Thursday, April 2, 2015

Butterfly Defect

Doctors are often accused of playing God* and should take care when they do, but it is with even greater care that lesser folk should play Doctor.

Flash back about two years...

A teenager, around 15 years old suffers from heart disease, a particular condition that will prove fatal, possibly in short order. These are circumstances that warrant consideration of a transplant. But...Consideration is not the same as "Guaranteed On-Time Delivery." This is not Fedex. This consideration generally considers many factors: overall health of the recipient; psychological and lifestyle evaluations; and assessment of the recipient's likelihood of following the rigorous post-transplant medical regimen. Some considerations are viewed as harsh but they are driven by the reality that need far exceeds supply. These assessments inherently assign value to the lives of individuals and determine who lives and who dies based on relative value. But who would really recommend transplanting a heart, a life, into a 68 year old grandfather while denying life to a 30 year old father of two preschoolers?

But in this case medical considerations did not carry the day as the medical assessment indicated the heart, with its rare gift of life should go to some other recipient than our 15 year old. The medical considerations for denial relied on the psychological and lifestyle evaluations which, since the candidate was black, were met with cries of profiling and racism. The cause was taken up by local media as an attention grabbing cause célèbre -- they spoke of "his journey." Political pressure was added to the pressure of Political Correctness forcing a reversal of the medical decision that resulted in an at-risk black youth being given the second chance he, at the time, so adamantly claimed he would treasure.

And now his journey has ended and ended badly. So badly that had his body rejected the heart, killing him from medical complications it would be far better than the truth he created, the journey he took given his second chance. He is alleged to have done many things, but it is certain that he fled the police in a car that was not his to drive, a chase ending with him hitting a pedestrian before crashing into a an obstacle that ended his own life. And stopped forever the beating of the donor's heart.

He also proved wrong all those who said the Doctors' judgment was in error and did so at great cost and risk of even greater cost. Transplant is a zero sum game and if there is any upside it is that a lost life can provide life for another that might otherwise end as well. The scarcity of transplant organs compounds the inherent tragedy--in cases with multiple recipients a choice must be made and it will be a life and death decision that will inherently value the life of the donor, the life of the recipient and the lives of those who will not receive that transplant. In this case mob rule supplanted domain expertise devaluing a donor's sacrifice that could well have offered a recipient, who may well have died in this recipient's stead, a long productive life.

That was not to be as the wrong decision was made by the wrong people for the wrong reasons and yielded the previously identified expected outcome. And that is the direct damage. The disregard for the consequential, collateral damage is disgusting as an ill advised extended life nearly cost a pedestrian her life and is a alleged to have fired a weapon at another. That as little damage was done (that we know of) is something to be thankful for.  Unless you're the woman he hit with the car or the family of a young mother who died waiting for a heart.

* Old joke. Q: What's the difference between a Doctor and God? A: God knows She's not a Doctor. To bad more people won't say that.