Contemporary Science Issues

Lesson 2: Organ transplants – the choice

© 2006 Gatsby Technical Education Projects

The Choice is yours

James or Jessica? The choice is yours Royal Western Trust

Hospital

Cardio – thoracic specialist ward

Established 1978

– the facts

• Heart disease is one of the most common causes of death each year in the UK

• Many people have bypass, pacemakers and valve surgery

• This still leaves a large number requiring a new heart

• Some types of heart disease are inherited

• Smoking, drinking and obesity increases the risk

Royal Western Trust HospitalCardio – thoracic specialist ward

Established 1978

Transplanted 65%

On waiting list

26%Withdrawn

4%

Dead on waiting list 5%

As clinical director of the local NHS hospital, make a life & death decision

The Choice is yours

The patients in your charge

• James Silverman48 years old

• Jessica Carmel17 years old

They both need a new heart to survive

Artificial Heart

Human Heartvalves

•Prone to fatal clots

•Trials in the USA show longevity of patient only 112 days

•No need for immunosuppressant drugs

•The donor must die!

•Next of kin must consent

•The organ must match

•Immunosuppressant drugs must be taken for life

Transgenic heart – from a pig

A pig’s heart - compatible with a human

Jessica

Faye

Carmel

5/1/89

James

Silverman

17/9/59

Peter

Active Problems

Patient Details

Clinical History Notes

Medical Records

About James:

James has smoked. He has 3 children, divorced and now involved in another relationship. His heart disease seems to be due to his lifestyle - he had a stressful job as a car salesman. He worked long hours and ate take-away foods at irregular times. He admits to doing no exercise. James has had bypass surgery just over two years ago. He has given up smoking

About Jessica:

A typical teenager who just wants to fit in and be normal. Go out, have fun and enjoy music, boys and friends. Unfortunately born with problems with her heart and as a result lived with constant worry and depression. So much so, that she has attempted to commit suicide.

It’s not as simple as you think. Making ‘life & death decisions must be backed

by scientific (medical) evidence and ethical reasons– not just ‘gut feelings!

• What is their medical history?• What is their current health

situation?• What are the chances of success?• Are there any ethical issues?• Use the materials provided and

make your choice

Life and Death – The Choice

Your task:In groups of 3/4 produce two record cards that itemise information on the following patients - be prepared to discuss the facts with the whole group. One set is needed for each recipient. Use the information sheets provided and some enthusiastic imagination from TV programmes like ‘Holby City’ and ‘ER’, etc.

It is important to include facts, evidence and some ideas and opinions.

You send your mini report to the Hospital Managers with your final decision –

Which patient gets the heart, and who will probably die?

Fill in the Clinical Director Decision cards and stick into your books.

The Patients

Teenage girl: – Jessica Carmel (aged 17)

Family GPs notes & patients personal, family and social background (e.g. sets the scene – congenital heart disease, attempted suicide, ecstasy drug misuse, school results, friends, habits, religion, parents, social background)

Cardiac teams test results and prognosis (include information from anaesthetist, dietician, cardiac surgeon (consultant), ward sister and cardiac tests team)

Middle–aged man: – James Silverman (aged 48)

Family GPs notes & patients personal, family and social background (e.g. set the scene – heart disease, originally a smoker, heart bypass 3 years ago, three children, elderly dependent parents, diagnosed with a very rare benign cancer of the heart)Cardiac teams test results and prognosis (include information from anaesthetist, dietician, cardiac surgeon (consultant), ward sister and cardiac tests team)