Case 1: Patient with Criminal Past

Case 1: Patient with Criminal Past

Case 1: Patient with Criminal Past

A 55-year old man has worsening congestive heart failure. He is currently in the second year of a 10-year prison sentence. He has been transferred to a prison with specialized medical facilities and is sent to a nearby tertiary referral center for consideration for heart transplantation. His initial medical evaluation indicates that he is very likely to die of congestive heart failure within 2 years and that his survival can be significantly improved by cardiac transplantation. There are no other contraindications to transplantation. He is very polite and articulate and tells the evaluating physician that he was convicted of tax fraud. The day before the review conference, a curious team member Googles his name and discovers that he has, in fact, been convicted (for the second time) of child sexual abuse.

The discussion at the review conference quickly centers on the significance of his criminal offense. About 2/3 of the group believes that he should be turned down as a transplant candidate. They argue that donor hearts represent a scarce resource that must be used for the greatest societal benefit. Although they acknowledge that it would be difficult to decide where to draw the line in deeming an individual undeserving of a transplant, they see no problem in this case. They point out that program has no obligation to transplant him and that, with the majority in favor of declining him, it is “case closed.” A minority advocates for accepting him as a medically suitable candidate who will not be able to seek transplantation elsewhere. They believe that, in this country, all individuals should be treated equally in regard to the opportunity to receive a heart transplant. They note that there is not institutional or legal policy that precludes a prisoner from being accepted for transplantation. They are particularly concerned about the “slippery slope” of turning down medically acceptable candidates based on value judgement. They want the issue to be decided by the ethics committee. They are also concerned about legal issues.

If you were involved in this case, what course of action would you favor? Please explain your reasoning.

1. Unconditionally deny listing for heart transplantation

• Accept immediately for heart transplantation

• Other course of action (describe)