In this situation, I am faced with an ethical dilemma of giving an organ transplant to a successful elderly member of the community or to a 20-year-old drug addict. First, I must remain non-judgmental and gather information first. I must not jump to conclusions about age or the fact that one patient appears to have a dependence on drugs. First, I will ensure that both patients are indeed matches to receive this transplant. I need to find out about both patients’ conditions and what led them to requiring an organ transplant. I must also find out about the prognoses of both patients post-transplant. Which patient is more likely to recover and gain the most from this transplant, including not just quantity but quality of life? Since organs are a very limited resource, I need more information first. I also should not feel that only my opinion is important here. 

Healthcare is a team-based environment, and I should seek out others’ thoughts, including the patients’ physicians, nurses, other healthcare staff, and the hospital ethics or transplant board, which is often involved in finalizing these decisions. There are 2 outcomes here: either the elderly patient or the young patient. In either case, the decision will be made non-judgmentally and based on which patient will be able to have a strong recovery from this transplant. For the patient who does not receive the transplant, the healthcare team must discuss this with the patient and their loved ones, and ensure they understand that not receiving the transplant right now does not mean that we are going to stop treatment or looking for ways to improve their condition, and that they are still on the transplant list. Moving forward, I will ensure our hospital has a clear set of guidelines in place so organs are allocated on a non-judgmental basis with clear policies in place. To summarize, I would gather information and ensure we have been non-judgmental in deciding which patient to provide the transplant to, and ensure guidelines are in place for future situations like this one. Thank you and I look forward to addressing any further questions you have.

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I'm not really a fan of this answer. First of all, it does not give a clear answer to the question. The question tells us to make a decision, and this response states that the person will make a decision based on the facts (intent to make a decision is not the same as making a decision). Additionally, survival benefit is definitely something to take into consideration if all else is equal (urgency, suitability, and likelihood of survival). If the younger patient will only get 2 years out of the kidney because they continue to abuse alcohol, we should go with the older patient (we're not assuming he will; however, if his BAC is currently elevated and he displays signs of alcoholism, we don't know if he will take care of the new organ).


BeMo Academic Consulting

Hello Michael! Thank you for your comment. Remember that you are not supposed to make any such judgments. You are assuming that the young patient will continue to use drugs and alcohol - a huge red flag. Your position is difficult, but this is precisely why you need to gather enough info. If the patient is not going to accept the kidney with good results, then you must make you choice in favor of the older gentleman. Either way, your decision must be made based on facts and solid information.

BeMo Academic Consulting

Michael, you are the winner of our weekly draw. Please email us by the end of the day tomorrow (November 20) at content[at] from the same email address you used to leave your comment to claim your prize!