When it was time to decide which fellowship to do, I agonized for a bit; so much so, that I took a year off, actually, because I really don’t believe in agonizing over decisions – I think important decisions should be easy. The right choice feels right! I even wrote my residency personal statement on this – and got compliments on it!
But anyway, when I was agonizingly trying to decide which fellowship to do, for a while there I thought I might do hepatology and transplant GI. It came from the fact that two family members of mine had serious GI illnesses, plus I thought the liver was just dandy. When I got to fellowship, however, I found myself having very unpleasant thoughts, which I did not appreciate. I thought, for every person who “deserves” to receive an organ via someone else’s ultimate sacrifice, there are ten who spent their lives actively ruining their own organ, and now we’re about to spend hundreds of thousands of dollars and hours of manpower to save them so that they can do what? Go back to ruining their gifted liver? Or not? Will they ever be productive members of society? I kept thinking, are we playing god here, and do we have that right? Which then led me to think, isn’t being a doctor kind of like playing god, and is that right?
These are awful thoughts, especially for a doctor. Who am I to say who deserves what, and if a productive person’s life worth more than a person’s on disability? Tell that to family members, right? By the way, the method insurance companies use to calculate premiums and benefits for life insurance policies is to estimate how much the person would have produced in dollar amount if they had lived. Coming up with those numbers might be even more ethically dubious than deciding who deserves an organ!!
Regardless, in fellowship, we had a transplant candidate meeting every Friday morning, where a bunch of doctors, nurses, coordinators, financial advisors and other miscellaneous professionals discuss people on the list, and people who want to get on the list. It’s like the Jedi council. A patient’s picture and chart is put up on the projector, and everyone says their piece, they calculate a score of how sick the patient is, whether they can handle the psychological and physical stress of a transplant, how (note, how, not if) they will be able to afford it, and finally, a decision is made. Yea or nay, and if nay, why nay, and what can be done to turn the nay into a yea.
People waiting for a liver are in a curious predicament, as are their doctors: only the really sick ones get a liver, b/c it’s a rare organ around these parts (there are 4 transplant centers, and helmet laws are in place, so… livers are scarce), so you kind of want your patients to be a little bit sick, but you also want them to be better so they’re not too sick to handle a major surgery. Transplant medicine itself is kind of a curious predicament. For one sick person to live, a healthy person has to die. I try to think of it like, oh, people die anyway, and this way, they can leave a legacy behind. But the fact is someone has to die for someone else to live. And the doctors have to live too – with that uncomfortable fact, a fact that no one really talks about.
One day, we were discussing one person who was in the hospital that week, who was sick enough for a transplant, but who’s teetering on the threshold where they’re just a tad too sick for surgery. It was a nasty day, and I was actually surprised we had the meeting at all. There had been a snowfall followed by and ice storm and loss of electricity for many. I remember driving into work that morning; at some point on route 9, I crossed over from a wet road and naked trees to a a road flanked by trees with crystallized branches. It was so pretty, incongruous with the weather.
We were expressing worry that we may have missed the window for the patient. The head surgeon said, “What can we do! Would you believe it, in this district, there have been no liver offers. None at all whatsoever. Not even cirrhotic ones.”
Someone else replied: “What, even with the snow storm?”
A third person said, “Even with the plane crashing into the Hudson?” (remember? when the plane landed on the water, and all the people got out onto the wing? No deaths! No livers!)
The surgeon said, “Oh yeah. They all survived.”
“Oh that’s too bad,” someone else said.
And everyone kind of chuckled.
And it’s not really serious, except it kind of is. In that haha look away shake your head kind of way. Like sexist jokes or something. And I chuckled too, because it’s funny, and I like black humor.
But… I didn’t end up doing transplant. I’m not saying it’s because of my morbid thoughts or because I somehow took some sort of ethical high-ground – it could just be because I witness the grueling work and frustration of the field. Or it could be because the hepatologist in charge just wasn’t all that nice to me. Little things like that somehow end up making important decisions less agonizing, making the “right choice feel right.” Were they nice to me? Did they give me a lunch break?
So, I’m not saying life, death, productive society members, deserving, not deserving, all that jazz, is why I didn’t do transplant. But, I tellya, curious predicament, this transplant business. And as annoyed as I get at all the bloating and IBS, at least I don’t have to wish for people to die so others get to live…
2 thoughts on “When one person dies so another can live”
This was such an interesting read. I have never considered all the moral dilemas that surround transplant surgery before. I had no idea that doctors reviewed candidates that way either… necessary but kind of sad.
yes. It’s actually very impartial, there is a score and a list of criteria put forth by UNOS to make it fair, and prevent things like VIP patients getting ahead of everyone else… But it’s still so weird…