Term Paper: Hospital

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[. . .] However, in this instance, the second set of organs were not immediately sought.

Although grevous medical errors such as the one that occurred in this case are hardly uncommon, in this case, the error was compounded by the failure to seek (as opposed to failure to obtain) replacement organs quickly (Mitchel, 2004). However, it is also possible to consider another angle on the problem.

Because the medical team had reason to believe that the patient would have significant reduced likelihood of survival, as well as a questionable quality of life following a second transplantation, all indicator point to value judgments on the part of the hospital transplant team, causing them significant pause concerning the ethics of pursuing another set of organs for their patient. Clearly, the issue of organ scarcity was paramount in the delay of treatment.

However, had the transplant team been thoroughly briefed on hospital policy regarding responsibility as defined by the governmental standards concerning transplant eligibility, they would have known that their fundamental responsibility was to the preservation of the patient, not the supply of organs for more promising candidates. The simple fact was that they realized their error, the patient was compromised but not dead, and as such they were charged with finding every means at their disposal to save her. The sad fact, here, is that the patient required an additional set of organs, yet they were not actively and quickly sought. Further, the reality that if the case were different, and organs were not scarce, would have resulted in her immediate re-transplantation indicate that the value/ethical judgment was an inappropriate factor in this case. The simple fact is that under hospital policy, the physicians were not qualified to act in the interest of the organ program over the interest of their patient. Not only did she obviously still present a dire need for matched organs, but her condition indicated certain death without them. By not aggressively pursuing their acquisition, the team, in effect, gave up. Further, because the team failed to do this based on their inappropriate (based on governmental rules) consideration of future organ utility, they put the continued health of the transplant unit in extreme jeopardy.

The fact is, the patient, under governmental criteria, was clearly eligible for a second set of organs. The decision to delay was inappropriate and tragic. Not only should this serve as an example of the difficult nature of transplant ethics, but it should also serve as a springboard for an educational campaign aimed to assure that this issue will never arise again.

Although the issue of organ scarcity is necessarily an emotional one for all involved, there remains the salient truth that the physician's responsibility is to the patient before him or her (MCPM). To consider the greater issue of organ supply and utility over the immediate need of the patient on the table is a gross violation of this responsibility.

What should be done, then, to help future transplant teams avoid similar errors? First and foremost, the initial typing error must never again occur. Indeed, its very occurrence raises extreme doubt as to the safety of typing procedures nationwide. Therefore, an aggressive study of an appropriate typing procedure should be immediately implemented, developed, and applied.

Second, while it cannot be denied that there is a shortage of organs available for transplant, to place responsibility for this issue in the hands of hospital doctors and staff is a dangerous practice. The current wisdom clearly errs on the physician's responsibility to his or her immediate patient. To allow other ethical issues to arise necessarily violates patient trust. Further, in this case, the ethical decision presumably (if not overtly) violated HHS criteria as well.

Here, implementing an educational campaign concerning the ethical responsibilities of transplant team members will be entirely dependent on a clear and open example of communication (CSU). If the team is not aware of a clear and defined protocol for situations like the one presented here, there is simply a greater chance that they will rely on personal subjective judgment. To allow this is to invite error.

The reason that individual hospital employee or physicians should not be allowed to exercise ethical determinism in the treatment of their transplant patients is directly attributable to the complexity of the ethical issues surrounding transplantation, itself. A great deal of difficulty and ethical debate has gone into the national system for organ assignment. To allow the issue to be hashed and rehashed with every case invites disaster. Therefore, the following plan should be adopted:

The transplant procedure must begin with a new system of blood type matching that has a large degree of "built-in safeguards." Not only should this system be based on independent verification techniques, but should also be checked more than once.

A clear and well communicated program of education must be devised in which physicians and staff clearly recognize their ethical responsibilities.

The ethical responsibility of the transplant team are to be first and foremost to the patient "on the table." No other issues should be considered.

The current criteria for organ eligibility is dire need. Post-op life expectancy, or quality of life criteria is not to be invoked as part of a decision to acquire organs.

The dire shortage of organs, although tragic, is not to be considered when one has the opportunity to acquire an organ for one's patient.

The same amount of effort is to be applied to the acquisition and implantation of transplant organs as the procurement of any other medical supply required in the operation. No value judgment is to be placed on the organ.

Medical errors are an inevitable part of health care. As such, there must be an environment in which such errors are immediately documented, communicated, and learned from.

Physicians and transplant teams will always use swift action to acquire needed organs. No patient should die as a result of hospital delay (as opposed to availability problems, which are out of hospital hands).

Value judgments concerning quality of life will not be considered with regard to acquiring a second set of organs post-procedural error.

The fate of other patients awaiting transplant must not be considered when transplanting a patient with lower probability of survival or a lower expectation regarding quality of life.

Policies communicated thorough as a result of this case must be applied to similar cases, should they arise. This includes cases involving staff error, as well as other factors that affect perceived outcomes/quality of life issues.


Again, understanding the dynamics in any case study marked by human tragedy can be problematic. The young girl in this case unfortunately was the victim of error based not only due to blood typing, but due to unfounded ethical considerations as well. Therefore, it is essential that the hospital put into motion educational plans to prevent any such breakdown of hospital-patient responsibility in the future.

Clearly, transplant ethics are tricky. The shortage of organs is a dire problem, and the issues surrounding the rules of allocation are complex. For this reason, it is imperative to communicate a clear hospital policy on all foreseeable issues.


Chibbaro, Lou. (2004) Victory Claimed in HIV Suits. Washington Blade. Web site. Retrieved on August 8, 2004, at http://www.washblade.com/print.cfm?content_id=2771

Colorado State University Writing Center. "Case Studies." Retrieved from Web site on August 2, 2004 http://writing.colostate.edu/references/research/casestudy/com2a1.cfm

CTDN. California Donors Network. (2004) Facts about organ and tissue donation. Web site. Retrieved on August 8, 2004, at http://www.ctdn.org/resources/faqs.php?id=3&NoHeader=1

Duke University. (2004). UNOS and DUH Safeguards for Organ Transplant Safety. Duke Medical News. Retrieved on August 7, 2004, at http://dukemednews.org/filebank/2003/06/28/UNOS%20and%20DUH%20Safeguards%20for%20Organ%20Transplant%20Safety.doc

De Noon, Daniel. (2000). As Transplant Gap Widens, New Organs Sought. Web MD. Web site. Retrieved on August 7, 2004, at http://my.webmd.com/content/article/27/1728_60333?printing=true

Keen, Lisa. (2001). HEALTH: News Analysis: People with HIV reaching top of transplant lists Anti-viral drugs may trigger liver problems, but are also making organ receipt available. Washington Blade - September 28, 2001. Retrieved on August 7, 2004, at http://www.aegis.com/news/wb/2001/WB010904.html.

MCPM. Massachusetts Coalition for the Prevention of Medical Error. (2004) Patient Safety Tools. Web site. Retrieved from Web site on August 8, 2004, at http://www.macoalition.org/publications.shtml

Mitchel, Steve. (2004). Transplant Safeguards Already in Place. MedServ. Retrieved on August 8, 2004, at http://www.medserv.dk/modules.php?name=News&file=article&sid=1892 [END OF PREVIEW]

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