Continued from June 1996 UpBeat
Ethical Issues in Organ Transplantation by James F. Chitdress, Ph.D.
Public health considerations often justify autopsies to determine the cause of death, even against the conscientious objections of adhere nts of religious groups. Strong communitarian views extend such arguments to justify conscription or expropriation of cavaderic organs. Some ethicists contend that the good of persons needing transplantable organs and the good of the community can justify the removal of organs even against the will of the decedent and the next of kin, because the cadaver lacks autonomy a nd cannot be harmed. Respect for the beliefs of the decedent while alive, and his sociocultural practices regarding burial, does not outwe igh significant therapeutic benefits to recipients of organ transplants. I strongly agree with the critics of organ conscription who appeal to the "principle of extra-territoriality," and contend that individuals may be wronged (by having their will thwarted after their deaths) without being harmed, and note that sociocultural practices of disposing of bodies remain very im important for various communities. Furthermore, in a liberal society, respect for autonomous choices made prior to death shou ld not be overridden if there are acceptable and effective alternatives.
Another possible mode of transfer of organs and tissues is abandonment, that is, a failure to claim bodies and their pans. For example, following some medical procedures patients simply abandon their excised organs, tissues, blood, urine, and the like, which may under some conditions be used by researchers. This mode of transfer of body parts has been widely debated in the case of living sources: for instance, the famous Moore case in California in which researchers developed a profitable cell line, named " Mo," from a spleen removed during Mr. Moore's treatment for hairy cell leukemia. It also appears to characterize statues that authorize the removal and use of organs and tissues from unclaimed bodies. In principle, this mode of acquisition of cadaveric organs and tissues could be ethically acceptable, but it will not s ignificantly increase the supply of organs or tissue for transplantation. Furthermore, strict rules are needed to ensure that the body is actually unclaimed.
In our society, any time there is a disparity between supply and demand, the market appears to offer a feasible solution. Why not for organs? While setting a legal framework for donation in the late 1960s, the original UAGA did not prohibit the sale of org ans because the Commissioners on Uniform State Laws did not want to establish an absolute barrier to sales. They apparently believed that this matter could be handled by local medical communities. Hence, for many years the sale of organs and tissues was aarguably not illegal in most of the U.S.
In 1983 there were several hearings on organ transplantation before congressional committees and subcommittees. In April 1983, in hearings on organ transplants before then-Congressman Alber t Gore's Subcommittee on Investigations and Oversight of the HouseCommittee on Science and Technology, I proposed in passing that Congress might consider prohibiting the sale of organs for transplantation. Congressman Gore interjected: "Dr. Childress, you recommended a legal prohibition on the sale of organs and body par ts. You don't think that there is a sufficient record of such practices to warrant legislative action at this time, do you?" I responded: "I have no evidence to suggest that there is. I think in a way this would be a preemptive action to avoid some problem s down the road, in part because of the increased publicity about the need for organs." While indicating that he and his colleagues would consider such a ban, Congressman Gore stressed that they were "becoming increasingly skeptical of preemptive laws."
Within a matter of months, as reflected in several subsequent hearings and in public statements, Congressman Gore, along with several of his colleagues, had changed his mind. not because of arguments offered by ethicists and others who testified, but because se of a proposal by an ex-physician in Virginia to set up a brokerage firm to purchase organs, particularly in the third world. for retransplantation in the U.S. Outrage was instantaneous and widespread. As a result, the 1984 National Organ Transplant Act (NOTA) made it illegal "for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable cons ideration for use in human transplantation if the transfer affects interstate commerce." Several states also prohibited the sale of organs. It is not illegal in the U.S. to sell blood, sperm, and ova. No country is reported to allow the sale of cadaveric organs, even though stories circulate about sales in some countries.
What happened between 1968 when the UAGA was promulgated, without a prohibition of the sale of organs, and 1984 when NOTA and several states prohibited the sale of organs'? When organ transplantation really started to gain momentum in the early 1980's, particularly as a result of improvements in immunosuppressive medication, the problems of scarcity became more troubling, the growth potential more obvious, and the limitations of the system of voluntary, altruistic donations more evident and troubling.
The legal prohibition of sales in 1984 did not silence the discussion, and numerous proposals have emerged since then to institute som e sort of market in organs, at least on the side of procurement if not the side of distribution. These proposals have in p art reflected the 1980s' style of competition, markets, and deregulation. They have also reflected concern about stagnation in organ procurement, since organ donation had been expected to increase substantially as a result of laws and policies of required request directed at decedent's families.
However, to take just one example, kidney transplantation experie nced substantial increases for five consecutive years from 1981 to 1986 (increases of 475,754, 856, 1,027, and 1,280), but then it declined slightly in 1987 and has been somewhat stagnant, wi with occasional bursts of growth. A significant increase in kidney transplants in 1990 resulted mainly from changes in criteria of eligible donors, rather that from improved rates of donation from previously eligible donors. And the small increase in kidney transplants in 1991 resulted from additional donation from liv ing donors. Further increases follow similar patterns.
Two main arguments support the transfer of organs and tissues by sales. One is based on the principle of respect for autonomous choices, the other on the principle of utility or maximization of human welfare. The first argument, a libertarian argument, holds that autonomous agents should have the liberty to dispose of their body parts in whatever ways they choose, whether by donation or sales. The second argument, a utilitaria n argument, holds that society should accept transfers of cadaveric body parts bysales as the most effective and efficient way to increase the supply of organs that can save human lives.
The main objections to the libertarian argument for sales rest on several moral claims: (1) There are the risks to living vendors or to others whose parts may be transferred by vendors after being killed or allowed to die; (2) there are concerns about thevendors' lack of voluntariness, especially if they are poor, economically vulnerable, and subject to exploitation; and (3) buying and selling organs involves cornmodification, that is, treating body parts as commodities, and thus depersonalizes and degrade s vendors and the society. According to defenders of organ sales, societal regulation rather than prohibition could reduce risks and establish voluntariness, and, they believe, cornmodification is a vague and speculative concern. However, opponents contend that societal regulation itself, even if successful on the first two points, legitimates cornmodification and thus violates fundamental societal values.
The main rejoinders to the utilitarian argument hold that there are other effective, ethically acceptable (and even ethically preferable) ways to increase the supply of organs. Shifting to sales, they contend, would be costly, would probably drive out many donations, and could have serious negative effects through promoting commodification. In addition, critics question whether sales would actually increase the supply of organs. Proponents of markets stress that potential donors now fail to act because of i inertia, inconvenience, mild doubts, and distaste in thinking about the transfer of their (or a relative's) cadaveric body parts, and that compensation will overcome these grounds of resistance. It is unclear whether fundamental attitudes of distrust will yield so easily to monetary incentives. Fears of being declared dead prematurely or having one's death hastened in o rder to provide organs for others can be expected to pose problems for a futures market.
Winston Churchill once said that democracy was the worst form of government ever created except for all others ever proposed or tried. The same can be said of express organ donation (by individuals while alive and/or families after relatives' deaths) in co comparison with all other proposed methods. B ut can we make express donation more effective without transgressing ethical boundaries and limits? I have already offered some positive and negative recommendations, for instance, opposing mandated choice direct e d at individuals, and supporting the possible designation of surrogate decision maker as well as routine or required referral (rather than merely required request).
We need to re conceive public (and professional) education, which has been to rationalistic, individualistic, formalistic, and legalistic. Some of the major deficiencies of most public education for organ donation flow from a misconception of the implication n of respect for personal autonomy in organ donation. The moral and legal principle of respect for personal autonomy entails that if the individual while alive, decides that he does not want to donate, and he does not want his organs donated by others, that a t decis ion should be respected (just as the decision to donate should be respected). However, this foundational principle does not entail further that individual autonomy should be promoted by getting people to sign donor cards. Rather than taking the individualistic approach of trying to get more individuals to sign donor cards, public education should be more social and even communitarian, while still recognizing and stressing that respect for individual autonomy is fundamental and remains a trump ca rd . This & quot;liberal communitarian" approach would target individuals as members of smaller communities (often but not always families). It would educate individuals about the importance of indicating their wishes about donation to their family members aswell as imagining themselves in the position of deciding for others who are deceased.
Not only will effective educational programs have to address individuals as members of families, rather than merely as potential signers of donor c ards, they will also have to address both individual and familial attitudes of fear and distrust, which appear to pose obstacles to express donation.
Certainly, education of the public (as well as health care professionals) about brain death is one crucial step. Education regarding brain death needs to underline that there are simply different ways to determine when the same state or condition of deathhas been reached. This is an area of education that is cognitive as well as attitudinal.
A feasible policy for obtaining organs and tissues from cadavers also presupposes a clear, compelling, and workable boundary between life and death. The development of the criteria of brain death in the late 1960s was essential to the expansion of organ transplantation because of the need to obtain viable organs from heart-beating cadavers, whose cardiopulmonary function is maintained by machines. However, problems have emerged.
First, uncertainties about brain death figures prominently in many of the stated reasons for individual and familial reluctance to donate organs. But these uncertainties are also evident in comments by many health care professionals. For instance, the attending physician in one famous case of organ donation noted that the patient was "brain dead and there isn't much chance he will recover."
Second, we m ust not overlook the possibility that vigorous societal and professional efforts to alter the criteria of death may be partly responsible for the public's distrust. Warnings appeared in the late 1960s and early 1970s that updating the criteriaof death in order to gain access to additional organs could lead to a backlash. Ramsey contended that there is a parallel between the necessity on the practical level of differentiating professional roles in declaring death and transplanting organs (so that the physici an involved in the transplant should not determine whether the potential source of organs is dead) and the necessity on the intellectual level if differentiating reasons for updating the criteria for determining death. Criteria of death should be updated, he insisted, as part of the care of dying patients, not as part of the effort to increase the pool of potential organ donors. Changing the criteria of brain death, or even creating an exception to brain death, to accommodate, for example, theanencephalic n ewborn may further threaten a fragile system.
Third, some institutions in the 1990s have attempted to enlarge the donor pool by again including non-heart beating cadavers declared dead by cardiopulmonary standards, often following patients' decisions to decline further life-sustaining treatment. One concern is that such efforts will create a conflict of interest among professionals who have to manage the dying process in order to maximize the likelihood of viable transplantable or gans without violating rules against killing patients or directly hastening their deaths.
I have noted here, in a general way, the prominence of various complex psychosocial factors in individual and familial decisions, as well as in health care professionals' involvement in procurement. The discussion of brain death and of attitudes of trust a nd distrust also identifies some of these factors. Successful organ procurement must attend to the complex array of emotions, sentiments, symbols, and beliefs along with various rituals and practices associated with the dead human body. Only narrowly andexcessively rationalistic approaches deny their importance and their role in organ procurement and donation.
We have too often thought of organ donation as a question of the relation between the broader society/state and the individual and/or his/her family. We have, in the process, too often neglected the role of religious and other intermediate communities. Yet these intermediate communities play a tremendously important role in the way we organize and live out our lives. In a nice phrase, William May referred to religious communities - his point is not limited to those communi ties - as possible sources of "organized giving." This phrase suggests both (a) what is given (organs) and (b) how the giving is structured: by the beliefs, symbols, rituals, and practices of particular communities. Some seem to think of religion as a barrier, when in fact it is more oftena source of perspectives or frameworks within which organ donation can be viewed as obligatory or praiseworthy. We don't know the donor's framework in the Mickey Mantle case, but she viewed organ donation as obli gatory, not merely praiseworthy. For her itwas "the decent thing to do."
Official religion rarely stands in the way of organ donation, and some religious objections, for example, in Orthodox Judaism, center largely on problems with brain death. For the most part, particularly in Catholicism, Protestantism, and Judaism, there is a convergence or overlap, establishing cadaveric organ donation as an ideal, praiseworthy action, if not morally mandatory.
Consider the mother's comment regarding her act of donation in the Mickey Mantle case. She felt that she had an obligation. The reporters covering the case underlined the "sacrifice" of organ donors and praised their "heroic" actions. Others have called such cadaveric organ donations "extraordinary." Clearly there are two frameworks of moral discourse used for the mo ther's act of donation: morality of aspiration and morality of duty; ideal and right; good and right. These are not totally separate; the lines between them are not always clear, and we move back and forth between them. The mother, the actual donor, used the language of obligation, of duty, of right; the television reporter used the language of aspiration, supererogation, ideals, and good action s. These two frameworks of moral discourse produce different descriptions of and responses to the failure to dona te. Within the morality of aspiration or supererogation, the failure to donate does not produce guilt. (It might produce shame if an agent has committed himself to living up to certain ideals.) By contrast, within the morality of duty or obligation, the failure to donate does produce guilt, and others may be indignant and complain.
Both are part of our social-moral practices regarding organ donation, but we need to think through very carefully how we can and should use them in the society at large as well as in particular communities (for instance, religious communities). It is at least partially correct to say that one perspective is internal, not only to individual but also to family, as in the case or' the donor mother - and perhaps to a small community - and the other is external, the perspective that observers and spectators must take, as in the case of the reporter, legislators, courts, and the society at large.
The following question has emerged in recent years: Could financial and other tangible incentives strengthen the system of express donation through "rewarded gifting" without crossing the line into sales? Thomas Peters has proposed a pilot program to testthe effects of providing a one-time death benefit of $1,000 for recoverable donations. Critics contend that rewarded gifting differs very little from direct sales. Howeve r, a modified approach might be effective in providing financial incentives and yet preserving the meaning of the act of donation: As a regularized expression of gratitude for acts of donation of organs and tissues, the society could cover the decedent's funeral expenses up to a certain level. In this way, the community would recognize with gratitude the decedent's and the family's act of donation and would also pay respect to the donor/source of the organs and tissues by sharing in the disposition of the f inal remains, following the removal of donated parts.
Any particular proposal for rewarded gifting requires careful scrutiny, in part because organ donation is a highly sensitive activity, marked by complex beliefs, symbols, attitudes, and sentiments, as well as by ethical and political pitfalls.
The last point builds on the impo rtant moral connections between organ procurement and organ distribution. To increase the donation of cadaveric organs, we need to ensure that our allocation and distribution policies are fair, and assure the public that they are in fact fair.
Who owns donated organs? I am somewhat embarrassed in retrospect that it took me several months on the federal Task Force on Organ Transplantation to grasp that much of the debate about selection criteria was in reality a debat e about who owned - or who had dispositional authority over - donated organs. It was in part a debate about power and authority. At that time, in the mid- 1980s, according to Jeffrey Prottas, organs donated for transplantation belonged to the surgeons who removed them. But then, in its most important philosophical move, the federal task force held that donated organs belong to the community, as public resources, whose effective transfer is in the hands of transplant teams, which hold the organs as trustees and stewards on behalf of the community. However, as Prottas notes, the task force's new conception both fundamentally changed matters and yet left them the same. On the one hand, professional dominance remains. On the other hand, it is now more circumscribed and publicly accountable. With organ allocation and distribution now in the public domain, in part because transplant professionals sought governmental assistance, there are now more players, and the rules of the game are now different. "Alternat ive allocation systems are now defended in public debate," as Prottas notes, "and equity (fairness, justice) as well as efficiency (medical utility, etc.) must be considered and defined. Physicians dominate the debate, through knowledge as well as power, but they must justify their actions now as trustees of the public. The organs are no longer theirs." Public participation occurs in several ways, through discussions in the media, through the UNOS board and various committees, through local a nd regional boards, and so forth.
The points I have just made apply to the allocation and distribution of organs to patients on waiting lists. The next stage of the discussion, which was raise by the Mickey Mantle case, is setting some public criteria for admission to waiting lists. This i s now the big problem area, marked by too much mystery and perhaps even too much professional discretion. At least it's debatable, and the debate is now beginning in UNOS in an effort, for insta nce, to reduce clinicians' efforts to game the system by putting patients on lists early.
Another problem emerges at the point of admission to waiting lists, and that is the relevance of ability to pay. In a 1993 Gallup poll, respondents were asked to agree or disagree with the following statement: "Given equal need, a poor person has as good a chance as a rich person of getting an organ transplant." Fifty-eight percent disagreed or strongly disagreed, and eight percent indicated they didn't know. Even when we appeared to be headed toward health care reform that stressed universal access, therewere problems about whether and which organ transplant procedures should be included for coverage. Now, in the midst of the managed care revolution, which has cost control and cost reduction as the ever-present bottom line, this question becomes even moreurgent. Everywhere there is a global budget, questions are raised about organ transplantation. It is not surprising that after the state of Oregon decided to stop providing Medicaid funds for most organ transplants (except for kidneys and corneas), a boycott of organ donations was organized by some low-income people.
The federal task force, on which I served as vice-chair, argued for eliminating ability to pay as a criterion, in part because of the distinctiveness of organ transplantation, which depends on public donations. According to the Task Force, it is unfair, even exploitive, to ask rich and poor alike to donate organs, if only the rich have any effective chance of receiving organ transplants in cases of medical need. Ethically and politically, it is going to be difficult to request organs from the public, when so many could never receive an extrarenal (in contrast to a renal) transplant. Over 37 million citizens are without health insurance at any one time, and additional 10 to 12 million lack insurance some time during the year, and many are underinsured (or with benefit packages that exclude some expe nsive transplants). And yet they are aware of the Mantles, Caseys, Hagmans, Crosbys, and other wealthy celebrities who are able to get on waiting lists and who sometimes seem to receive a transplant very, very quickly.
Debates can be expected to continue about effective ways to obtain more cadaveric organs and tissues for transplantation, particularly in view of the long waiting lists for transplants and the limited increases in the acts of donation. Religious beliefs, symbols, and practices, along with various other psychosocial forces, are important for determining the ethical acceptability and ethical preferability, as well as the feasibility of different laws, policies, and practices to obtain organs and tissues for transplantation. Some of the policy reforms in the U.S. in the 1980s may have been ineffective and perhaps even counterproductive because of inadequate sensitivity to such psychosocial factors.
It is critical that policymakers consider the whole range of relevant factors in order to ensure the effectiveness and minimize the negative consequences of organ procurement policies. The system of express donation remains our best ethical hope, but evenwith the changes I have proposed it may not produce as many organs as it could (certainly, we need alternatives to human organs). Not every problem has a solution, much less an ethically acceptable solution.
Dr. Childress is Kyle Professor of Religious Studies, professor of medical education, and
co-director, Virginia Health Policy Center, University of Virginia, Charlottesville, VA
Bulletin of the American College of Surgeons, March 1996 Contributed by Don Marshall, M.D.
By Matt Crenson - AP Science Editor
NEW YORK (AP) -- A new surgical technique that paradoxically strengthens the heart by cutting out a chunk of it has emerged from the Brazilian jungle, and surgeons say it could help thousands of cardiac patients lead longer, more active lives.
Dr. Randas Batista developed the method to treat his patients at the Hospital Ange lina Caron in Curitiba. Many of them are afflicted by a parasitic infection known as Chagas' disease that weakens the heart and eventually causes it to fail.
In the United States and Europe, doctors believe the procedure could benefit patients whose hearts have failed for any number of reasons, including heart attacks, high blood pressure, congenital defects or diseased valves.
"In the jungle, I don't have much help," Batista explained in a tel ephone interview. "So, once you don't have the facilities, you always question, 'Isn't there any other way to treat this patient'?'"
That other way that Batista came up with turns out to be deceptively simple. It's so simple, in fact, that many cardiac surgeons can't believe it works. That's why it has taken Batista, who has been using the method for 15 years, a long time to attract attention to it. Heart surgeons in the United States and Europe now are excited about the technique, not only because it appears to work, but also because it fills a void in their surgical toolbox. Current treatments for heart failure include complicated andrisky open heart surgery, mechanical valve replacement and even heart transplant.
"It's such a radical approach that it's difficult to see how this is possible," said Dr. Tomas Salerno, chief of cardiovascular surgery at Buffalo General Hospital. "This is one of the major contributions in the history of cardiac surgery."
In Batista's procedure, doctors buttress an enlarged and weakened heart by cutting a piece out of the left ventricle. Restored to its proper size, the heart can beat more efficiently.
"By bringing the diameter of the heart down, one reduces the tension on the wall of the heart," allowing it to beat more strongly, said Dr. John Elefteriades, chief of cardiovascular surgery at Yale University in New Haven, Conn.
In the United States, the operation has been tried by surgeons at Yale, Buffalo General, the Cleveland Clinic and Holy Cross Hospital in Mission Hills, Calif. Surgeons in Europe and South America also have tried the method.
Salerno said that he and his colleagues in Buffalo have performed the operation 12 times. Seven of their patients are still living. Salerno said those survivors are in much better shape than they were before the operation.
Doctors think that about 70,000 people in the United States would benefit from a heart transplant each year, but only about 2,300 of those people receive new hearts annually, most ly because there aren't enough donors.
James Absalom, 65, of Youngstown, is a retired grocery store manager who was a candidate for a heart transplant when he became the Cleveland Clinic's first patient to have the surgery. He was able to go home 10 days after his May 23 operation.
"I'm feeling great. I really am," Absalom said Friday. "I am looking forward to getting out and doing things I haven't done for years," including bowling a nd going to his grandchildren's baseball games.
Batista has performed the operation on about 300 Brazilian patients. Approximately 60 percent of them survived a year after their surgery. That rate, which is considered good in light of the dire condition of heart failure patients, and the remarkable condition of many of the survivors, have drawn attention to the procedure.
Despite their enthusiasm, cardiac surgeons caution that Batista's results haven't b een rigorously studied yet.
"What we have here is truly, by and large, anecdotal reports," said Robert Michler, a heart surgeon at Columbia-Presbyterian Medical Center in New York City who is considering trying the technique.
Surgeons also noted that the technique will not benefit every heart failure patient. Heart failure can be caused by a number of problems, and many of them may be better addressed by other methods.
"It may be effective in one form of heart failure and not in other forms," Michler said. "I'm saying, let's do it, but let's study it."
SOUTHFIELD, Mich., (UPI 6/21/96)- Jack Kevorkian's attorney said Friday that the man once dubbed "Dr. Death" may soon become known as "Dr. Life."
Attorney Geoffrey Fieger said Kevorkian h as plans to offer an organ donation process to patients who decide to end their own lives.
Detroit radio station WWJ said Fieger did not release details of the plan but said people involved in assisted suicides "would be given the option of making their organs available for transplant."
Neither Kevorkian nor Fieger could be reached for comment Friday.
On Thursday night Kevorkian and other doctors reportedly attended t he suicide of an Bette Lou Hamilton, 67, of Columbus, Ohio, who was suffering from a neurological disease. The woman was dropped off at a Pontiac, Mich., hospital by her best friend. It was the second assisted suicide this week for Kevorkian and the third in less than two weeks.
While there was no official confirmation of Kevorkian' s involvement, a spokesman for Pontiac Osteopathic Hospital said Fieger was one of two people who delivered the body in a wheelchair. Hamilton suffere d from a progressive, neurological disorder calledsyringomyelia, which causes a"wasting away" of memory, balance and other functions, Aranosian said. After dropping off the body, Aranosian said, Fieger and an unidentified "friend" left the hospital.
Tuesday, a 58-year-old Virginia woman was the 30th person to commit suicide with help from Kevorkian. Lona Jones died of carbon monoxide poisoning, and her body was later wheeled into North Oakland Medical Center in Pontiac, Mich.
Last week, the body of 69-year-old Ruth Neuman of Columbus, N.J., was wheeled into North Oakland hospital by her son. She also died from carbon monoxide.
Kevorkian has been tried three times on charges stemming from suicides in which he had a role and was acquitted of all charges.
Kevorkian, a retired pathologist and long-time advocate of organ donation, has assisted in 31 suicides since 1990. Kevorkian has ofte n spoken of his wish that organs be harvested from the otherwise-healthy bodies of death-row inmates after execution.
BERLIN (Reuter 7/7/96) - A German with an artificial heart has set a world record for longevity by surviving nearly two years with the device, a Berlin hospital said Sunday.
Reiner Hege, 37, was taken to the Berlin Heart Center on July 8, 1994, suffering from an enlarged heart caused by an infection, a hospital spokeswoman said.
He decided against having a donor heart implanted and instead had doctors put in a pump that supports the heart's function. The artificial heart has helped clear up his illness to such an extent that he will not undergo a transplant at all.
Hege has lived in his home village near the eastern city of Magedeburg since November.
The previous record listed in the Guinness Book of World Records was set by an American who survived with an artificial heart for 620 days.
By Tom Anderson - UPI 6/19/96
A young New Zealand woman was recovering from a liver transplant at an Australian hospital Thursday after being rushed there because a volcano prevented her from being flown to New Zealand's North Island.
Charlotte Bell, 18, from South Island city of Dunedin, was on a life- support machine at a Dunedin hospital Tuesday when a suitable liver donor was found in Auckland, on the North Island.
But smoke and ash from the Mount Ruapehu volcano. which began belching debris Monday, closed Auckland International Airport and grounded a medical evacuation aircraft. The airport has since reopened.
Doctors found another suitab le donor at the Princess Alexandra Hospital in Brisbane, Australia, and a Sydney-based air ambulance flew to Dunedin to get Bell.
Bell was transported back across the Tasman Sea Tuesday to Brisbane in the specially equipped and staffed air ambulance operated by NRMA Care flight.
"Everything went according to plan and there were no hitches," Careflight medical coordinator Ian Badham said of the two-hour/'light.
"T he girl would have died had she not had the transplant and this would have happened with the closure of Auckland airport because of the volcano," he said. "We were only too pleased to have come to her aid."
A Brisbane hospital spokesman said"the operation was successful and that Bell was in stable condition in intensive care.
I sent in for this booklet, see, called Free and Low Cost Prescription Drugs. It cost me $3 from: The Cost Containment Research Institute, Capital Hill Office, 611 Pennsylvania Ave. SE-Suite 1010-C, Washington, DC 2003-4303. The opening page reads as follows: "If you're poor and have illnesses from cancer to severe anemia, you may be eligible for free lifesaving drugs. Most major drug companies provide free medication, but rarely, if ever public ize the programs. Consumer advocates like The Cost ContainmentResearch Institute say that in light of rising health care costs, its time to change all that." Inside is a list of many, many major drugs, including Neoral and Imuran, plus a list of all the manufacturers of same with a contact name, address, and phone number. Does it work? I haven't got a clue
Refere nce the comment made here last month about the Claire Sylvia book and movie, I had a call asking for further information so that perhaps pressure could be brought to bear on the publishers and filmmakers indicating that they were creating a disservice to transplant recipients and organ donation. Herewith is all the information I have on the subject at this time:
Second Offer Accepted. Hollywood Pictures, which made an offer months ago for A Change of Heart, at last h as been granted an option. The deal felt through initially because the movie company, part of the Disney organization, tied its bid to one from Hype r ion, also Disney owned, for publication rights. The authors, Claire Sylvia and William Novak (lacocca), and their agents, Palmer & Dodge, sold the book - still being written - to Little, Brown instead.
Recently, Sally Field heard a National Public Radio report on Sylvia's story. At 47 the former professional dancer underw ent a heart-lung transplant. Soon she developed food cravings she couldn't account for and a need to be constantly on the go. (Ed. Note : There's that darn prednisone again!)
Investigating the donor's background convinced her she had taken on characteristics of the young man whose organs had replaced her own. Backing Field in her wish to play Sylvia, Hollywood Pictures - bidding for a second time - has now secured an option onA Change of Heart through Jon Levin of CA A, negotiating for Palmer & Dodge's Elaine Rogers. The pickup price is well into six figures.
Publishers Weekly 4/22/96
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