From cop cars and stalactites to kidneys and transplantation: thinking deeply
I just passed an alpaca farm. Do they make good pets or decedent furry slippers?
I miss the deckled fore edges on musty books that gave me paper cuts. Now I am just destined for aching carpal tunnel.
Oops. There is a trooper obscured by that overgrown ledge beside a commemorative cast metal statue of a town hero that I have never heard of. The pastel Trilliums and meticulously trimmed evergreens benevolently surround the towering hero. That move away from the Crown Victoria vehicles is playing tricks on me.
There is a 13.1 sticker dressing the windshield of a dawdling electric car in the passing lane. The number after the decimal is called a mantissa. I remember that from Quiz Bowl. I am proud of you, marathoner, even without the .1 mantissa. Guess that I would not understand the significance of a 13 sticker…Carry on in good health and thanks for your help in reducing carbon emissions. Move over!
Occasionally my mind wanders toward random things that are little distraction during my long daily commute. As I steer past small hamlets and away from rest stops, I listen to NPR (National Public Radio). No, I do more than listen. I curve with the hills. I am dismayed by the break up my pristine radio reception like a cave stalactite cursing the warming of its permafrost. I heard Dr. Art Caplan on NPR recently discussing a myriad of reasons why a patient may never become a candidate on the National Waiting List for a solid organ (Heffernen, 2013).The factors weighed to balance need against scarcity often lead to arbitrary, system derived disadvantage. The only advantageous diffusions taking place for many are between the patient’s blood and dialysate that removes the unwanted waste.
Clinical worthiness is prudent medicine. However when social worthiness is invoked wantonly, I have a problem. Even the slightest mantissa of improvement in mortality makes a difference reminiscent of every well-positioned, oxygen deprived step on the marathon route. They are welcomed events with the finish banner next to the town fountain of rotund cherubs in sight. One finish is draped in applause for the exhausted runner. The other signifies more time with your loved one but yet more weary marathons (as ceaseless post-transplant care) in sight.
There are good, even stellar transplant centers who serve patients with the best clinical and emotional care possible. While the intentions may be the right place, the holiness of “worth” leaves far too many with a bum deal. Transplant centers, according to Caplan, can make a list of demands to make a patient worthy of organs. Many make perfect evidence- based sense. Some may even make financial sense. But does the inherent inconsistency of qualifications to the wait list make moral sense? From personal experience and enough time around the block studying ESRD, people are dying at an average rate of 18 per day. Far too many fathers, mothers, friends, even foes are perishing as blood tubing act as external capillaries to sustain life.
How can a society be held to such a high moral standard? The million dollar question is making the people care when their own kidneys pump and filter vital fluids with no clinical concern (for now). The statistics are working against us all. This is a comradeship of failing organs that we all should avoid at all costs. However, with far too much frequency, tough decisions of life and death are made under duress and under the casing of outstripped demand.
Hefferton, S. (2013) Who Should Be First In Line to Receive a Transplant Organ? (video file) Retrieved on Sept. 5, 2013 from http://www.npr.org/2013/09/04/218811165/who-should-be-the-first-in-line-to-receive-a-transplant-organ.