I took a class called "Vice, Crime and American Law," a few years ago, it was very interesting... we had to write an essay that answered the following question:

You have several options:

1) There is a list of patients who have been waiting for a liver, you can strictly adhere to this list regardless of who is at the top, or how badly the patient needs the liver. Keep in mind: the person who is number 1 may have a less serious condition than the person who is number 5; patient #5 may only have a week to live...while patient #1 may have several months to live. But patient #1 did sign up before #5.

2) You can suggest a lottery. Draw a name out of a hat, and that person receives the liver. This way it relies all on chance, not on need. There is no need for you to look over the cases to decide who is in the most need the liver.

3) You review the cases and you decide who needs the liver the most.

These are your patients:

Dan: A homeless 45-year-old man, he has already had one liver transplant due to his alcoholism. He is currently at the top of your hospital's list for liver transplants [you have the right to veto anyone on the hospital's list, as long as you have good reason to]. Dan's problem is serious, but realistically he could live for another 4-5 months without being treated immediately.

Kristen: A 36-year-old lawyer. She is willing to donate enough money to the hospital to add on an additional wing to the hospital if she receives the liver transplant ASAP. Her condition is not as serious as some of the other patients, she could live for a few more months without the liver, but if she has to wait she would not donate the money to the hospital.

Megan: A single 24-year-old woman who has five children. She is unemployed, and doesn't have any insurance. Her condition is very serious, and she may not survive the operation.

Carl: A married 80-year-old man, who happens to be a noble-peace prize winner. His condition is very serious, but he has a very high chance of living through the operation.

April: A 7-year-old girl who is in desperate need of a liver. She is very sick and will likely die with the next 2-3 days if she doesn't have this operation immediately. The success rate of this operation is very low.

What do you choose to do? And why?

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I think most people agree option one and two are out, so option three:
First I would figure out which patient has the best chance of non-rejection, that aside and assuming it is equal. I also assume that once the liver is used and something happens on the operating table and it ruins the liver.

Dan; I would not give a liver to an alcoholic, especially since he has had a transplant before and it was ruined.

Kristin; She would be one of the top of my list for the transplant, people say that money shouldn't matter but if you can save 10 lives with that money and have a name and bio to go off of it would make it a hard decision to just discount her.

Megan: I wonder what the cause of the liver failure is. If it is self induced then that would push her to the bottom of the list, if its an unpredicted condition I would put her somewhere near the middle of the group. Taking the case Pro-bono puts strain on the hospital and lessens resources to help other people.

Carl; While a Nobel prize winner it would be hard for me to put an 80 year olds life before a 7 Year old girls. He would probably be a close third behind Kristen.

April: I would have to try and give April the liver. She has the most potential to make something of her life.
well this is how i see it
dan: Is 45 years old and has already had several transplants, therefore this person does not deserve a transplant already fked up the first one, due to the same problem, therefore this person either A: doesnt want to live B: is too stupid to stop drinking or C: Hasnt had much help with her problem.. either way on this person i judge her to be a bad canidate due to alchohalism, why waste an organ on someone that most would say "has more time to live" when they keep wanting to shorten thier time.

Kristen: A lawer basically trying to bribe her way into getting herself fixed, yet at the same time, would majorly contribute to the well being of others for her own greedy little self. Gotta wait on this one.

Megan: a woman who has 5 children, asumming that she has had no double triple or quadroople births means that she was say around 16-17 years old when she started getting pregnant. Means that either A) she has never heard of birth control B) she is a very loving person "aka" very very very "loving"
C) is really really stupid or D) all of the above or E) someone who has just had the worst luck being rapped 5 + times within 6 years, either way i do not have enough information on her to determine her canadecy.

Carl: A nobel prize winner very smart choice but is 80 years old witch means within the next 10+ years he will be having other major health issues...

April: a 7 year old girl has a low chance of living and will die within the next few days...

Appearently i havent taken any law classes because im only 19 and going to colledge for psychology and sociology, but this is how i would lay it down, who ever deserves the liver more should get it first.

Dan is homeless and had a transplant before due to alchohalism, and is back again, he goes to number five auto matically, because he deserves the liver last. April is a 7 year old girl who is very ill, maybe not even her fault she has more years to live for and hasnt expierianced the world at all, she shoot strait to number one. Carl is a 80 year old nobel prize winner, very smart, but he is married and therefor his wife must be around the same age or within 10 years if not then heh what a perv, his wife will greatly miss him but she will die more soon than any of the other canedates thus making her life not as miserable because its going to be gone quicker than the other person, nobel prize winner but only so many years to live afterwards, he goes to number three. Megan is only 24 years old but she has 5 children yet she may not survive the treatment, she has no insurance, i dont care what you say she goes second because A) children shouldnt go through that grief, and B) it would ruin 5 people's lives. ill explain afterward Kristen is 36 years old she wants it fast and she is willing to contribute to the hospital for a speedy recovery, she goes fourth for being selfish and greedy.


April because she is the most innocent and has more to look forward too is first
Megan: Because she has more to look forward too and longer to live afterwards and she has 5 kids...
Carl: Because he is a smart man and may be able to contribute once again to the better ment of humanity.

Kristan: because she is basically trying to bribe the hospital in order to get the surgery done faster implying she is selfish.

Dan: Because he blew his first chance, why would we waste a second...

but thats just based on the information above, really if i had the choice i would investigate everyone on the list fully, no just "are they elidgeable" and what is thier "survivablity" but aswell on who "deserves it most" would you a give a killer who has killed 12 people the new liver and only has 2 days to live but has a high probablity of survival or to a woman who is and x veteran who is a firefighter, has won the nobel peace prize but has 1 year to live and has a low probability to survive, me i would give it to the woman for the fact that she hasnt killed anyone. One id feel a lot better knowing that we dont have any personal population control maniacs out there and two the woman just deserves it more in my opinion.

What it comes down too is "good people" deserve better than "bad people". case and point...
I am not morally obligated to give it to anyone. Therefore, the question is m00t.

I would like to add, however, that bribes are not immoral in and of themselves. It is purchasing a service for an agreed upon price.
It goes to Megan. I was a patient advocate for a public hospital and attended numerous transplant committee meetings where these issues came up. It isn't just being at the top of the list that's important, many other factors have to be considered and each patient often has an advocate. In this case, it's pretty clear. Every committee I served with agreed that both likelihood of death without the surgery and the likelihood of life with it are imperative considerations, risk always being understood. Responsibilities to others, particularly family members was also high on the list of factors. Kristen would probably just go to India and get the surgery.


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