Brother’s Decision

A developmentally delayed man is in need of a kidney transplant. The patient's brother is his guardian, but is not a suitable donor. There is a third brother, though, who may be a suitable donor. The catch is that this brother is also developmentally delayed, and shares the same guardian (the middle brother) as the renal patient. Can the third brother donate a kidney, based on the guardian-brother's consent?

Wife Overrides Husband

A man suffers cardiac arrest and dies in the hospital. His daughter has been on dialysis for a while, but the man refused to give his kidney. He did not sign an organ donation card. His wife wants the man’s kidney given to his daughter. Should the hospital honor the wife’s request?

Patient Wants to Determine Who Gets His Organs

A man comes to the hospital after a motorcycle accident and dies in the ICU. The man’s advance directive indicates that he has agreed to donate organs only under the condition that they “benefit someone who is also Jewish.” Should the organization that allocates organs agree to the request?

Organ Sale

The sale of organs is currently illegal, but a philanthropist offers an interesting way to address the organ shortage. He offers to pay family members of people who are brain dead but did not sign organ donation cards $10,000 to agree to donate the organs of the deceased. Is this an unethical offer? Should the laws be changed to allow payment for organs from live donors, such as kidneys?

Kidney Donor Rules: Moving down the list

Currently, donor kidneys are allocated based on a formula that takes into account four factors: 1) degree of match, with a perfect match giving the patient absolute priority to the kidney, 2) length of time on the waiting list, 3) priority to children, and 4) priority to those who themselves donated a kidney during their lifetime. This formula is under review because it is perceived to have numerous weaknesses. You are on the committee reviewing the rules (called the OPTN/UNOS Kidney Transplantation Committee). What are some possible factors that you might add to the distribution formula? For instance, would you add any of the following to move people down the list?:

• Alcoholism
• Obesity
• Dangerous activity
• Crime

Kidney Donor Rules: Advancing up the list

Currently, donor kidneys are allocated based on a formula that takes into account four factors: 1) degree of match, with a perfect match giving the patient absolute priority to the kidney, 2) length of time on the waiting list, 3) priority to children, and 4) priority to those who themselves donated a kidney during their lifetime. This formula is under review because it is perceived to have numerous weaknesses. You are on the committee reviewing the rules (called the OPTN/UNOS Kidney Transplantation Committee). What are some possible factors that you might add to the distribution formula? For instance, would you add any of the following to advance people on the list?:

• Nearness to death
• Others depend on the recipient
• Contribution to society
• Past service to society

Feeding Tube

A 58 year old man develops multi infarct dementia, and is placed in a nursing home. He is alert, responsive, and can walk with a cane, though he has short term memory loss and believes himself to be in his brother's home. Nevertheless, he seems quite happy where he is.

After 2 years in the home, he has a stroke, and upon waking is unable to speak, though he, can fix on objects. He is paralyzed on the left side of his body, and needs a feeding tube for nutrition. After a few weeks in the hospital, he has shown some improvement, but it is not known whether, or to what extent, he will recover his faculties.

The patient signed a Durable Power of Attorney prior to developing dementia which.
states that he does not want to be kept alive by artificial means, including a feeding tube, if 1) he is terminally ill; or 2) he is permanently unconscious; or 3) the burdens of treatment exceed its benefit. He also told his family at that time that he does not want to live out his life in a nursing home. The DPA/HC names his son as his agent, but the son is uncomfortable asking for limitation of treatment. What should the physicians do?