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A man in his 60’s walked out of Barnes-Jewish Hospital in July of 2023 with a brand new liver, saving him from his liver cancer and cirrhosis caused by hepatitis C.1 Who does he have to thank for this? While Dr. Adeel Khan and his trusted team of surgeons worked relentlessly to plan and execute a life-saving liver transplant, the true hero of this story may be the robot who performed the actual surgery.




Around 9,000 liver transplants are performed in the U.S. every year, and around 12,500 people are added to the waitlist for liver transplants each year.2 Liver transplantation is a highly complex surgical procedure, involving incredible precision and a high donor match for it to be successful, as complications can immediately arise from rejection following the procedure. In order to ensure a successful transplantation, surgeons use a combination of precision and dexterity to reach difficult and obscure places in the abdomen while maintaining minimal invasiveness. Dr. Adeel Khan, the leader of the team of surgeons at the University of Washington, dedicated more than five years of relentless effort to pioneer the groundbreaking achievement of the world's first robotic liver transplant.

The procedure began with a team of highly skilled surgeons who meticulously planned every detail. A state-of-the-art surgical robot, equipped with multiple robotic arms, served as an indispensable assistant during the operation.3 The robot provided the surgical team with unmatched precision, dexterity, and the ability to access difficult-to-reach areas of the abdomen with minimal invasiveness.

The surgery was a remarkable success; the patient is currently doing well and has fully resumed all normal activities. He was easily walking after six weeks as well as golfing and swimming after seven weeks. His case marks a pivotal moment in the medical community. Healthcare professionals, as well as patients, are now faced with the possibility of using technology like Artificial Intelligence (AI) to add immeasurable value to the operating table. While there are many healthcare professionals fearful of the threat that AI and technology pose to their careers, this liver transplantation is a prime example of professionals working alongside new technology to provide the best outcome to their patients. 

Edited By: Sanjana Anand

Designed By: Heiley Tai


Citations:

  1. Bhandari, T. (2023b, September 21). First robotic liver transplant in U.S. performed by Washington University Surgeons. Washington University School of Medicine in St. Louis. https://medicine.wustl.edu/news/first-robotic-liver-transplant-in-u-s-performed-by-washington-university-surgeons/#:~:text=For%20this%20robotic%20liver%20transplant,a%20football%2C%20inside%20the%20abdomen

  2. professional, C. C. medical. (n.d.). Liver transplant: Criteria, surgery, Procedure & Recovery. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/8111-liver-transplantation 

  3. Washu doctors perform first robotic liver transplant surgery in U.S. WashU doctors perform first robotic liver transplant in U.S. (n.d.). https://spectrumlocalnews.com/mo/st-louis/news/2023/08/22/washington-university-doctors-perform-first-robotic-liver-transplant-surgery-in-u-s-


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  • Jack Ringel

Updated: Mar 4

Every day, 17 people across the world die waiting for a life-saving organ transplant. In fact, there are currently more than 100,000 people waiting for an organ donation in the United States alone (1). Organ Donation Euthanasia (ODE) seems to be a possible solution that could help provide more suitable organs for transplantation. ODE involves performing an organ extraction of a terminally ill anesthetized patient (2). This process may increase the quality and quantity of organs available for donation. However, there is an important ethical consideration surrounding this process. Unlike traditional euthanasia, the terminally ill patient does not die due to purposefully administered drugs, but rather as a result of the removal of organs to be donated. Given that this process saves a life at the expense of another, is Organ Donation Euthanasia ethical? 


According to The Uniform Determination of Death Act of 1980, “an individual who has sustained either irreversible cessation of circulatory or respiratory functions, or irreversible cessation of all functions of the brain, including the brain stem, is dead” and can therefore be an organ donor (3). However, purposely causing a patient's death for the purpose of organ donation would be considered euthanasia, which is illegal throughout the United States, according to the Dead Donor Rule (4). 

Advocates for ODE argue that terminally-ill individuals have a right to determine how their life will end and whether that includes through an organ donation. However, gaining informed consent in this situation would be extremely difficult as these individuals would face many external pressures that may bias heir ability to make truly autonomous decisions. Other ethical considerations include the role of the medical professional in the decision process. Medicine has traditionally used The Hippocratic Oath to guide ethical dilemmas. This oath explains that physicians should only give beneficial and life-saving treatments and not cause harm or damage (5). Therefore, asking physicians to knowingly speed up the death of a patient for organ donation purposes may create internal conflict for the physician.  

Ultimately, proponents of ODE believe that when a terminally ill patient's quality of life is severely compromised, providing them a way to die peacefully while saving another life would be justified. However, those against ODE believe that this is a form of devaluing a person who still has the potential to live longer. One thing is certain: this debate will continue for years to come. 


Reviewed By: Vishruth Hanumaihgari Designed by: Alejandra Gonzalez-Acosta


Citations

  1. Bollen, Jan. "Organ Donation Euthanasia (ode): Performing Euthanasia through Living Organ Donation." Transplantation, Dec. 2020, journals.lww.com/transplantjournal/fulltext/2020/09003/organ_donation_euthanasia__ode___performing.440.aspx#:~:text=We%20have%20called%20this%20%27organ,out%2C%20which%20then%20causes%20death. Accessed 23 Feb. 2024.

  2. Britannica, The Editors of Encyclopaedia. "Hippocratic oath." Encyclopedia Britannica, 5 Dec. 2023, https://www.britannica.com/topic/Hippocratic-oath. Accessed 23 Feb. 2024.

  3. "Ethical Considerations of Imminent Death Donation White Paper." Organ Procurement and Transplantation Network, Dec. 2016, optn.transplant.hrsa.gov/professionals/by-topic/ethical-considerations/ ethical-considerations-of-imminent-death-donation-white-paper/ #:~:text=The%20dead%20donor%20rule%20is,the%20death%20of%20the%20donor. Accessed 23 Feb. 2024. 

  4. "Fast Facts: January – March 2023." Life Source, 18 Apr. 2023, 

     www.life-source.org/latest/fast-facts/. Accessed 23 Feb. 2024

5. "Organ Donation and Transplantation Legislation History." Health Resource and 

Service Administration, Fast Facts: January – March 2023. Accessed 23 Feb. 2024.



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Imagine that you are the presiding judge of this courtroom, reviewing the case of Horacio Estrada-Elias⎯a 90-year-old inmate serving a life sentence for a nonviolent marijuana trafficking crime [1]. When you read about his crime, you are doubtful about his character. Yet, your eyes also linger on his spotless disciplinary record in prison. You then look at his medical records: “less than 18 months to live.” He has requested for a compassionate release. 

Now, what decision should you make? Do you maintain “justice” for those who have suffered from his crime by keeping the sentence and letting him die in prison? Or do you allow him to spend the last 18 months of his life outside of prison on supervised release?



This debate becomes an ethical dilemma within the justice system when an inmate’s death is anticipated to be near. Incarcerated individuals remain one of the largest populations with the most complex health needs; more than 4,000 people have died annually in prison since 2003 from various health diseases, such as heart disease and cancer [2]. Palliative care needs are prevalent within prisons, yet the population remains poorly underserved with current measures. For instance, hospice services of prisons were only available at 69 out of 1,719 state correctional facilities and often lacked quality care [2].  The reason behind is countless: mistrust between staff and prisoners, concerns of safety, potential misuse of services (e.g., medications), and the financial cost associated with providing such quality services [3].

However, with consideration to the growing palliative care needs of this population, 48 states within the United States have implement some form of early release for incarcerated individuals with serious health illnesses [2]. A common form of such mechanism is called “compassionate release” and is designed to grant inmates release from prison when their death is near due to health-related causes [4]. However, mechanisms like compassionate release remains rarely accessed and even more rarely successful. For instance, the Federal Bureau of Prisons only granted 3.24% of the small number of requests for compassionate release in one year [2]. Therefore, even though these current measures remain an option, most inmates perceive them to be almost impossible to be used successfully and protect their well-being. 

To examine this issue further, the debate must return to the fundamental question of ethics. Do prisoners deserve the same rights to provision of care as any other individual? From possession of drugs to series of murders, these individuals are in prison for a reason; they have committed some form of harm to others through their actions. If such level of care is offered, is justice truly being served for the victims?

From a human rights perspective, it is important to consider that inadequate palliative care may be considered a “cruel and unusual punishment” [3]. Activists claim that these rights are basic and must be provided to individuals regardless of the nature of their crime. They further argue that current measures do not conserve the dignity that all humans deserve to have before their deaths. For instance, staff have recounted encounters of terminally ill inmates being “shackled, put in an orange jumpsuit” even just a few days before their deaths [2]. 

The conservation of dignity for these individuals crosses over to the responsibilities of medical professionals. The American Medical Association (AMA) Principles of Medical Ethics states that physicians have “a responsibility to see changes in those [legal] requires which are contrary to the best interests of the patient” [2]. This principle has been considered to urge medical professionals to become more involved with the issue of offering appropriate palliative care to even the incarcerated. As asserted by McParland et al. (2023) in their review, the provision of such care must be an interdisciplinary effort between the custodial and healthcare staff [4]. Custodial staff must maintain the security of prison systems and ensure the well-being of inmates, while the healthcare staff must assess the needs of prisoners and administer treatment as they would do for any other patient. This becomes especially crucial as many inmates lack the support of loved ones when they spend their last days in prison alone. 

Whether you made the choice to grant Horacio compassionate release or not in the beginning, it remains imperative to consider the different ethical perspectives of the debate. In the end, to strike a balance between punishment and rehabilitation within a prison environment, there must be a stronger collaboration between various individuals involved within the justice and healthcare system.


Reviewed By: Laura Wang

Designed By: Shanzeh Sheikh


Citations:

[1] Tolan, C. (2021, September 30). Compassionate release became a life-or-death lottery for thousands of federal inmates during the pandemic. CNN Investigates. https://www.cnn.com/2021/09/30/us/covid-prison-inmates-compassionate-release-invs/index.html 

[2] Mitchell, A. & Williams, B. (2017). Compassionate release policy reform: Physicians as advocates for human dignity. AMA Journal of Ethics, 19(9), 854-861. 

[3] Maschi, T., Marmo, S. & Junghee, H. (2014). Palliative and end-of-life care in prisons: A content analysis of the literature. International Journal of Prisoner Health, 10(3), 172-197. https://doi.org/10.1108/IJPH-05-2013-0024

[4] McParland, C., Johnston, B., & Ouwehand, I. E. I. (2023). Caring for people in prison with palliative and end-of-life care needs. Current Opinion in Supportive and Palliative Care, 17(3), 224-230. https://doi.org/10.1097/SPC.0000000000000661


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DMEJ

   Duke Medical Ethics Journal   

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