Organ Donation and Transplantation: Christiaan Barnard

Ethical Dilemma

Barnard had two options. Option 1 was to allow Denise to die naturally without speeding up the process. Option 2 was to inject her heart with potassium and paralyze her heart. The outcome of this was option 2. He chose to inject her heart.

Autonomy

Barnard violated Louis's autonomy by putting him on a respirator even though Louis did not want this treatment.

Conflict of Interest

Barnard was benefiting himself by performing the world's first successful transplant. He desired the fame more than the quality of life of Louis. He was the doctor for both Denise and Louis. In today's standards, this would be considered conflict of interest. There would be one doctor designated for the donor and another doctor designated for the recipient

Veracity

Barnard withheld information about his worries of possible rejection. He did not fully tell him the truth, nor did he know how to treat rejection after an organ transplant.

Main Players

Christaan Barnard. His brother Marius and 20 other surgeons (name unknown) Louis Washkansky (recipient) Denise Darvell (donor).

List of Courts, Decisions, Dates

December 3, 1967 - The day the first heart transplant was performed.

Consent

Did Denise want her organs to be donated? Her father made that choice for her when she became incompetent.

Nonmaleficence

Do no harm. Barnard did more harm than good to his patients. Louis was only healthy for 1-2 days.

topic

First Heart Transplant

Location of Case:

Groote Shurr Hospital, Cape Town, South Africa

Impact on Society

Harvard created a criterion considering "brain death". The criteria calls for the entire brain to be nonfunctioning before the organs can be removed. Laws were put in place for physicians regarding criteria of death. Physicians who declare those "brain dead", cannot be a part of the transplant team. Barnard continued to perform transplants on the heart and other organs. In 1974-1983, 49 heterotopic and orthotopic transplants were performed by him. Heterotopic heart transplants are performed by leaving the recipient's heart in place and connecting to the donor's heart. The donor's heart acts by assisting the recipient's heart in case there are complications. This is the United States' 3rd most common organ transplant surgery.

DAYS 6-15

Louis faced rejection. ❖ He suffered from constant pain and dark circles formed under his eyes. ❖ His heart and breathing rates climbed. ❖ A shadow of unknown origin appeared on his lung X-ray. ❖ He lost his appetite and lost bowel control. ❖ Mottled patches appeared on his legs, indicating circulatory failure.

DAYS 16-18

Louis resisted being put on a respirator because he wanted to talk. Barnard however went against his wishes. • Louis felt as if he was dying. • New X-rays showed that bilateral pneumonia klebsiella and pseudomonas had infiltrated Louis's lungs. • Earlier treatment with penicillin had killed one organism but allowed others to grow. • His breathing began to become worse and by day 18, infection overran his lungs and he suffocated. After gasping for air for 2 hours, the transplanted heart went into wild fibrillation from lack of oxygen and stopped beating.

Persons/Groups For and Against

No known groups were against the heart transplant except for racial issues. For example, putting a "black" person's heart/organ into a white person's and vice versa.

Teleological theory

The ends justify the means. Barnard was "goal" driven to complete a successful heart transplant. Even though he stopped Denise's heart immorally, Louis could receive a healthy heart.

TRANSPLANTATION & ORGAN DONATION TODAY

There has been a growing demand for donor hearts over the last 25 years. There are 20,000 people who would benefit from a heart transplant but the supply demand stays flat at 2,000- 2,500. The survival rate for heart transplants today has improved significantly since the first heart transplant. About 88% of patients survive the first year after transplant surgery. 75% survive for 5 years and the 10 year survival rate is about 56%. The oldest living heart transplant patient as of 2013 is John McCaffery. He is in his early 70's and had his transplant back in 1982.

DAYS 1-5

Urine output, enzymes, and heart rate were abnormal. ➢ Barnard was worried about rejection and infection. He did not inform Louis about his concerns nor did he have the knowledge to control rejection. ➢ Louis had been administered many drugs (such as immunosuppressants), which caused him to become very ill. ➢ A shadow appeared on his lung X-ray.

Final Outcome

after the 18th day Louis Washkansky passed away - December 21, 1967. Cause of death: pneumonia