When Past Behavior Blocks You From The Transplant List

Image courtesy of Vichaya Kiatying-Angsulee /

Image courtesy of Vichaya Kiatying-Angsulee /

A story broke Monday that Anthony Stokes – a teenager in Georgia, given six months to live on account of his dire heart condition — was denied a place on a heart transplant list due to his history of “non-compliance,” that is, not following medical orders. (Anthony’s family said the real reason they believe their child was denied a spot was due to “low grades and trouble with the law” according to an ABC news report.)

Either way, though it was announced today by Stokes’ family that their son will now be placed on the transplant list, this controversy raises important questions: should bad behavior block a patient’s acces to the list?

While it may seem harsh to deny a child a spot on the heart transplant list because of past transgressions, George Annas, Chair of the Department of Health Law and Bioethics at Boston University, says a patient’s ability to follow post-transplant medical advice is an important screening criterion.

“There are not enough hearts for everyone,” he says.  “When someone gets a heart transplant that means there is someone who does not get one.  Continue reading

The Emotional Toll Of A Race-Against-Time Organ Donation

All the doctors agreed. There was no question that the patient, a 54-year-old man, was going to die.

He’d suffered a stroke as a result of cardiac arrest. His brain injury was irreversible. His heart rate was dropping — fast. His family had been told there was no hope. Still, for a mix of complex reasons — denial, grief, overwhelming love, miscommunication — his daughters couldn’t fathom why their father was being rushed from the intensive care unit, where earlier, the family had hoped doctors could rescusitate him, to the operating room, where a team of transplant surgeons waited to remove his kidneys and pancreas before the organs ceased to be viable for donation.

A sense of urgency was in the air, according to nurses who were there, and though by all medical measures the patient had no chance of recovering, his dying, erratic heartbeat still registered on the cardiac monitor as he was whisked toward the operating table where his organs would be harvested.

“The daughters kept saying,’This is so wrong, this is so wrong,'” said nurse Jo Fontaine, a case manager who was there.

When The Heart Stops

We hear most often about organ donation after brain death, when neural activity stops. But there is another form of donation: after cardiac death, when donation occurs after circulatory and respiratory functions cease. As demand for organ transplants has increased, donation after cardiac death has been rising rapidly, now comprising about 35% of donations in New England and 11% nationally. The trend has helped increase organ supply — but brings with it different types of challenges.

At Norwood Hospital, where the 54-year-old man died in September, organ donation after cardiac death was something new for the staff. None of the ICU team had ever experienced this type of race-against-time donation. The entire episode was so fraught that several of the doctors and nurses involved in the case agreed to come together on a recent Monday afternoon and discuss their intense emotions.

“I wasn’t ready,” said Oscar Le, a critical care doctor who was involved in the case. “The healing process that we usually go through when a patient dies, we couldn’t go through it in this case. We had five minutes. When you go home, you go home feeling a little empty.”

Dr. Le said that this patient and his family “did not have the kind of death” any of us hope for.

More Compassionate Care

Dr. Le’s comments before a crowd of about 50 doctors, nurses and other hospital staff were part of a professional venting session known as “The Schwartz Center Rounds.” Continue reading