In transplantation, there’s currently a debate in whether cognitive function should be considered a legitimate criteria in allocating organs. This article highlights the ideas of each side in the argument which ultimately comes down to a clash between equity and efficiency. The proponents for transplantation argue for equity in saying that we shouldn’t factor in cognitive impairment because it means that we are deciding whose life is more valuable and everyone should have an equal chance to a resource if they are in equal need and sufficient health to receive and survive a transplantation procedure. From the opposing side, they counter with efficiency saying factoring in cognitive ability would allow for a quality of life assessment which could be included in the outcome success measurement which already takes into account number of lives saved and life-years gained per individual. The life-years gained per individual is influenced most obviously by their age and often times patients with cognitive impairments don’t live as long as their counterparts which could help relate cognitive impairment to that component of efficiency. Since people with cognitive disabilities happen to have problems in other areas that are already validated consideration criteria in organ allocation (such as probability of adherence to postoperative instructions to ensure success and survival), they are able to be ethically removed from consideration for transplant without needing an extra consideration criteria of cognitive function. Of course, there are less controversial reasons to look at cognitive impairment besides quality of life, such as assessing survival rates postoperatively between control and cognitively impaired groups to inform who should receive transplantation based on probability of success. This could be a more validated reason for considering cognitive function in allocating organs. Patient needs to be fairly healthy and illness-free to receive a transplantation, as was highlighted in the article sent out by Dr. Campisi, “The Rules of the Doctor’s Heart”. Given this, it is important to bring up the fact that a particular group of cognitively impaired individuals, Down Syndrome/Trisomy 21 (T21) patients, have an increased susceptibility to infection. The mystery surrounding this phenomenon is still under investigation in many research facilities including my lab at Anschutz where I’ve created overexpression models to explore the contribution of one of the immune-related genes on chromosome 21, the Type I IFN receptor, in relation to the T21 phenotype. In considering organ allocation, is it ethical to add another hurdle for patients such as those who have T21 making it harder or even impossible for these individuals to receive a transplant?
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ReplyDeleteI think this topic is really thought-provoking; thanks for posting Alysha!
ReplyDeleteIn the article you referenced, they spoke about an individual with autism who was permanently denied a heart transplant. For a disorder like autism, which has a spectrum of symptoms/effects, where do you draw the line of "appropriate" cognitive disability vs "unworthy" cognitive disability? There are many high-functioning individuals with the disorder who are very important contributors to society- should they be denied as well because they have the same diagnosis? But more importantly, as you mentioned, does even this make their lives more "valuable" than those who are lower functioning?
Personally, I don't believe that cognitive functioning should be a factor in determining transplant candidacy. Though to some, it may seem that a certain level of impairment is "beyond help," it is impossible to determine where to draw the line to separate who deserves a transplant and who does not. That being said, it's worth noting that many cognitive impairments are accompanied by significant comorbidities which would hinder transplant success. These things need to be considered in the same regard "normal" cognitive functioning individuals would. Unfortunately, this discounts many individuals with impairments from being placed on transplant lists. In summary, it is not up to us to determine "worthiness" based on cognitive function, but we need to hold everyone to the same rigorous standards across the board to ensure maximum success and benefit of organ transplants.