Zambrano Organ Allocation Analysis

Responsibility Ought to be Considered in Organ Allocation
Organ allocation. A process in which someone, somewhere decides where to place people on the transplant list. Many factors must be considered as organs are a scarce resource. Such factors must include, life style, age, prognosis, other comorbidities and most importantly the cause for the transplant. To explore these ideas, I will focus on the Zambrano article introduced in class. In this article, the author explores the argument of responsibility. The argument of responsibility states that a person should be placed lower on a priority list for receiving an organ if they have caused the illness. Zambrano uses the example of an alcoholic who is now in need of a new liver because of the
drinking. However, Zambrano also brings the case of a firefighter who has chosen to work in the field knowing he could develop lung cancer. Throughout this paper, I will attempt to explain and demonstrate how there is a difference between consuming something purposefully and unintentionally.
I will first begin with the case of the firefighter. Zambrano states the firefighter had the option to stay in his current position. He also clarifies that if the firefighter stays in his current position, there will be no harm done to him. Here, the question is raised whether we can say the firefighter is responsible if he decides to become a firefighter. I propose that we cannot. As a person who works in the world of fire and emergency medical services, we do not know what we are exposed to. A firefighter signs up to help people. They do not sign up to be exposed to toxins that may result in lung cancer. There are many a time when firefighters walk into peoples houses to help them or remove them from danger. This contributes to our communities and allows the community to sleep restfully knowing they have a competent department. If we spun this around and made it so firefighters wouldn’t risk their lives to help people, then we wouldn’t have a fire department. Without a fire department, who would clean up car accidents, hazardous material spills, or put out fires? The point is the fire department is a vital piece to our society. They don’t always know what they are exposed to. In addition, the firefighter goes through extensive training on personal safety. They have respirators and SCBA apparatuses that protect their airways to the best of their ability. These men and women are not putting things into their bodies knowing it could cause cancer or organ failure. They are performing their responsibilities and sacrificing themselves for their community.
Meanwhile the alcoholic who is drinking their life away does not better the community.
Let’s pause for a moment and define the alcoholic used in this example. There are two different types of alcoholics. Those who are productive during the day and contribute to life and drink at night. Then there are the kind who drink all day, rely on others for their housing, food, and other necessities. I think the distinction here is important. I think our argument relies on the person’s contribution to society. I will elaborate on this later in the paper. Returning to the case of the alcoholic. When a person cannot feed themselves because they are consumed by alcohol, how can we trust they will take care of their new organ. Zambrano answer’s this question stating, for his argument, the alcoholic would be one who is recovering and no longer drinks. My response to this is the fact that addiction is a very real thing. These people may be “cured” from their alcoholism but how do we know they are for the rest of their life? How do we know they won’t turn back to alcohol? I don’t know that we can say 100 percent they won’t go back. Alcoholics make a choice every day. They make the choice to pick up a beer or a fifth or a pint. They choose this. Said from a former addict, “I made the choice every day to pick [it] up.” Now this person is someone who I know dearly. I believe even if addicts feel it is their choice, then it truly is. The alcoholic decides to prioritize alcohol over their body’s
health.
My response to how we ought to prioritize people on the waitlist due to responsibility is as follows. First, did they (the firefighter or alcoholic) knowingly do something which can and will cause detrimental damage down the road? In the case of the firefighter, I argue they did not. I believe they are aware of certain products they may encounter. However, they are not aware those things are on the scene they are going to. They are exposed before they know. In the case of the alcoholic, they must go to the store to buy the product. They then willingly put a product with warnings on the bottle into their bodies. This is their responsibility. It is not by accident alcohol enters their system, especially in the quantities they consume. Secondly, did the person’s actions benefit the community or anyone else? For the firefighter, in their 20-year career, they would have saved many lives. Pulled many people out of burning buildings, saved the lives of other EMS personnel, etc. Our firefighters are the reason towns don’t flood from broken pipelines, they are the ones who jump into fast water to save a person, they also are the ones who will work hours on end without sleep to help you. The alcoholic does not do these things. They sit at home, waiting for other people to wait on them. Alcoholics often rely on the government for section eight housing, food stamps, and the emergency response system for when they’ve drank too much. In another argument, you could say they waste resources; require unnecessary transports to the hospital. This ties up firefighters and paramedics which could be detrimental in not being able to help somebody who is having a heart attack. I believe we have an obligation to prioritize those who are not responsible for their condition.
To counter this, however, would not be difficult. One of the ways to do so would to say, how can we say one life is more important than another. You could argue that the lay person should not have a say in who lives or dies. A great, unrelated, example of this is in the case of overdoses. Certain states have proposed laws that emergency medical services (EMS) will only save you three times from an overdose. The counter to this is that EMS has a duty to act in that they are there to save lives, not let people die. To relate this to our case, how do we delegate who chooses who lives and dies? Another way to repudiate the above argument is the case that alcoholism is a medical condition. One could say that yes, they have the choice to drink but when they develop a dependence, they now require it to survive. People can and have died from alcohol withdrawal.
Responding to the above counterclaims is as follows. I agree that it is hard to delegate who lives and who dies. I believe that is the point in the consideration of if you are responsible for your condition or not. I would not say I believe it to be true that one is marked towards the bottom for one aspect of their life. Rather, I believe a screening process would be necessary which would consider other factors in one’s life. Comorbidities, age, lifestyle, etc. would all account for the other factors. My response to the fact that alcoholism is a medical condition is that it would be taken into account under comorbidities. I still hold strong that it was the person’s fault. They picked up the first drink and continued from there. In addition, there are programs for alcoholics that the person could have entered long before the need for a new liver was ever a need.
Organ allocation is not an easy process.
I deem it necessary for many life circumstances to be taken into consideration when deciding who gets placed where on the list. Of those circumstances, whether or not you caused the issue should be investigated. Should it be the end-all decision? I don’t think so, but I don’t have the answer for that. Zambrano wrote a paper explaining how one could believe a firefighter was responsible for their lung cancer. I have attempted in this paper to refute that idea. A firefighter’s lung cancer is merely a biproduct of their job. They do not choose to walk into smoke. They have proper equipment to mitigate the risk. In addition, they may not know what they’ve walked into until the exposure has already occurred. I have shown in this article that the firefighter is necessary in our community; they contribute to their society and attempt to make it a safer place. Meanwhile the alcoholic decided to pick up that first drink. The chose not to go to a program early on. They chose to continue drinking. Their alcoholism is not a biproduct of anything. It is simply their choice and their responsibility. When deciding if the alcoholic should be placed above or below the firefighter, the act of responsibility ought to be
considered.