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American Morning

Transplant Ethics

Aired February 24, 2003 - 09:31   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


PAULA ZAHN, CNN ANCHOR: We return now to the story of Jesica Santillan, the 17-year-old girl who received a botched organ transplant. She died Saturday after a second surgery at Duke University Hospital, after first being given transplants with the wrong type of blood. Doctors took Jesica off a respirator on Saturday. Given her low chances of survival, some now say the case raises some ethical problems. Was Jesica unfairly given priority for the second transplant? Should those organs have gone to someone with a better chance of survival.
Art Caplan is a medical ethicist at the University of Pennsylvania, and the author of "The Ethics of Organ Transplants." He joins us now from Philadelphia.

Welcome back.

Do you have a problem with the way Jesica's case was handled the second time around?

DR. ART CAPLAN, MEDICAL ETHICIST: Everybody, I think, understands why, having gotten into this terrible situation due to a mistake, the doctors at Duke would want to try to rescue her. But if you look at the waiting list at the time she got the second set of organs, there are probably 50 kids waiting for hearts, lungs or heart/lung combinations. If you've got a mismatch situation, a very sick, dying girl, her chances of surviving that second operation were very, very low.

The system says gives the organs to the sickest. But my own view is we might want to build in more about who's going to do well with the organs as part of thinking about how best to use this scarce resource.

ZAHN: But, Dr. Caplan, when you say the system says give the organ to the healthiest, are there written rules about how cases like this should be handled? Or is there an understanding, as a friend of mine described to me over the weekend at Metropolitan Hospital that when you make a mistake, you do everything in your power to correct it, sort of an unwritten rule.

CAPLAN: The unwritten rule is there, and the doctors at Duke will say, we made a mistake, we're going to go all out to get these organs.

However, there is a system. We have a national policy about giving out organs. It's run by a semiprivate organization called The United Network for Organ Sharing. They keep tabs on where organs go, and their rule says, sickest go first. So the sicker you are, if you're Mickey Mantle and you have three diseases and you're really at death's door, you're going right up to the top of the waiting list. I'm not sure if that's the best rule, however. I understand why the doctors want to fix the mistake, but you know, we don't see the pictures of the other kids who might have been able to live if they had gotten a shot at that second set of organs.

ZAHN: How did the system get to this point, where the organs always go the sickest, and who makes the determination that this person has no shot of survival, so we're wasting a scarce resource here.

CAPLAN: Well,the system really got to where it is by history. And when organ transplants first started 30 years ago, they didn't work very well, and so the way you were comfortable about doing them, knowing that most people who got them died, is you took the people who were dying, and said, look, if it fails, they're not much worse off. So they kind of carried that forward, and forward and forward, same rules still apply, but now transplants work better, so I'm not sure it makes sense to keep the rules.

Who would have to make the call. Well, you need both the local doctors to say, boy, this is a mismatched situation, where a child has now been completely compromised, almost impossible to save her, in that national network to take a look and say, given that medical profile, she's got almost no chance to live. There may be another kid on the list somewhere else who has a much better chance to live.

ZAHN: A lot has been made in the last couple days of Jesica's illegal alien status. Does that play any role on the priority list? Is there any designation on whether someone is an American citizen or not? Or should it?

CAPLAN: Well, we had some scandals in the 1980s where transplant centers would bring over very rich people and give them transplants ahead of Americans. So, a quota was put in, 5 percent of organs, no more than that, at any transplant center can go to non-Americans.

However, if you talk to people who donate organs who are faced with that tough, terrible choice, when they make that gift, most of them think Americans are going to get priority. So I have to say, there is some threat to organ donation if Americans don't get the first shot at these. So it may not be a policy -- my own view is 5 percent is about right. But if it adversely affects organ donation, that's trouble, because these organs are tough to get.

ZAHN: You raise some fascinating issues that we will be debating for many months to come. Art Caplan, always good to see you. Thanks for your time today.

CAPLAN: Good to see you, and happy birthday, Paula.

ZAHN: Well, thank you very much, adding to chorus of the very nice greetings I've gotten here today. Boy, they better be nice to me at home is all I can say. You guys spoil me rotten.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com







Aired February 24, 2003 - 09:31   ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
PAULA ZAHN, CNN ANCHOR: We return now to the story of Jesica Santillan, the 17-year-old girl who received a botched organ transplant. She died Saturday after a second surgery at Duke University Hospital, after first being given transplants with the wrong type of blood. Doctors took Jesica off a respirator on Saturday. Given her low chances of survival, some now say the case raises some ethical problems. Was Jesica unfairly given priority for the second transplant? Should those organs have gone to someone with a better chance of survival.
Art Caplan is a medical ethicist at the University of Pennsylvania, and the author of "The Ethics of Organ Transplants." He joins us now from Philadelphia.

Welcome back.

Do you have a problem with the way Jesica's case was handled the second time around?

DR. ART CAPLAN, MEDICAL ETHICIST: Everybody, I think, understands why, having gotten into this terrible situation due to a mistake, the doctors at Duke would want to try to rescue her. But if you look at the waiting list at the time she got the second set of organs, there are probably 50 kids waiting for hearts, lungs or heart/lung combinations. If you've got a mismatch situation, a very sick, dying girl, her chances of surviving that second operation were very, very low.

The system says gives the organs to the sickest. But my own view is we might want to build in more about who's going to do well with the organs as part of thinking about how best to use this scarce resource.

ZAHN: But, Dr. Caplan, when you say the system says give the organ to the healthiest, are there written rules about how cases like this should be handled? Or is there an understanding, as a friend of mine described to me over the weekend at Metropolitan Hospital that when you make a mistake, you do everything in your power to correct it, sort of an unwritten rule.

CAPLAN: The unwritten rule is there, and the doctors at Duke will say, we made a mistake, we're going to go all out to get these organs.

However, there is a system. We have a national policy about giving out organs. It's run by a semiprivate organization called The United Network for Organ Sharing. They keep tabs on where organs go, and their rule says, sickest go first. So the sicker you are, if you're Mickey Mantle and you have three diseases and you're really at death's door, you're going right up to the top of the waiting list. I'm not sure if that's the best rule, however. I understand why the doctors want to fix the mistake, but you know, we don't see the pictures of the other kids who might have been able to live if they had gotten a shot at that second set of organs.

ZAHN: How did the system get to this point, where the organs always go the sickest, and who makes the determination that this person has no shot of survival, so we're wasting a scarce resource here.

CAPLAN: Well,the system really got to where it is by history. And when organ transplants first started 30 years ago, they didn't work very well, and so the way you were comfortable about doing them, knowing that most people who got them died, is you took the people who were dying, and said, look, if it fails, they're not much worse off. So they kind of carried that forward, and forward and forward, same rules still apply, but now transplants work better, so I'm not sure it makes sense to keep the rules.

Who would have to make the call. Well, you need both the local doctors to say, boy, this is a mismatched situation, where a child has now been completely compromised, almost impossible to save her, in that national network to take a look and say, given that medical profile, she's got almost no chance to live. There may be another kid on the list somewhere else who has a much better chance to live.

ZAHN: A lot has been made in the last couple days of Jesica's illegal alien status. Does that play any role on the priority list? Is there any designation on whether someone is an American citizen or not? Or should it?

CAPLAN: Well, we had some scandals in the 1980s where transplant centers would bring over very rich people and give them transplants ahead of Americans. So, a quota was put in, 5 percent of organs, no more than that, at any transplant center can go to non-Americans.

However, if you talk to people who donate organs who are faced with that tough, terrible choice, when they make that gift, most of them think Americans are going to get priority. So I have to say, there is some threat to organ donation if Americans don't get the first shot at these. So it may not be a policy -- my own view is 5 percent is about right. But if it adversely affects organ donation, that's trouble, because these organs are tough to get.

ZAHN: You raise some fascinating issues that we will be debating for many months to come. Art Caplan, always good to see you. Thanks for your time today.

CAPLAN: Good to see you, and happy birthday, Paula.

ZAHN: Well, thank you very much, adding to chorus of the very nice greetings I've gotten here today. Boy, they better be nice to me at home is all I can say. You guys spoil me rotten.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com