Case 6: Marriage Squabbles
55 years old diabetic hypertensive admitted with intra cerebral bleed.
Declared brain dead on day 3. Family requested for eye donation on their own. On making solid organ donation request family very willingly agreed. All preparation for organ retrieval made, kidney recipients hopes raised with cross match on 3 patients being negative.
Suddenly one member of the family claiming to be the first legal wife appears on the scene and flatly refuses for organ donation and creates a nasty scene. Other family members tell the doctors to ignore the wife ( as she is deemed 'mad') and go ahead with their request.
Question:
- How will you approach the problem?
- Is there a legal way out of the problem?
What actually happened -
The situation was felt to be a little too complicated, the doctors and counselors appealed to the first wife, but she did not budge from her decision. This it was felt was more due to the fact that she felt insulted and bitter with the behavior of her family members towards her.
Efforts to harvest organs were abandoned.
Case 7: The Belligerent Family
A 55-year-old man influential businessman with political connections is admitted to ICU of a famous city hospital in a state of unconsciousness. He requires ventilatory support. He shows initial signs of recovery however deteriorates on day 3. His CT brain shows a massive intracranial hemorrhage in the tempero-parietal region. His GCS on day 5 is 3/15 with total absence of brain stem reflexes.
The doctors inform the family and wish to discontinue ventilatory support. Initially the family seems to understand the situation, hence the social worker requests for a possible "eye donation and possible organ donation".
After a few hours a couple of male members (sons) of the family are very abusive and threaten the hospital of dire consequences. They accuse the hospital of neglecting the patient and not caring enough. They feel that not only eyes but their father's other organs would be removed and traded. They disallow any discontinuation of the ventilatory support. The hospital management has an emergency meeting and are in a dilemma.
Questions:
- How should this situation be tackled?
- Are there any legal implications if ventilatory support
is discontinued?
- Did the request for organ donation precipitate the crisis?
What actually happened -
The hospital authorities decided to firmly tackle the situation as it was felt by the ICU and other clinicians that the patient had been rendered the best possible care.
The sons and the family were called in for a meeting and first this fact about the best possible care was re emphasized by all the doctors to the family. They were also advised to get a second opinion from any doctor or doctors from outside the hospital who they trusted in to come and fully evaluate the case. They also said to the sons that if the doctors felt the care was not right they would be happy to shift the patient to another hospital if necessary.
They also showed the family all the X ray, CT scans and the brain death confirmation by the neurologist.
The sons pacified on their own after a few hours and changed tune and were apologetic of their behavior. They actually went on to donate the eyes of their father the next day.
Case 8: Willing Kidney Donor or What?
A 23 years Old married well-educated woman from middle class seeks appointment with a leading transplant clinician. She and 6 to 7 of her friends have read about kidney failure patient and wish to donate their kidney without any monetary benefit. She and her friends are very keen and motivated and are told about some of the risk of surgery but they still wish to go ahead.
Questions:
- Should they be encouraged?
- Is there any legal problem envisaged if she goes on to
donate her organs?
- Are there any ethical and moral issues involved?
By- Dr.Sunil Shroff, Dr.Sumana Sundaram
Careers