Should physicians bend rules to get patients new hearts amid donor shortages?

How far will physicians go to get their dying patients a new heart?

Matthew Movsesian, MD, cardiologist and professor at the University of Utah School of Medicine in Salt Lake City, investigates this question in a recent column featured by NPR.

The United Network for Organ Sharing follows criteria to ensure hearts go to the most severely ill patients. For example, if a patient receives an IV drug as treatment, they are listed as "Status 2" and have a median wait time of 630 days for a heart. A patient in the intensive care unit on a high dose of an IV drug with a pulmonary artery catheter is deemed "Status 1A" and only has a median wait time of 110 days.

In 2014, around 6,950 patients were approved for heart transplants in the U.S. Only 2,250 donor hearts were available that year. In response to these shortages, Dr. Movsesian believes some physicians are providing more serious medical care to their patients, even when not needed, to move them higher on the donor list.

The system — and the bending of it — forces physicians into quite the ethical dilemma, says Dr. Movsesian. Is it right to boost one patient's chances of getting a transplant by decreasing someone else's odds? If other physicians are increasing care to move their patients up the list, are other physicians putting their patients at a disadvantage by not also doing so?

Dr. Movsesian said UNOS is developing a new system to decide how donor hearts are distributed. While the new system promises to better select patients with the most severe diseases, he believes the same incentive to increase patient care will still be present, along with the ethical dilemma it produces.

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