thepuncture.com

Heart transplants are tricky buisness, because in order to have good outcomes, the patient needs to not be too sick (poor organ perfusion over time will be problematic for organ rejection) – but sick enough to be elibible for a heart transplant. It’s not easy to decide and that is where the United Network for Organ Sharing (UNOS) is involved.
An interesting excerpt from their website:

Social criteria such as celebrity status, wealth, or prison status, are excluded from medical criteria and therefore are not permitted in consideration of organ allocation. Federal law permits use of medical criteria, not social criteria in organ allocation policies.

(source)

Under the UNOS policy 3.7.3(d) (yes, i looked it up under policies) part of the criteria for being at the top of the list for receiving a heart is being on a continuous infusion of a medicine that will be benificial in heart failiure for example Milrinone.
My patient today is on Milrinone, but he is not on a high enough dose to be counted on the 1a list, so we are giving him another medication to make his numbers look worse so that he will require more Milrinone, and be bumped on the list.
Shady buisness? Absolutely.

I just got done talking to our transplant coordinator and asked “is this cheating ?” Well no! Since of course, it’s in our patients favor. But where the ethical dilemma is, is what bumping someone UP on the list does to the person who WAS on the top of the list.. she didn’t have as much to say about that.