Wasting A Heart

Heart transplant patient

I don’t have a solution to an ethics fiasco like this or know how it could be avoided, but there have to be some lessons buried here somewhere.

In 2013, 15-year-old Anthony Stokes was denied a place on the waiting list for a life-saving heart transplant  at Children’s Healthcare of Atlanta at Egleston because, the hospital explained, he had “a history of noncompliance, which is one of our center’s contraindications to listing for heart transplant.”

This means that doctors doubted that Anthony would take his medicine or go to follow-up appointments. In other words, he was too unreliable and irresponsible to be entrusted with a heart that could save the life of someone else more likely to make good use of it. When a doctor told the family that Anthony’s low grades and time spent in juvenile detention factored into the assessment, however, that gave the family an opening to save the boy’s life. They played the race card. Anthony was being sentenced to death because he was poor and black, and a white patient would naturally be a better risk. The media ran with the narrative, and there was national outrage. Fearing a public relations disaster, the hospital reversed its decision, and Stokes got his heart.

From the Washington Post today:

Tuesday afternoon, [Anthony] Stokes died after a vehicle he was driving jumped a curb, hit a pedestrian and collided with a pole in a car chase with police, according to WSBTV. The pedestrian was hospitalized for her injuries, but Stokes’s car was nearly split in half by the sign, according to the Atlanta Journal-Constitution.

Police said he had to be cut out of the Honda by first responders and rushed to a hospital where he later died…Stokes was driving a car that matched the description of one used by a person suspected of breaking into an elderly woman’s home. The chase began after officers responding to her 911 call attempted to pull Stokes over, according to WXIA.

Pensive and Rueful Observations:

  • The doctors were right: Stokes was a bad risk to receive a rare heart.  However, if Stokes had never received his heart, the decision would have been decried as racist.
  • In allocating scarce medical resources, “death panels” like this are a necessity and an inevitability. They have to be isolated from media pressure, public influence, lobbying, and emotionalism, or they will have no integrity. Yet they also have to be monitored for fairness and competence. How are both of these goals to be accomplished? I have no idea.
  • This is why advocates of national health care deny the need or inevitability of “death panels.” It is also why they feel the need to lie about it.
  • Loving parents can’t be blamed for doing everything in their power to save a son. If the race card is there to be played, they should play it.
  • Would the family of a white patient exactly like Anthony in every other way have been able to reverse the hospital’s decision? I doubt it. Is this fair or right? No.
  • Anthony obviously did not appreciate the gift he was given, nor feel any obligation to make certain that the life he had retained at the cost of another would be long and productive.
  • Still, it was his life. Did he have any less of a right to throw it away than anyone else?
  • Is any 15-year old responsible enough to be a good risk for a heart transplant? Yet isn’t the value of such a transplant greater the younger the recipient is?
  • At this point, almost any analysis is poisoned by hindsight bias.

I don’t want to think about this story any more.


Pointer: Democratic Underground

Facts and Graphic: Washington Post

30 thoughts on “Wasting A Heart

  1. Sounds like the plot from a movie on the Tragedy Lifetime Channel. It has a different version of Ick Factor. Maybe the “Aw Geez Factor.”

  2. Considering the long list of people waiting for a transplant in the U.S.A., Anthony’s actions and his parents will probably make more people reluctant to sign their donor cards. The heart was wasted and other people will die as a result of these lowlifes actions and the media.

  3. You just have to think about the patient who likely died due to his misfortune in simply not being black enough. Or maybe he was black, but older. The likelihood is that the vast majority of those people on the waiting list, regardless of ancestry, were better candidates than this criminal youth.

  4. Pingback: A Wasted Heart | Grouchy Old Cripple

  5. Hindsight bias? If the panel had been allowed to do what it wanted to do and thought was right, the heart wouldn’t have been wasted. End of story. Once the experts were frustrated in doing what they know to do, the car wreck ensued. So to speak.

    • Hindsight bias. If the kid had grown up to be President, nobody would question that they did the right thing to change the decision. It could have turned out a million ways. The fact that it turned out this way can’t be turned into an inevitability.

      • Inevitability? No. Probability? Now were cooking with gas. Other Bill’s use of inevitable is hyperbolic probability, and exaggeration aside he (and the doctors) were more right than wrong.

      • Sometimes we make our own luck. Sometimes we need to just let competent people have the opportunity to make some luck for us.

    • There is another ethical question: unless his parent(s) give permission to harvest this heart (or anything else), it stays with him, to be buried. In a case like this, where the recipient of a highly valued organ dies during a crime, can the medical team supervising his aftercare ‘repo’ the heart? Would it be an ethical law to propose?

    • Wow, my exact first thoughts after reading the story!
      And if he isn’t a donor, should it be a requirement of all recipients – it seems only fair.

  6. They’re not death panels, it’s “end of life counseling”, and “rationing”. See how much more palatable that is?

    • Maybe they can show the condemned some nice nature films before they off him… like they did with Edward G. Robinson in “Soylent Green”! You have to wonder just how much of that crazy nightmare film is about to come true.

  7. – Still, it was his life. Did he have any less of a right to throw it away than anyone else?

    – Is any 15-year old responsible enough to be a good risk for a heart transplant? Yet isn’t the value of such a transplant greater the younger the recipient is?

    You know the answer to both of those already. If your life came at the cost of someone else’s you reasonably and ethically have a higher standard to live up to. That was one of the themes of Saving Private Ryan: be worthy of the sacrifice – it isn’t given lightly. Stokes didn’t lose his life in the pursuit of happiness and the american dream, he lost it while running from the police after breaking into someones house (though the source doesn’t go so far as to confirm this). You don’t have to cure cancer but you sure as hell dont get to be a social cancer.

    And of course some 15 year olds are responsible enough to handle a new heart. There have been Eagle Scouts as young as 11. Age is a factor in maturity (vs. the determining factor) and the logic behind valuing young mature recipients over older mature recipients is plain – survivability and return on investment are higher.

    The media wasted a good heart by falling over itself to be on the right side of history and bringing the near-unbearable weight of public outcry on the panel doctors. The panel doctors wasted a heart by not resisting that pressure and caving. And Stokes wasted a heart by a being unworthy of it both before and after. I blame all the dominoes here, but I blame the first one the most.

    • Well, it is a bit much to expect Ryan-like insight from a 16 year-old, though. And Ryan had the advantage of knowing the men who sacrificed his life for him (really stupidly, I may add). I doubt that this boy considered the Zero sum game nature of his transplant, or even knew what a zero-sum game was. And while there are responsible teens, brain studies show that it is folly to depend on any one teen being responsible.

  8. Something like this was bound to happen. In fact I think there was a Law and Order Criminal Intent episode along the same lines. (Disgruntled donor kills to get organ back because recipient wasn’t doing enough good.)

    It’s inevitable that there will be abuses when science enables us to delay death. Cultural and political pressure groups make it difficult to make decisions that will satisfy everyone. If I were in the life saving professions I think I’d be tempted to out of it as fast as I could. I have two children in the medical profession and the subject of making life and death decisions comes up often. It’s lucky for me that not everyone thinks like I do, but according to my kids there are some who are opting out just as I would.

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