Ethical Issues Involved In Medicare-Funded Organ Transplants

Introduction

When the dialysis machine was discovered in 1960s, there were hopes that renal failure patients would get a life prolonging care. For renal failure patients it was a matter of life and death and everyone was willing to pay the amount no matter what to get to the dialyzed. Soon, it became a controversial issue when it was realized that the demand was outstripping supply and equal distribution of the few dialysis machines available became controversial.  While the issue of dialysis machine is still controversial, our health care system has been caught in another ethical dilemma regarding organ transplant.  Organ transplant is closely tied to the issue of dialysis since renal failure patients can get organ transplant as an alternative to dialysis.  The issue has been complicated by the fact Medicare has been funding organ transplant and there are those who feel that allocation of the scarce transplant is not fair.

There are thousands of terminally ill patient whose life can be saved by organ transplant but there is no any working formula that can be used to determine who among the thousand patients will be given priority. It is left to the discretion of the medical officers to decide who is worth saving. In order to deal with this problem, there is need to come up with strategies that will ensure fair distribution of Medicaid funded organ transplants in order to save the life of those who are deemed deserving. This strategy should take into consideration the condition of the patient and their financial position such that only those who cannot afford to purchase the organs are given priority. However, prevention is better than cure and therefore promoting prevention strategies for condition leading to organ failure should be the long term strategy to deal with the problem.

Background

The problem faced by the health care organization in fair distribution of medical resources and the role played by medical professionals is not new to our health care system.  Since the turn of the 20^th century, the problem has been indicated in several medical publications especially with the rising healthcare need and the inability of the government to put in place effective strategies to deal with the problem. As we outlined in the introduction, the discovery of the dialysis machine was the first real ethical dilemma that was faced by the health care sector as it because difficult to determine who would be allocated the few dialysis machine available.   It was a matter of life and death as patients struggled to access the few dialysis machines especial for those patients who were covered by Medicare (Veatch, 2000).

Since 1970s, the increased researches in genetic engineering opened a new medical front. The continued research introduced new medical procedures through which a failed organ could be replaced with a working organ without adverse effects on the patient.  Immediately, there were many patients who lined up to get organ transplants in order to save their life.  The scarcity in organs and tissues against the rising demand makes the transplantation impossible. The limitation of supply of organs and tissues is not likely to be alleviated by simple argumentation of funding (Mone, 2002).

Medicare came into being in 1960s after the government realized that there was a growing segment of the population mainly the elder and the poor who could not afford the rising cost of medical care. From a simple program supporting a small segment of the population, this number has risen considerably and today, Medicare is the backbone of public health in the country. Apart from providing medical service, Medicare has also added the range of conditions covered to include organ transplant (Caplan and Danile, 1998). Medicare funds organs transplant for patient who are already enrolled in the program although this may vary from state to state.

Problem definition

Since 1970s, the continued genetic engineering research has offered a promise to individual suffering from organ failures another hope of life. However, this hope is dashed by the inability of individuals to gain access to the rising waiting list for organ transplant.  Although Medicare has become the backbone of the public funded health care in the United States, the distribution of these funds, especially on the issue of organ transplant is quite controversial. While the demand for organ transplant has risen considerably, the current supply of organ transplant has continuously decreased. The ethical issue therefore surrounds the procurement of transplant organs and ensuring fair distribution among Medicare patients based on their needs. How can the ethical issue regarding procurement and distribution of organ transplants be resolved?

Literature review

Medicare is a government-sponsored insurance scheme which covers medical expenses for the low income patients. The administration of Medicare depends on the individual states and the coverage as well as the extensiveness of the coverage also depends on the individual states. Due to the increasing need of organ transplants, Medicare has therefore become an important backbone in providing organ transplant expenses.

One of the ethical issues surrounding organ transplanting has been lack of equitable distribution of organ transplants (Levine et al., 1992).  As early as 1980s, this problem had been singled out as a great impediment in improving the health care status of Americans.  Therefore in 1984, the congress enacted The National Organ Transplant Act which in advance provided for creation of Organ Procurement and Transplantation Network. However, despite the existence of this Act there were more than 4,000 patients who died in 1990s, as they awaited organ transplant.  At the same time, the act also put in place guidelines which ensured that the families of dying patients were well educated on the importance of organ donation (Wendler and Neal, 2001).

The list of those waiting for organ transplant has been on the rise since 1970s (Matt, 1994; Iglehart, 1983). Even with the enactment of The National Organ Transplant Act   1984 there has not been a solution on sight. The problem is complicated by the fact that the sale of organs is still illegal in the United States.  Theoretical impact of the ban or organs is that this has greatly reduced the number of organs available in the country for transplantation (Perry, 2009).  In some cases, there are patients who can afford to purchase transplant organs but this ban has been a great impediment on such effort (Mistichelli, 1995; Veatch, 2000).

Problem analysis

The ability to keep an individual alive through replacement of one or more body organ has been one of the major achievements of the scientific world in the 20th century. However, there are several ethical issues surrounding the development of this technology.  Traditionally the debate has surrounded the religious issue and sanctity of life regarding the organ transplant (Mistichelli, 1995). With time, the important role played by organ transplant has been recognized and the debate has shifted from religious view to the sacarcity of these resources and prioritizing of those who should receive the available organs.  Since 1970 data from National Transplant Waiting List has swelled and by 2001, there wren more than 76,555 patients in the waiting list for organ transplant.

In Doctros Dillema, Dr. G. B Shaw argued that;

 “Your must understand. You’ve got to understand and face it. In every single one of those ten cases I have had to consider not only whether the man could be saved but whether he was worth saving. There were fifty cases to choose from and forty had to be condemned to death. Some of the forty had young wives and helpless children. If the hardness of their cases could have saved them they would have been save ten times over” (NHMRC, 1997, p. 2)

This doctor statement outlines that ethical dilemma that our health care system is facing.  The issue has been complicated by the fact that Medicare has been offering funding for transplant organs. The free funding acts as an incentive which attracts more people to line up for organ transplant. However, as we have seen in the above doctor statement, the main dilemma is prioritizing who will receive the available organs while there are hundred of patients in dire need of organ transplant.

The main ethical issue surrounding the Medicare funded organ transplant therefore surrounds the availability of the organs to match the rising demand.  Research has found out that the list for those waiting organ transplants has been increasing more than the increase in the list of organ donors. In most cases physician feel that government rules on access and donation of organs is sometimes a greater impendent in their work. Most physicians are left with the ultimate solution of deciding who will get priority on the even increasing list of those waiting for transplants (Gerald, 1992).

Furthermore, there is a growing number of government rules on access and donation of   organs is sometimes a greater impendent in their work. Most physicians are left with the ultimate solution of deciding who will get priority on the even increasing list of those waiting for transplants.

Under the current government provision, there must be consent from the donor or a member of the family to donate their organs when they die.  This means that there are a number of people who would have donated their organs but because there are no members of the family to give consent or just because they cannot give consent, they don’t donate their organs.  This has greatly impended on increased supply of organs to match the rising demand (Caplan and Danile, 1998).

Furthermore, there is a growing number of medical and social workers who feel that the ban on sale of organs has also been a great impediment in ensuring increased access to organs. Although this ban is meant to control proliferation of illegal organ trade, the government effort to entice the community for increased donation of organs has also been limited. The government has not done enough to sensitize the whole community the positive aspect of organ donation which has led to inadequate supply of organs.

Possible solutions

In order to resolve the ethical dilemma surrounding this access of organ transplant, there are different solutions that can be put into practice.

The first solution would be to increase the supply of organs for transplant through different ways.  This can be implemented in different ways ranging from fostering a greater public understanding of the importance of organ donation. This should be accompanied by informing the public of the necessary safeguards that will guarantee them that patient care is more important than harvesting of organs.  This would also involved changing our organ harvesting  laws like those of Belgium and Brazil where organ donation is not based on patient or relative consent but rather it would be presumed obvious (Perry, 2009).

The other solution would be encouraging of living donors of single kidneys or a part of the liver or the lung. This would involve giving them assurance for their wellbeing even when they are not given any financial compensation. This would however involve a lot of public campaign in order to win public trust that their donation will go to save someone’s life and not traded for money (Perry, 2009). In some cases, we have seen parents conceive in order to increase chance of transplant for their older children. Although these measures are controversial, they should be explored as a possible way of encoring living donors to assist those in need of organ transplant.

The third long term solution would be increased public campaign aimed at reducing the case which leads to organ failure. This means that the government should carry out continuous public campaign that will ensure that the public become aware of the different activities like alcoholism, smoking, and others which leads to organ failure (Perry, 2009). This would be along term strategy that would be aimed at reducing the increase of organ failure.

Solution and implementation

The most appropriate solutions that can be accepted from the above solutions would take both short term and long term strategies.  This means that long term strategy involving increasing public awareness of the activities that are likely to lead to organ failure and short term strategy including increase the supply of organs would be most appropriate deal with the problem.  Currently there is a long list of patient waiting for organ transplant the most appropriate way to deal with this situation would be to increase the  number of  organs which are available for transplant and at the same time collaborate with physician in order to prioritize those who need organs. To implement this solution, the government will have to take various strategies including fostering a greater public understanding of the need to foster organs, changing the current rule to remove consent from donor or their relatives which would increase the number of organs harvested from dying patient, use organs from encephalic infants, increased research aimed at increasing whole organs from stem cells and synthetic organs, and many others.

The long term strategy would be aimed at reducing the demand for the organs. This would be implemented by increasing public awareness on the need to avoid risky behaviors like alcoholism which progresses to end stage renal failure. This strategy would take a great deal of public campaign to educate the public about the dangers of such risk behaviors. However, it should be understood that this strategy would take 10 to 20 years to have impact.

Justification

This short term and long term solution would be most appropriate to solve the problem faced Medicaid funded organ transplant. This is because increase supply of organs would help to deal with the immediate high number of patients who are in the waiting list for organ transplant.  On the other hand, the long term strategy of reducing the demand for organs would be most appropriate to deal with the future trend probable rise in organ transplant demand.

Reference:

Caplan, L. & Danile, H. (1998). The Ethics of Organ Transplants: The Current Debate. Amherst: Prometheus Books

Gerald, W. (1992). TRIAGE and justice: The ethics of rationing life saving medical resources. Berkeley: University of California Press

Iglehart, J. (1983). Transplantation: The problem of limited resources.  New England Journal of Medicine, Vol. 309(20 123-128

Levine, C., Randal, J., Lois, K., & Arthur, C. (1992). To mend the heart: ethics and high technology. New England Journal of Medicine Vol. 12(1): 11-14

Matt, C. (1994). A breakthrough transplant? Newsweek, Vol. 104(20)

Mistichelli, J. A. (1995). Baby Fae: Ethical issues surrounding cross-species organ transplantation. National Reference Centre for Bioethics Literature, Georgetown University

Mone, T. (2002). The business of organ procurement: organ procurement and preservation. Current Opinion in Organ Transplantation, Vol. 7(1): 60 – 64

NHMRC, (1997). Ethical issues rise by allocation of transplant resources: Ethical issue in organ donation. Discussion Paper No. 3, National Health and Medical Research Council

Perry, D. (2009). Ethical consideration in organ transplanting. Retrieved 14^th February 2009 from http://home.earthlink.net/~davidlperry/organs.htm

Veatch, R. (2000). Organ transplantation: Thorny ethical issues. Retrieved 14^th February 2009 from http://content.healthaffairs.org/cgi/content/full/20/3/289

Wendler, D. & Neal, D. (2001). The consent process for cadaveric organ procurement: how does it work? How can it be improved? Journal of the American Medical Association, Vol. 285:329–333.