Written speech - to transplant organs only to those who maintain their health
A written speech by Limor Parker - presented in the frame Speech and persuasion course. Moderator: Guy Yariv
Today I will talk to you about transplants and I will present to you a controversial topic: are people who knowingly harm their health entitled to appear like everyone else on the waiting list for transplants?
First I will describe to you how organ allocation is done, and later I will present my position supporting the idea of placing these people lower on the list. I will explain this position through a social argument and a health aspect.
Background: Organ allocation policy
The organ allocation policy of the National Transplantation Center is based on a computerized system. All those waiting for a transplant in Israel are in one database detailing age, medical urgency, length of wait and more. According to these data, a score is determined for each patient. For example: every person under the age of 16 gets an extra 2 points. Accordingly, the patients are placed on the list.
In Israel there is a shortage of organs for transplantation. Just to explain the ear in Israel, about 1000 patients are waiting for organ transplants and every year more patients are added. Every year only about 200 get the long-awaited organ that can save their lives and this is as a result of a gap between demand and supply.
Moral argument - those who take care of themselves deserve more
Now I will start with my social argument and say that when a person is faced with the need for a transplant it is no longer a private case. Transplantation is a complicated social matter that requires an educated and fair decision as possible towards all people who are in a life-threatening situation. And according to my opinion, the issue of moral guilt should be included in this decision. A person who decided all his life to consciously damage his organs, even though he knew in advance all the risks, even though his doctors warned him dozens of times, it is not fair that society will now put him on an equal footing with a person who took care of his health all his life and one fine day his organs failed.
To illustrate the moral dilemma I will present to you two real cases, I will use pseudonyms:
In July 2007, Herzl came to Dr. Levin at Tel Hashomer Hospital after undergoing countless grueling tests in the past two months. Herzl is a father of 3 children, 52 years old, professor of mathematics and a lecturer at Ben Gurion University. For the past 20 years after his father was diagnosed with diabetes, Herzl maintains a healthy lifestyle as much as possible. Twice a week he makes sure to go for walks with his wife, once every six months he goes for routine blood tests and makes sure to eat nutritious and healthy food. In the last two months, Herzl suffered from stomach pains, weight loss, weakness, and darker urine than usual. When Herzl came to Dr. Levin, he was informed that he had disseminated cancer in the liver and there was no other treatment option other than a transplant.
3 months later at the end of October 2007 at the Blinson hospital, Shlomi arrives at the emergency room in Ambalones. Nurse Rinat who worked the same shift in the emergency department already recognizes the patient. Shlomi arrives dirty, smelly with ragged clothes and smells of alcohol. Shlomi is a homeless man who lives close to the hospital and visits the emergency room many times. He has already entered a rehab facility twice where he was explained about all the damages caused by alcohol, and was told that if he manages to stay sober then his fatty liver disease is potentially reversible. But about 4 months ago, Shlomi left the institution in the middle of the process. Dr. Goili, who was on duty at the time with an enlarged liver. After further tests, it was determined that Shlomi's liver no longer functions and he needs a transplant.
In most modern countries of the world, they try to ignore moral considerations, but the question arises, how can this be ignored? How can Shlomi and Herzl be brought to the same court in light of the fact that in Israel as of the beginning of 2008 there are 117 candidates for a liver transplant and only 33 received a transplant in 2007? And who guaranteed that Shlomi would be able to overcome his addiction to alcohol after leaving the rehab facility twice? Is it right to take the risk and transplant a liver to an alcoholic when there are 4 other people waiting together with Shlomi for the same liver?
Health argument - transplantation in a healthy body has higher chances of success
Another argument is a health argument. Smoking, apart from being an important factor in the development of various cancers, causes severe respiratory diseases, sclerotic heart diseases, increases blood pressure, damages the brain and kidneys, and more. The success of a lung transplant in a person whose other systems are not functioning properly decreases by tens of meters compared to a non-smoker. 65 people are currently waiting for a lung transplant. Only 35 received a lung in 2007. In my opinion, the chance of successful transplantation is a decisive factor in prioritizing the people on the waiting list.
In conclusion, I brought up a painful issue that raises many ethical dilemmas and we as a society sometimes have to decide against the impossible. Alongside the desire to treat everyone equally and to allow everyone a life, there are the cruel and dry statistics of the lack of organs in the country and we have no choice but to make cold considerations and face the social and health arguments I raised today.
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