Calling all Social Workers…

Okay, so my knowledge of social sciences and family well-being aren't all that great, and I know that there are several MSWs here on CC, so I figured I would ask for some help.

We're running a hypothetical transplant board meeting tomorrow for our Doctoring Class in which we have to decide which of three patients should get a heart transplant. The patient that my group is assigned to is a 30-yr-old mother of two (from two different relationships). She can't hardly do anything on her own because she has fulminant heart failure. She lives with her mother and get a lot of help from her brothers. She also has some history of marijuana use.

So here's where I'm doing some research. I am under the impression that this mother is the best qualified to raise her own children. I know that this isn't the case with all mothers, but even in situations where the mother is somewhat negligent, don't children develop better if they remain in their own family? Is this correct?

I found some good support in Donald Winnicott's assessments of a "good-enough mother."  Also, there seem to be a lot of support for child development in a complete family (mother and father), but our case is a single mother. Are there other sources that you know might help?

Original Post by pgeorgian:

so what was the rationale for giving your patient the heart over the others?

The main reasoning was the fact that she was so young and that, in general, postpartum cardiomyopathy patients who get a transplant, do as well or better than others of the same age range. 

The social aspects of her motherhood came into play a little bit when we were considering her ability to comply to her treatment regimen after the transplant surgery, but didn't take a very important role in the overall decision. 

well i'm sorry she didn't make it, sim, but i have to admit to a little satisfaction ;)

Original Post by sybil878: 

This attitude that someone's life is more important if they have kids is ridiculous and infuriating! Procreating does not take any talent and does not give someone a god given right to be put ahead of the rest of society. Would the same argument be made of a man who had kids? No. Why not - a father is just as important as a mother. What if the person without kids was a genious and their research was contributing to the cure for cancer - would they then be on the same level as someone who simply popped out a baby? It's ridiculous. Everyone has family/friends who's lives would be affected from a death. Who are you to judge who would be worse off. 

Transplants should be based on science - who is the most likely to survive. And yes, that means that younger people may get a higher chance of wining an organ because they are younger and healthier - and that's how it should be. All other (health) things being equal, the most likely to get the most life out of the organ should get it.

1/5 of the people who are put on the heart transplant list will get a heart even though they all deserve it. More often than not, people have to choose between cases that have the same survivability. Wouldn't it make sense to take more aspects into consideration in these cases. I don't think the point is to say that motherhood trumps all other reasons for a transplant, but it might influence the decision just the same. There is evidence to support the idea that the relationship between a child and its biological mother (as opposed to the father or an adopted mother) is exceptionally significant. The fact that choosing not to give the heart to this mother will adversely effect the ability for her kids to properly develop is worth taking into consideration, even if it only increases her chances of getting the heart by an iota.

Also, its not always easy to tell which patients will survive the longest with a heart transplant. In our situation, it was the 65 year old with a 30 year history of smoking that survived the best with his transplant.

Original Post by pgeorgian:

i have to admit to a little satisfaction ;)

Why is that?

Original Post by simwaves1:

Original Post by pgeorgian:

i have to admit to a little satisfaction ;)

Why is that?

um...'cause it's pretty much exactly what i told you yesterday.

re: #22 - you're forgetting who your patient is again.  the woman is your patient and your concern; her kids are not.  and like i said yesterday (and as you just told us) caring for children is more likely to be detrimental to her outcome than of benefit.

can her relationship to her family, kids included, be a source of support and strength?  absolutely.  but the benefit to her kids is peripheral.  they're not your patients.

Original Post by simwaves1:

I don't think the point is to say that motherhood trumps all other reasons for a transplant, but it might influence the decision just the same. There is evidence to support the idea that the relationship between a child and its biological mother (as opposed to the father or an adopted mother) is exceptionally significant. The fact that choosing not to give the heart to this mother will adversely effect the ability for her kids to properly develop is worth taking into consideration, even if it only increases her chances of getting the heart by an iota.

I disagree - there is no evidence that those who have grown up without a mother or who have lost a mother have any less of a chance of a better life. The evidence you're quoting is that of a primary care giver - not necessarly the mother, and it looks at infants, not children. Even in your study it only states that 70% of mothers form this secure attachment with their child - only 20% greater than a unrelated caregiver - certainly NOT a high enough percentage to give mothers an automatic pass.  Especially given there is no evidence that the 30% who don't create that secure attachment don't go on to lead nomal, healthy, happy productive lives.  

not to mention the fact that we don't know whether or not she's a good mother.  if it turned out she's abusive, what would that do to her chances of getting a transplant?

Original Post by pgeorgian:

um...'cause it's pretty much exactly what i told you yesterday.

re: #22 - you're forgetting who your patient is again.  the woman is your patient and your concern; her kids are not.  and like i said yesterday (and as you just told us) caring for children is more likely to be detrimental to her outcome than of benefit.

can her relationship to her family, kids included, be a source of support and strength?  absolutely.  but the benefit to her kids is peripheral.  they're not your patients.

I think I misunderstood. I was under the impression that you were satisfied that she died.

I wasn't disagreeing that the patient and her medical concerns were the crux of the decision to give her a heart. I was only trying to gain support for her based on a side issue. 

I understand that you thought I should have focused more on the patient and not her relationship to her kids, that just wasn't what I was assigned to do. The others in my group took care of that part.

Original Post by sybil878:

I disagree - there is no evidence that those who have grown up without a mother or who have lost a mother have any less of a chance of a better life. The evidence you're quoting is that of a primary care giver - not necessarly the mother, and it looks at infants, not children. Even in your study it only states that 70% of mothers form this secure attachment with their child - only 20% greater than a unrelated caregiver - certainly NOT a high enough percentage to give mothers an automatic pass.  Especially given there is no evidence that the 30% who don't create that secure attachment don't go on to lead nomal, healthy, happy productive lives.  

I never said that mothers should receive an automatic pass. I'm only saying that it should play a part in the decision (even if it is a very small part).

If we assume the existence of two female patients who are identically matched in all physical and social aspects, but one has kids and the other doesn't, then it seems clear that the mother should take priority over the woman without kids. If we only have one heart to give out, then the only way that we can decide between these two is based on motherhood. Sure, both women deserve a heart, but I think that the mother should be given priority. No?

Original Post by sybil878:

There is no evidence that those who have grown up without a mother or who have lost a mother have any less of a chance of a better life. 

Maybe this is better than the last one.

or this

or this one : "institutionalization in early childhood increases the likelihood that impoverished children will grow into psychiatrically impaired and economically unproductive adults."

Sybil: You seem to be leap-frogging over Sim's responsibility and the responsibility of his team. 

Sim's job was to find every single possible reason for his patient to get the heart. If he can make the case that her death makes orphans of her children and enough people on the board agree and she gets the heart because of it, then he has done his job. 

You are right Kathy, this is an exercise for class credit.

In real life potential recipients for transplant are not chosen in this biased unethical manner, if it were I would no longer be on the donor list.

but 'gator (and sim), in a clinical context, the children don't make a strong argument.  and trying to use that to people who take the perspective that the children aren't relevant isn't going to strengthen the position.  it's probably going to look like emotional blackmail, which isn't particularly professional and clinical.  either that or you've completed missed the point.

as i said, focusing on the patient's capacity to be a mother, that's different.  that's relevant.  that's about the patient.  but the welfare of the kids - aside from the fact that the mother's survival doesn't guarantee that, it's just not relevant to the question at hand. 

maybe a shiny new heart gives her the strength to beat them harder.  maybe it gives her the hope to abandon them and embark on a brand new life.  that's irrelevant, too.

crap, bagga.  i didn't know.  best of luck, hey? 

pg, I am a registered donor not on the waiting list to receive

Edit: thank you kindly anyway for the well wishes...I re-read my post and it is a bit convoluted, sorry.

ah - gotcha.  like, live donor?  kidney/liver stuff?

i'm on the organ donor list, too, but inelligible to donate blood products or bone marrow because i lived in the UK for four months in 1989/90.  makes me very angry.  like, don't you think if i had kreutzfeld-jacob i'd have had some symptoms by now?

come to think of it, i don't know if they'd use my organs, for the same reason.

My husband was a donor. His liver was given to a 70 year old man. And a kidney to a 60 year old lady. Heart valves were harvested as well as cornea. Both were used for patients, the cornea for a young girl. They also harvested long bone and skin tissue. The rep explained that often these can be used in treatment for wounded soldiers.

While I understand your point Bagga - I think as a donor myself, I would be more concerned to find out that they dole out parts based on ability to pay.

ew, 'gator.  i hate that i think that's likely.

I find it interesting that most of the new studies, including the one in the OP *center on treatment of the elderly. Maybe it's because I live in a retirement state, but it sure seems like most of the breakthroughs and new treatments come about because the only patients that can afford them are on medicare. :/

*hee hee edit: I was thinking of the other thread that Sim started.

huh.  yeah, and prolonging the lives of the elderly really is the last thing we need to be focused on.  let 'em go.