Chapter 10 LO's- Bioethics

Did Barnard go too far in treating Washkansky against his will? What is the best example to illustrate that?

Barnard did go too far in treating Washy past his will. Him forcing the respirator on Washy after an explicit request not to have it crossed the line. Further, this was the last appeal Washy was able to make as he died on the respirator. Washy also forcefully kept Barnard away from him in the process of Barnard attempting to reopen his tracheal tube.

Discuss the first human heart transplant that was carried out by Christiaan Barnard. What were the findings from this transplant?

Barnard was a South African doctor living in Cape Town. He did not have extensive knowledge about organ rejection and was basically a nobody at the time. Barnard used Washy as his first heart transplant patient. He and his brother Marius used the heart of Darvall. The surgery took all night, but it worked and Washy had a new heart, yay. The days after, however, were very rough. Washy felt constant pain and was eventually unable to control his bowels or function normally. There was a constant threat of both rejection and infection due to the immunosuppressants Washy was given. In the end, Barnard gave him too many immunosuppression and infection overtook his lungs. Washy died on December 21, 18 days after his heart transplant.

Medicine almost uniformly has judged that artificial hearts are not cost-effective. Should Does society still encourage the use of artificial hearts or promote a healthier lifestyle?

Based on the rule of rescue, society generally works toward saving an identifiable, dying organ rather than helping prevent that need in the first place. This is obviously bad and results in higher expenditures in the long run. It is more ethical to prevent people from having to use medical harm by stopping the problem before it becomes an issue. Based on Kantian ethics, people should be able to make their own decisions rather than rely on medical technology.

After implanting the Jarvik-7, what were the problems faced by William Schroeder and Jake Burcham with regard to the quality of life?

Both of these individuals had a terrible quality of life post surgery. Schroeder lived for 21 months but suffered a stroke from a blood clot, and then another series of strokes. He was then put on a tracheotomy. Burcham had a way worse fate. The Jarvik-7 would not fit into his chest, so they could not reclose his body after the heart was attached and he died shortly after. He only lasted 10 days after his procedure.

How long did Barney Clark live? What did The New York Times say about how long he "was dying"?

Clark lived 112 days with his artificial heart. He was supposedly "dying" for all 112 of those days because of his constant discomfort and pain. Clark had terribly low quality in the remainder of his life post heart transplant.

In what way was Barney Clark a bad candidate to receive the first Jarvik-7? What kind of patient would have been an ideal candidate?

Clark was not a great candidate as he was not extremely healthy in other aspects of life and he was a lifelong smoker with emphysema, an obstructive lung disease. An ideal candidate would be someone who was younger, had better lungs, with strong familial support who seems committed to doing the physical therapy required for success.

Why was there a trade-off in treating Barney Clark's medical problems?

Clark was on blood thinners to prevent any clots and potential strokes in his brain. However, these same blood thinners resulted in him bleeding out in the seams of his heart and through his nose, which is really bad.

How did Clark's case symbolize controversies about the quality of life for heart transplant recipients, such as the definition of quality of life, clots, and the quality of heart valves?

Clark's quality of life was terrible post transplant. He was unable to walk or go home, he suffered from potential strokes or bleed outs, and, had he even lived a month more, the valve in his heart would have burst rendering him dead anyway. Overall, it was not an ideal way to end his life. It brings up the controversy of whether or not it is ethical to use machine hearts in humans given their models were not fully proven perfect with hard data.

Who is Dirk van Zyl, and how long did he live with his transplanted heart? How do you think he feels toward Christian Barnard?

Dan van Zyl was the longest surviving heart transplant patient living for 23 years. He must have felt extreme gratitude toward Barnard because he allowed him to live significantly longer.

What was the criterion used to declare Denise Darvall brain-dead? Why did Denise's heart stop beating?

Darvall was declared dead based on the whole-body standard of death which only refers to the lungs and heart having stopped functioning. Darvall's heart stopped beating because Barnard injected potassium into it. This allowed him to prematurely take her undamaged heart for use in transplant.

How did Jarvik and DeVries fare after Barney Clark's death?

DeVires divorced his wife, set up a failing practice, and then started teaching surgical residents at Uniformed Services University of Health. Jarvik was on Playboy talking about sex, divorced his wife, remarried to Marilyn Von Savart, and advertised for Lipitor. He also founded Jarvik Heart, a company that makes artificial cardiac pumps.

In treating Washkansky, what trade-off existed between fighting rejection and fighting infection? Was it ethical on Barnard's part to risk Washkansky's death and wait for a definitive diagnosis?

The trade off was risking organ rejection, thus the attack of his heart, with too few immunosuppressants and risking infection, thus possible death, with too many immunosuppressants. The question of whether or not this situation is ethical is very difficult. Barnard had to make his best guess at the end of the day. Unfortunately, he guessed wrong, and Washy died from the effects of the infections over running his lungs.

Describe the cases of Jean-Michel Dubernard and Maria Siemionow. Were their transplants successful?

Dubernaud, in a rush to be first, jumped the gun performing the first face transplant on Dinoire. She was an addict who attempted suicide, not a great candidtae, but the transplnat did work and she lived for 12 subsequent years. Siemenow did an ethical transplant knowing all the information before starting. She did hers on Connie Culp, a previous abuse victim. Both were successful, but Siminow did hers with more confidence and knowledge. She was hyper focused on doing no harm.

What problems developed while implanting the Jarvik-7 in Barney Clark?

During the implant, the heart's fastens were ripped out because of the tin atrial wall not being substantial enough to dock them while the pressure exceeded their threshold. When attempting to implant the heart, the left ventricle would not pump blood. Devires tried three times by opening the ventricle and he finally had to replace some of the parts with those from another heart. The whole process ran risks of introducing air into the blood (dangerous).

Why was it awkward for Christiaan Barnard to ask Edward Darvall for his daughter's Heart?

It was awkward because Darvall was technically still alive, just brain dead. As such, especially given the grieving over Edward's wife, the conversation was strange. Further, Barnard's actions were so messed up because he literally ended up stopping her heart in order to declare her dead... talk about an uncomfy situation. Darvall needed to be dead for him to actually take the heart.

Why did most reporters not understand the problem of post-transplant psychosis and a low quality of life?

Post transplant psychosis is caused by the large doses of immunosuppression which initially cause euphoria followed by catatonia and severe depression. This can result in temporary or permanent psychosis. Reporters do not understand this as they are merely awed by the simple fact that transplants are possible. Doctor's and hospital staff did not discuss these issues, thus reporters did not know or understand them. No one wanted to bring down the mood of these revolutionary accomplishments.

How did Robert Tools fare with the Abiomed artificial heart? What was the essential the problem of titanium artificial hearts?

Robert Tool lived for 151 days with his titanium heart. The essential problem was that if an artificial heart failed it could not merely be replaced quickly, it requires the sternum to be cracked. Anything artificial will ultimately be rejected, and there are seams on these fake hearts that may either burst or clot blood.

Who received the first hand transplant, and where was it performed? What were the unexpected problems with compliance by the patient? How did the case end? Who was the first American patient to get a hand transplant? How did the transplant affect him or her? Approximately how many hand transplants have now been performed in the world?

The first hand transplant was performed on Clint Hallman by Dubernaund in France. Hallman was unwilling to undergo physical therapy, and he refused to take the anti rejection drugs. He never had a normal feeling in the hand and made Dubernard amputate it. Matthew Scott was the first American to get a hand transplant because he lost his hand to a firecracker. Scott had feeling in his hand through nerves that reached his wrists. He could tie his shoes, write his name, and wear a wedding ring. By 2017, approximately 85 hand and forearm replacements have occurred worldwide. Rejection with these transplants have been much better than those with hearts.

3. What is the controversy surrounding whether Christiaan Barnard should have done the heart transplant in the first place?

There was controversy because Barnard really did not perform this heart transplant in the most ethical manner. He chose an arguably poor candidate because of underlying health issues and he did not know hardly anything about organ rejection. Further, there is an argument that Washy may have lived longer had no transplant been done at all. ***No one knew how to properly control rejection and had been trying for years without success

Was Christiaan Barnard glorified for conducting the first heart transplant at the cost of other great heart surgeons who laid the foundation?

Yes, he was. He was the talk of the United States because he was the first person to actually do it despite being under qualified and kind of unethical in the process.