Rescuing Lives: Can't We Count?

On 16 September 1993, five-year-old Laura Davies of Manchester, England, received small and large intestines, stomach, pancreas, liver, and two kidneys in a fifteen-hour, transplant operation at Children's Hospital of Pittsburgh. The National Health Service paid for little of her care, but scores of private donors responded to newspaper publicity and her parents' appeals to provide the half-million pounds and more required for her various operations. In this case, where was medical technology taking us? Laura died on 11 November. According to her Manchester physician at the time of the operation, however, Laura had a "better that) 50-50 chance." After all, the three previous child recipients of multiple organs at Pittsburgh since the advent of a new antirejection drug in 1992 are still alive. It is thus difficult to dismiss the willingness of Laura's parents and physicians to proceed as using her for their own emotional or scientific purposes. Though surely "experimental," the surgery was the only chance Laura had. And if anyone, either then or now in light of her death, claims that the 50-50 odds were inflated, a straightforward reply is available: maybe you're right, but let us employ this procedure, now and at other times, to see. Plucky Laura herself seemed to put the "guinea pig" charge to rest. "I'm not worried," she told reporters at a press conference. Then she ended the session with a song. A standard objection to high expense-per-benefit care also does not apply: funded privately by response to special appeal, Laura's care does not come at the expense of anyone else whom limited funds might have saved. With a child like this and the money pouring in from donations, why should we dispute her parents' and physicians' decision? On a medical mission? Sure. Carried away? In the circumstances, seemingly not. Still, something has been missed that is very problematic about Laura's aggressive care: in the attempt to save her, a greater number of other lives were sacrificed. It's a straightforward function of the marked scarcity of organs. Nearly half the children now on organ transplant waiting lists the before they get them. We should all be able to see the big picture: if one person at the head of the queue gets four scarce organs instead of one, four others somewhere down the queue, not one, never get any. Both the British and the U.S. publics seem reluctant to recognize this. Take Pennsylvania's Governor Casey last spring. At first his waiting only a few days before receiving a heart-liver transplant met with skepticism: had he been allowed to jump the queue because of his political status? The Pittsburgh transplant center quickly replied: absolutely not, he was treated as any other multiple organ failure patient would have been. Because of the multiple failure, his need was more urgent. With the political queue-jumping charge rebuffed, the critics backed off. But if organs are scarce, and those used in multiple scarce organ transplants could virtually always have saved more fives if used on others, what can possibly justify any multiple organ transplant candidate's elevation to the top of the queue? Except in the event of an extremely rare match, only two readily understandable explanations seem available, and neither justifies what was done. One is pushing outward the medical frontier: carry out Casey's and Davies's more challenging operations despite the current sacrifice of a greater number of others' lives, and we will eventually develop new, effective forms of lifesaving. But this sort of argument represents the most extreme kind of medical adventurism. With the scarcity of organs virtually certain to continue--especially for children and infants, where we are already getting close to maximum contribution--what is the likelihood that multiple organ transplants will ever cease to use up on one person what could have saved several? A totally pollyannish view of future organ supply chives the "experimental development" argument. …