Duke was] just scrambling around in CYA mode trying to keep her alive so they wouldn't look bad/get sued. How can I make such a harsh statement like that? It's simple. Because I'd bet anyone a million bucks that if that patient were any OTHER transplant case (in which Duke wasn't liable), they would've said:
"Sorry, but you're not healthy enough for a 2nd transplant right now. Go away." This is what they do every single day (turn people away who aren't healthy enough for a tranpslant).

Actually, the reverse is true. In order to be put on the transplant list in the first place, you have to be sufficiently sick. And once you are on the list, in order to achieve top priority, you have to be DEATHLY ill: status 1A is reserved for those who will die within days without a transplant. For heart transplants, this means those on life support. This system ensures that donor organs go to those who need them most, but it also means that those organs go to those who are least liable to be able to withstand the stresses of surgery and recover completely.

 

[omores]

Originally posted by CatsAreKillers
The only reason they put that second set of organs into Jessica's body was because it would have been even worse press had they not given her a second set; so at least Duke could proclaim "well, we tried".

That's unforgiveable considering that other potential transplant recipients may die because of this chain of events.

Originally posted by dynx
They might as well have thrown the second set of organs in the trash can. It was a stupid decision. In an attempt to cover their asses these doctors did more harm than they did in the original mistake. The first error was excusable...mistakes do happen and nobody is perfect. The second mistake was a deliberate decision to save face at the expense of other potential organ recipients lives...By putting the 2nd organs in a girl they KNEW was going to die these doctors willingly cost up to three people there lives.

I find the cynicism evident in these replies to be very disturbing. How can any of us be certain that the only reason that the second transplant took place was as a face-saving gesture? Do you truly believe that the only thing that mattered to her surgeons was preserving their own reputations? What about trying to save a life they themselves had jeopardized? Transplant surgeons, like most others in medicine, are motivated by strong desires to help people get better. Yes, ego and reputation are also involved, along with money, job security, and all those other reasons nobody likes to discus in an AMCAS personal statement. But to argue that the surgeons were only concerned with their own reputations is simplistic, cynical, and sad.

If her surgeons had known in advance that Jesica was unequivocally doomed with or without a transplant, then of course the second operation should never have taken place. But who could possibly have known that? Yes, Jesica was dying, but that's a prerequisite for achieving priority status on the transplant list. To be eligible for organs, you must be near death. Her one chance of getting off life support was with a new heart and lungs, and her surgeons took that chance. I'm glad they did, even if it proved fruitless.

 

[dynx]

blood stopped flowing to her brain BEFORE the 2nd transplant. Can you think of any OTHER reason to put organs in a brain dead girl? I for one cannot.

 

[Gradient Echo]

Originally posted by dynx
They might as well have thrown the second set of organs in the trash can. It was a stupid decision. In an attempt to cover their asses these doctors did more harm than they did in the original mistake. The first error was excusable...mistakes do happen and nobody is perfect. The second mistake was a deliberate decision to save face at the expense of other potential organ recipients lives. I don't give a damn about her nationality...She was here and in need so in my opinion she deserved the first transplant. And again regardless of nationality she should have never gotten the second set of organs. I Don't mean to insult people but if you wouldn't have had the heart or the balls to make the tough decision in this case to deny her the second organ transplant then you should reconsider your career in medicine. By putting the 2nd organs in a girl they KNEW was going to die these doctors willingly cost up to three people there lives.

I think the first mistake was inexcusable. You cant just fail to check for an organ/tissue match. That just cannot happen and be normal or a foreseeable mistake or in any way excusable.

I dont think its clear that there was a 100% chance she was going to die if she got the right organs. From what I heard her chances were about 50%. Not great, but her death wasnt a sure thing either.

I am wondering if there were any improprieties with UNOS. Supposedly, institutions are not supposed to be able to circumvent the UNOS priority algorithm, but I'm sure there were a few phone calls made by Duke to UNOS to try and "speed up" the 2nd match process

 

[Gradient Echo]

Originally posted by dynx
blood stopped flowing to her brain BEFORE the 2nd transplant. Can you think of any OTHER reason to put organs in a brain dead girl? I for one cannot.

She was brain dead BEFORE the 2nd transplant? Thats the first I've heard of that

 

[Gradient Echo]

Originally posted by omores
Actually, the reverse is true. In order to be put on the transplant list in the first place, you have to be sufficiently sick. And once you are on the list, in order to achieve top priority, you have to be DEATHLY ill: status 1A is reserved for those who will die within days without a transplant. For heart transplants, this means those on life support. This system ensures that donor organs go to those who need them most, but it also means that those organs go to those who are least liable to be able to withstand the stresses of surgery and recover completely.

thats my understanding too... I know that the UNOS computer gives priority to people slated to die within 7 days without a transplant.

Now the real question is how much are institutions (like Duke) able to circumvent these priority rules by taking the organs for someone else.

 

[geromine]

my reaction to poll results so far:
I think it is completely irrational to think that the second transplant should have been given IF they had evidence of brain damage before the second surgery. The prospects of a multimillion dollar lawsuit may have once again hurt healthcare delivery in this country, this time by wasting valuable organs that could have gone to save a life that was actually salvageable.

I also think that it is sad to see that there is such a big discrepancy between results that consider and those that do not consider nationality. We can afford to donate billions of dollars to help the AIDS and infectious disease epidemics in countries that are thousands of miles away but we're somehow not supposed to help out a fellow human being on the verge of death that lives in our own country?

How does that make any sense??

 

[INeedAdvice]

Originally posted by dynx
blood stopped flowing to her brain BEFORE the 2nd transplant. Can you think of any OTHER reason to put organs in a brain dead girl? I for one cannot.

For those questioning - I think dynx is correct about this. The Duke spokesman wsa essentially giving this as the main reason why the 2nd transplant never took.

It was stated several times over the weekend that the surgeons could find no blood flow to her brain after the first transplant. I'm sure the Duke surgeons would have been able to detect blood flow, if in fact, there had been some.

 

[MacGyver]

Originally posted by INeedAdvice
For those questioning - I think dynx is correct about this. The Duke spokesman wsa essentially giving this as the main reason why the 2nd transplant never took.

It was stated several times over the weekend that the surgeons could find no blood flow to her brain after the first transplant. I'm sure the Duke surgeons would have been able to detect blood flow, if in fact, there had been some.

How can her heart be beating yet there's no blood flow to the brain?

Was there a clot or something?

 

[dynx]

MacGyver - a clot, shock causing hypotension and inadequate perfusion, a couple of ways. I however cannot find the source I read this in before the 2nd operation so if anybody else can help me reference my statement it would be greatly appreciated.
Gradient echo - I think excusable may not have been the perfect word for me to use. I was just trying to convey understanding of the fact that people make mistakes and to crucify the doctor or other staff for something that anybody having a bad day (very bad) could do was not, in my opinion, the right thing to do.

 

[womansurg]

Actually, nearly all cases of organ harvest take place in bodies which are brain dead but still with beating hearts. Brain death can be defined by nuclear medicine testing demonstrating lack of blood flow (blood doesn't flow through dead organs), or clinical criteria which include no response to deep pain, loss of pupillary reflexes, no response to cold calorics testing, and no attempt at spontaneous respiration despite adequate challenge with hypercarbia and hypoxia. That's partly why there's such a scarcity of organs available for donation: while people die all the time, the criteria for organ harvest are a living, perfusing body with a dead brain. Pretty rare. Usually just seen in cases of isolated head trauma or massive hemorrhagic stroke.

Recently there have been provisions to harvest in non-beating heart scenarios. So if someone doesn't meet criteria for brain death - continues to have pupillary response despite massive brain injury, for example - you can withdraw life support down in the OR and, as soon as death is documented, immediately harvest the organs before (hopefully) warm ischemic injury is incurred.

Wild and wacky stuff.

 

[CatsAreKillers]

Recently there have been provisions to harvest in non-beating heart scenarios. So if someone doesn't meet criteria for brain death - continues to have pupillary response despite massive brain injury, for example - you can withdraw life support down in the OR and, as soon as death is documented, immediately harvest the organs before (hopefully) warm ischemic injury is incurred.

I don't know about you, but this sort of scares me.

I would be afraid that someone in my family have a massive head injury and the doctors would want them taken off of life support in order to give their organs to someone else...even if my family member was not brain dead. If they're not brain dead, I would hope for a miracle and they could pull through...it's not unheard of. I wouldn't want to give up on my family member until all options were out (i.e., until they were brain dead).

 

[Tuesday Weld]

I don't know about you, but this sort of scares me.[/B]

And for good reason.

This is the kind of stuff that science fiction writers love. Ever see the movie, "Coma" ?

I think doctors are going to run into a backlash from the public if they are perceived as wanting to harvest organs from someone who they regard as being closer to death than someone who needs those organs.

That is playing god.

I would hope there aren't any doctors out there that would rationalize taking an organ from a dying person by saying that they have a closer chance to dying than their organ recipient.

Or that there are doctors that think that the dying patient's quality of life will be so impaired because of their brain injury that they should be passed over to give their organs to someone else.

Or even worse, that they could perform "impressive" transplant surgeries with that dying patients' organs. That's very cynical and I don't think it exists. I'm sure doctors don't put their careers ahead of a dying patient's life...but when you hear about these medical "break throughs" it makes you wonder if there's not 1 or 2 sick people wrapped up in their medical career that would do such a thing. People have been know to do far worse.

 

[Yogi Bear]

As of 85 votes, here's the summary statistics:


QUESTION A: If we were to ignore nationality, based on all the facts you've considered, should the girl have received the 2nd organ transplant?
-65 people voted.
-75% Yes, 25% No.

QUESTION B: If we were to consider the fact that the girl was an illegal immigrant (not us citizen/permanent resident) based on all the facts you've considered, should the girl have received the 2nd organ transplant?
-41 people voted.
-44% Yes, 56% No.


QUESTION C: If we were to consider the fact that the girl was an illegal immigrant (not us citizen/permanent resident) based on all the facts you've considered, would you have given her the 1st transplant?
-49 people voted.
-59% Yes, 41% No.

QUESTION D: If we were to ignore nationality, based on all the facts you've considered, should the family sue Duke and/or doctor(s) involved?
-63 people voted.
-67% Yes, 33% No.


QUESTION E: If we were to consider the fact that the girl was an illegal immigrant (not us citizen/permanent resident) based on all the facts you've considered, should the family sue Duke and/or doctor(s) involved?
-43 people voted.
-42% Yes, 58% No.



--interesting that in general, people were reluctant to answer the 'consider immigration status' questions. about 50% more answered the 'ignore immigration status' questions.

 

[womansurg]

Sure, that type of thinking is why this approach is only now being utililized. People are understandably cautious about making irreversible decisions when hope for recovery exisits.

There's a difference between being brain dead and being in a persistent vegetative state with no hope for improvement. For instance, if a bullet or blunt trauma has blown apart much of your cerebral cortex, you may not be brain dead. You may still retain medullary functions of pupillary response, homeostasis and such, yet you would never, ever have any hope of regaining any cognitive functions. In these situations life support is withdrawn and the patient expires naturally usually within a short period of time, usually from respiratory failure. It's far less than ideal for organs to be harvested after being exposed to a period of hypoxia and hypotension. Some injury must necessarily occur.

This is unlike when organs are harvested after a declaration of brain death. Multiple surgical teams converge on the patient simultaneously. The heart is taken first, and is beating and perfusing right up to the point of crossclamp. At that point, the ventilator is turned off and the anesthesiologist often physically leaves the room - his/her work is done. The other teams then rapidly harvest the remaining organs: lungs, kidneys, pancreas, rarely small bowel. Other types of tissue are taken at a more lesiurely pace, but for these major organs there are significant time constraints on ischemic times.

 

[omores]

Originally posted by dynx
blood stopped flowing to her brain BEFORE the 2nd transplant. Can you think of any OTHER reason to put organs in a brain dead girl? I for one cannot.

I can't find a reference to this in the written press, and I've looked -- the only mention I've seen is "minimal brain damage according to CT two days before the transplant". But if you are able to find a source, do let me know. But to answer your question: if she were brain dead after the first transplant, could I think of a reason other than face-saving to explain why she was given a second transplant? You bet: hope (however misplaced). Stubborness. A desire to put things right. Don't get me wrong -- I'm not saying that face-saving wouldn't be part of it, but I do believe the surgeons would have been motivated by far more than that. Surgeons fix things -- that's what they do. I imagine they would have a hard time admitting that the mistake they caused was irreparable. Never underestimate the power of self-delusion.

Originally posted by Gradient Echo
Now the real question is how much are institutions (like Duke) able to circumvent these priority rules by taking the organs for someone else.

Interesting question. Obviously they are to a certain extent, as evidenced by the juggling that went on during the first transplant. That may be because the organs were already at Duke and were rejected by the first surgeon, and it was too late to fly them to some other part of the country. But as for "a few well-placed phone call," hey, I wouldn't doubt it.

 

[turbomech7]

Very well put geromine

Student Doctor Network... none of you deserve to be physicians in any category if you put nationality or immigration status before your patients' health.

Picture a society where such rationality exists. Hypothetically two extremely critical gunshot victims are rushed to an ER, and one of them is an american citizen while the other is an illegal immigrant who is a bit more severely injured. Also, there is only one Emergency phycisian available for now.

According to such prejudiced rationality, the doctor should try and save the life of the american citizen because he is a tax paying american citizen and ignore the illegal immigrant's more severe condition because he believes he can only save one.

If you agree with this rationality you belong to Discriminating Idiot network, not Student Doctor Network! Please leave this profession!

Originally posted by geromine
I also think that it is sad to see that there is such a big discrepancy between results that consider and those that do not consider nationality. We can afford to donate billions of dollars to help the AIDS and infectious disease epidemics in countries that are thousands of miles away but we're somehow not supposed to help out a fellow human being on the verge of death that lives in our own country?

How does that make any sense??

 

[Yogi Bear]

Originally posted by turbomech7
Very well put geromine

Student Doctor Network... none of you deserve to be physicians in any category if you put nationality or immigration status before your patients' health.

Picture a society where such rationality exists. Hypothetically two extremely critical gunshot victims are rushed to an ER, and one of them is an american citizen while the other is an illegal immigrant who is a bit more severely injured. Also, there is only one Emergency phycisian available for now.

According to such prejudiced rationality, the doctor should try and save the life of the american citizen because he is a tax paying american citizen and ignore the illegal immigrant's more severe condition because he believes he can only save one.

If you agree with this rationality you belong to Discriminating Idiot network, not Student Doctor Network! Please leave this profession

geez...chill out turbomech7. name calling calling?!? c'mon!!! i think u could try to be a bit more logical and stop calling people/organisations names just cuz you don't agree what others believe. you're just using a bunch of sweeping generalizations...calling for people to "leave this profession" just cuz they don't believe what you believe.

you say"illegal immigrant who is A BIT more severely injured". why are you already giving the illegal immigrant the benefit of the doubt? That's not being very FAIR towards americans is it? what didn't you phrase it as: "illegal immigrant who is JUST AS severeley injured." that's something that i'd be willing to deliberate over. even then, would it be more morally sound to help someone w/in your community, who at least shares something in common w/ u, or to help total strangers? How would people w/in your community feel if resources are limited and you neglect one of them to help an outsider, all things being equal? I strongly believe that as physicians, we must also be sensitive to our communities and be realistics. although a sense of idealism is what many of us future docs have that pushes us towards medicine, we shouldn't only consider our beliefs, which may be a bit too idealistic at times. If our community is what made us what we are today (who will be paying the bills to support your training, support your office, etc.?), I don't think I could justify helping someone with no connection to my community when soemone w/in my community is also inn dire need of help, all things eing equal. however, if the person in my area won't be severely harmed, I would not hesistate help the illegal immigrant.

 

[womansurg]

Originally posted by turbomech7
Hypothetically two extremely critical gunshot victims are rushed to an ER, and one of them is an american citizen while the other is an illegal immigrant who is a bit more severely injured. Also, there is only one Emergency phycisian available for now.

According to such prejudiced rationality, the doctor should try and save the life of the american citizen because he is a tax paying american citizen and ignore the illegal immigrant's more severe condition because he believes he can only save one.

Let's try a more realistic analogy.

You rush your critically injured 10 year to the local ED with a GSW to the chest. After evaluation and stabilization, you're informed that your child has irreparable cardiac injury. She can be kept alive for a short period of time on life support, but that she'll need transplantation to save her life. Unfortunately, because the hospital practiced a fiscally irresponsible policy of treatment based soley on medical need, the transplant program is no longer existent. After last year, during which time two illegal aliens, an African, a Cuban and two Canadians received transplants - none of whom had any resources or assistance from government funding, the program went into bankruptcy. The surgeon is working as a general practioner; all of the OR crew jumped ship after 3 pay periods without a paycheck and loss of their own insurance coverage; and the transplant coordinators are now dealing kidneys with the private pay hospital across town.

Your child dies the next day. On arrival home from the funeral two envelopes are in your mailbox: a bill from your health insurance company for $1800 to cover your family's needs over the next quarter, and a W2 from your employer indicating that you paid $22,000 in taxes this year: 40% of your gross income.

 

[MacGyver]

Originally posted by womansurg After last year, during which time two illegal aliens, an African, a Cuban and two Canadians received transplants - none of whom had any resources or assistance from government funding, the program went into bankruptcy.

Jesica had full insurance coverage and was able to pay all her medical bills. I would argue that Jesica in fact paid for other peoples medical care (transplant surgeries are overcharged to those who can pay in an attempt to recoup funds for those who did not pay)

 

[Ryo-Ohki]

Hell yes. I would save the American one.

 

[Rhiana]

Quit with the holier than thou attitudes. There is a very good reason that an illegal immigrant shouldn't get priority. She could get deported back to Mexico where the medical care she recieves will not be the same as here. She is going to be on immunosuppresants the rest of her life and in Mexico she would be very susceptible to disease due to unsanitary conditions. And as for recieving prescription drugs from Mexican pharmacys, many times they are expired, diluted, or may not have the active ingrediant at all. Even if she didn't get deported her medical bills are only covered because she is a child, once she becomes an adult she'll get booted out of the system and will probably have difficulty getting a job with medical benefits because she's illegal.
The only reason there is so much sympathy and "hope" for this patient is because we've seen her picture. Let's not forget the pictures of the other patients who are dying because this girl recieved a second transplant. But we don't see those pictures because people die on transplant lists all the time: It's not special. If you think that being a doc means you don't have to face people who won't get the same chance this girl got then stay out of medicine. And if you don't have the balls to make tough descions about who is more deserving and who isn't, then stay out of medicine. It will eat you alive

 

[INeedAdvice]

That might be true, and I'm not commenting one way or the other, but where did she get the money? From that American guy asking for American donors to give their money. I doubt this takes place for the majority of illegal immigrants who get transplants in the U.S..

This reminds me of what the welfare community calls "health insurance". Many welfare programs have "Government paid health insurance". Well, that's not exactly health insurance...it's still welfare. I know lots of people who work and pay taxes, yet they don't have the discretionary income to buy health insurance....it's their call and they've decided that they can't afford it...yet they are forced to give money, by way of taxes, to pay for other peoples' "health insurance" (which isn't health insurance....their tax dollars are going to welfare.)

Again, I'm not commenting one way or the other on it, but I just want to point out the discrepancy between what something is called and what it really is...

Jesica had full insurance coverage and was able to pay all her medical bills. I would argue that Jesica in fact paid for other peoples medical care (transplant surgeries are overcharged to those who can pay in an attempt to recoup funds for those who did not pay)

 

[pillowhead]

You know what really pisses me off? Forget about the illegal immigration status...her parents are refusing to donate her organs. After she has recieved TWO sets of organs, her parents are unwilling to donate her kidneys, corneas, liver, etc. That is so wrong. If you are going to accept someone else's organs, you really should (how about damn well should) be willing to donate yours. Oooh..that makes me so mad

 

[Mr. Z]

Great point pillowhead!

I'm surprised it took that long for someone to mention that issue...

She recieved two sets of organs and then her parents refused to donate. I wonder how many lives that decision will cost??

It's a damn shame. There should be some type of contract legally requiring those that accept organ donations to be donors themselves, should the transplants not take.

 

[pillowhead]

I understand some people have religous objections to organ donation b/c they believe they need to be buried whole, as they came into this earth. but these people generally don't accept organs either. seems to me you can't have it both ways. If you don't want to give, fine, but you don't get to receive either.

 

[INeedAdvice]

Mr. Z - isn't that a good idea?? Poster "X" mentioned it a couple of days ago (see the "Forced Organ Donation" thread in the Everyone Forum). There should be a law about this. Granted, they probably can't take most organs from a former organ recipient, but a few are better than nothing.

Originally posted by Mr. Z
Great point pillowhead!

I'm surprised it took that long for someone to mention that issue...

She recieved two sets of organs and then her parents refused to donate. I wonder how many lives that decision will cost??

It's a damn shame. There should be some type of contract legally requiring those that accept organ donations to be donors themselves, should the transplants not take.

 

[opus]

FYI http://www.washingtonpost.com/wp-dyn/articles/A61400-2003Feb24.html

 

[CatsAreKillers]

So the family did inquire about re-donating her heart and lungs??

It sounds like Duke isn't really backing up the family on this and mentioning this in the news. They're just saying: "let the family grieve"...but they're not mentioning that the family did indeed ask about re-donating her donated organs?? I wonder if that's to take off some bad publicity from them and put it on Jessica's family? I'm not putting anything past Duke after they gave organs to a girl that they knew wouldn't live only to save face and minimize their liability.

Originally posted by opus
FYI http://www.washingtonpost.com/wp-dyn/articles/A61400-2003Feb24.html

 

[Yogi Bear]

http://www.usnews.com/usnews/nycu/health/articles/030728/28jesica.htm UPDATE