Fifteen –year-old Anthony Stokes needs a heart transplant. His mother, Melencia, says Children’s Healthcare Atlanta, a hospital near his home in DeKalb County, Ga., told her he is not going to be placed on their waiting list to get one.
Doctors said they don’t think Anthony will follow directions and do what he needs to do to keep a transplanted heart working. Melencia thinks that is just wrong. "If they got to know him, they would love him," she told a local TV station Family friends hint that maybe the hospital just does not want to give a scarce heart to Anthony.
This denial of a transplant comes hard on the heels of the Sarah Murnaghan case in Philadelphia. The 10-year-old girl's parents were told she was not eligible to get a lung transplant from an adult donor because of her age. After wide-scale media attention, she later got not one but two. So do American transplant centers have it in for young people? What is going on here?
In Anthony’s case there seems to be concern because to date he has not been a very compliant patient. This should come as no surprise. It is well-known that teenagers are among the worst group in terms of complying with doctors' orders, taking the medicines that keep a transplant working and simply showing up on time for regular appointments to make sure everything is OK.
The core ethical issues raised by Anthony’s case: Is he likely' to be non-compliant after a transplant? And would other transplant centers not list him if they thought he was a high risk to fail post -transplant?
No one can really say with certainty what someone will do after a transplant, but if there is concern about compliance, it might make more sense to get him and his family into intensive counseling. Despite the orneriness of adolescence, can he be persuaded to do what it will take to live if he gets the gift of a heart?
Not all transplant centers kick out unruly teenagers. Some would argue that a young person, even one who is a pain in the neck and might foolishly waste a scarce donor heart, should still be eligible based on age. Those who have not lived a life ought to get that chance when they compete with much older potential recipients.
Evidence of non-compliance must be a factor in deciding who gets a transplant. But teenagers are almost non-compliant by definition. Even if it means the loss of some organs that could have saved other lives, isn’t gambling on kids justified by giving them a shot at a life? Before saying "no" to Anthony Stokes, shouldn’t we insist that he be put through a very intensive program that makes him and his family absolutely aware of what it means if he says "no" to his doctors after a transplant?
First published August 13 2013, 9:30 AM