28 votes

Hospital refusing heart transplant for man who won't get vaccinated

33 comments

  1. [7]
    shiruken
    Link
    I wonder if he's refused any of the other vaccines required to get a heart transplant? Given the prevalence of COVID-19 and the immune system suppressants required post-transplantation, it makes...

    I wonder if he's refused any of the other vaccines required to get a heart transplant? Given the prevalence of COVID-19 and the immune system suppressants required post-transplantation, it makes absolutely no sense for the hospital to risk such a valuable organ on a patient refusing to get vaccinated.

    34 votes
    1. Greg
      Link Parent
      Not to mention that he apparently trusts the medical staff enough to perform incredibly difficult surgery on him, prescribe a complex array of anti-rejection drugs, avoid and/or deal with any...

      Not to mention that he apparently trusts the medical staff enough to perform incredibly difficult surgery on him, prescribe a complex array of anti-rejection drugs, avoid and/or deal with any post-operative complications, etc. etc. but he flatly refuses to listen to those same doctors about this one specific injection.

      29 votes
    2. [5]
      JakeTheDog
      Link Parent
      Where does it say there that it's "required"? It reads strictly as advisory.

      Where does it say there that it's "required"? It reads strictly as advisory.

      1 vote
      1. [4]
        cfabbro
        (edited )
        Link Parent
        Sure, it's "advisory"... but wouldn't "strongly advised" (the exact wording) essentially mean "do it or it's unlikely you will get a transplant" when organs are in such short supply? As...

        Sure, it's "advisory"... but wouldn't "strongly advised" (the exact wording) essentially mean "do it or it's unlikely you will get a transplant" when organs are in such short supply? As @patience_limited mentioned below, compliance to medical advise is a factor that doctors take into consideration when deciding on organ recipients.

        And even ethically speaking that makes perfect sense. Why would they risk giving an organ to someone who refuses to comply with medical advise to get vaccinated, especially when immunosuppressants are required after a transplant which will make them even more vulnerable to communicable diseases? Especially when there are likely countless others who are fully vaccinated, fully compliant, and thus far more likely to survive long-term, who are also waiting for that same organ.

        8 votes
        1. TavisNamara
          Link Parent
          Yeah, when there's not enough organs to go around (and there literally never are enough organs to go around), they have to make decisions, and those decisions tend to be boiled down to years of...

          Yeah, when there's not enough organs to go around (and there literally never are enough organs to go around), they have to make decisions, and those decisions tend to be boiled down to years of life. A hard-drinking, hard-smoking, motorcycle-riding anti-vaxxer (not saying this person was all of them, but certainly was one of them) would be pretty damn low on the list. It's the only fair way to distribute a critically limited resource. The most good. If money biases it, it's clearly unfair. If ANYTHING other than a strict and direct evaluation of how many years will be gained enters into the picture, it's going to be unfair. There is no choice but to say that if someone is not able to be trusted with the organ's survival, they will not get the organ.

          11 votes
        2. [2]
          JakeTheDog
          Link Parent
          I agree with your sentiment because it's all logical. My concern was just with the argument where you asked if "he refused other required vaccines", which was not true and begging the question.

          I agree with your sentiment because it's all logical. My concern was just with the argument where you asked if "he refused other required vaccines", which was not true and begging the question.

          1 vote
          1. cfabbro
            (edited )
            Link Parent
            Fair enough. "Required" probably isn't the right word to use, since strictly speaking they're not. But for the record, I am not who you originally replied to, so never asked that question. :P

            Fair enough. "Required" probably isn't the right word to use, since strictly speaking they're not. But for the record, I am not who you originally replied to, so never asked that question. :P

            1 vote
  2. pra
    Link
    As a transplant recipient, this is a "water is wet" story. There is a chronic shortage of organs. There is a long list of things that can disqualify you from, or significantly downrank you on, the...
    • Exemplary

    As a transplant recipient, this is a "water is wet" story.

    There is a chronic shortage of organs. There is a long list of things that can disqualify you from, or significantly downrank you on, the waiting list. The people running the transplant programs want to ensure that the recipients are in the best position to thrive, to benefit the most from the scarce resource.

    Prior to transplant, I underwent extensive bloodwork. Full medical history. Tweaked some long-term medications to get just a little more normal. Re-upped several routine vaccinations several years ahead of schedule, just in case. I was screened for financial fitness, my closest family was interviewed to ensure I had a good support network. I was drug tested. I was coached on maintaining insurance coverage.

    It was definitely an invasion of privacy, but I understood why. Transplants are miracles, and there will always be someone left wanting. If you're not all-in on taking care of yourself, and the organ transplant -- as defined by the medical establishment, yes -- you're going to be at the end of the line for a very long time.

    17 votes
  3. [8]
    patience_limited
    Link
    It's not really a new thing in the scope of medical ethics. My father-in-law, a rheumatologist (prior to targeted immunosuppressants), refused to treat practicing Jehovah's Witnesses. The...

    It's not really a new thing in the scope of medical ethics. My father-in-law, a rheumatologist (prior to targeted immunosuppressants), refused to treat practicing Jehovah's Witnesses. The standards of care at the time relied on heavy-duty NSAIDs, much more likely to trigger uncontrolled bleeding than aspirin. A religious refusal to accept blood transfusions would be potentially fatal. No other doctors called him out for this.

    Organ transplants in the U.S. have always been subject to patient evaluations for the rigorous behavioral compliance required to stay alive and keep the transplant functioning as long as possible. There have been racist, classist and ageist consequences to these evaluations, but withholding a liver transplant from an unrecovered alcoholic has rarely raised anyone's eyebrows. Refusing what your doctors judge to be a critical treatment for improving your likelihood of survival should be disqualifying, when there are plenty of other desperate people.

    [The addendum to this is that when my spouse had heart valve surgery, the other patient in the room was a 29-year old Black man who had an infected external heart pump connection and had been on a transplant list for three years. College educated, working three jobs, young baby. F-ck the privileged puppy who won't get a shot.]

    18 votes
    1. [7]
      frostycakes
      Link Parent
      I'm with you on your overall message, but this just feels gross to me. Why is a college grad more deserving of an organ transplant than someone who is not? That just reeks of classism to me.

      College educated

      I'm with you on your overall message, but this just feels gross to me. Why is a college grad more deserving of an organ transplant than someone who is not? That just reeks of classism to me.

      7 votes
      1. [6]
        patience_limited
        (edited )
        Link Parent
        Believe it or not, educational attainment is actually taken into consideration for "points" towards likely compliance with complicated medication regimens and behaviors that improve transplant...

        Believe it or not, educational attainment is actually taken into consideration for "points" towards likely compliance with complicated medication regimens and behaviors that improve transplant success.

        I'm not saying it's fair, just that it's one of the criteria used to prioritize who gets access to a limited resource first. [The U.S. as a whole and most states have opt-in, rather than opt-out, organ donor status, which means we have about half the available transplantable organs per unit population that opt-out countries do.]

        Adequate tissue match is the first limiting threshold, but other factors being equal, the person with higher SES is likely to move up the list faster.

        Also, fewer people of African-American or other minority ancestry are successfully recruited as potential organ donors, which limits matching, even though there's greater need.

        12 votes
        1. [5]
          frostycakes
          Link Parent
          I stand by my assessment; that is disgusting, institutionalized classism, and it kind of sucks that far too much of this site is comfortably in the PMC to not find it something to be fought...

          I stand by my assessment; that is disgusting, institutionalized classism, and it kind of sucks that far too much of this site is comfortably in the PMC to not find it something to be fought against.

          It's the acceptance of this with little pushback that makes this site feel pretty unwelcoming to me, as one of the rare working-class people who couldn't afford to finish a degree on here. Just going "oh well, the rich get to move up the line while the poor and working class get to break their bodies for the wealthy and get bumped to the bottom of the line-- it's just one of the criteria" is pretty callous.

          Also, why does the donor race matter? Is it impossible for people of two different races to be matches for organ donation? While I'm sure there's correlation between ancestry and organ compatibility, I highly doubt it's to the point where Black people can only have Black organs, for example. What about those of us (hello!) who are mixed race, do we need specifically mixed race organs then in the eyes of the government?

          The uncritical acceptance of this feels gross just like the existence of the wealth bias in the first place does.

          This knowledge that I'd be bumped down the list for being a recipient behind some rich guy simply because they competed college and I didn't makes me want to rescind my own organ donor status, in all honesty. Why should I donate my organs when I'd be bumped below others were I in need of receiving one?

          1. [4]
            cfabbro
            Link Parent
            IMO you're making a whole lot of uncharitable assumptions about people here. Just because patience_limited received slightly more votes for explaining the system (which even they stated wasn't...

            IMO you're making a whole lot of uncharitable assumptions about people here. Just because patience_limited received slightly more votes for explaining the system (which even they stated wasn't fair), doesn't mean anyone here supports all the aspects of said system.

            And as for mentioning race, you're also being incredibly uncharitable towards patience_limited as well. Especially when the answer you're looking for is just a quick google search away. E.g.

            Although organs are not matched according to race/ethnicity, and people of different races frequently match one another, all individuals waiting for an organ transplant will have a better chance of receiving one if there are large numbers of donors from their racial/ethnic background. This is because compatible blood types and tissue markers—critical qualities for donor/recipient matching—are more likely to be found among members of the same ethnicity. A greater diversity of donors may potentially increase access to transplantation for everyone. -donors1.org

            7 votes
            1. [3]
              frostycakes
              Link Parent
              How does a simple statement of "I'm not saying it's fair" say anything about supporting or not supporting the system? There's no mention of wanting to change that from them or anyone else here....

              How does a simple statement of "I'm not saying it's fair" say anything about supporting or not supporting the system? There's no mention of wanting to change that from them or anyone else here. Have you never had someone use "well, life's not fair" as a thought terminating cliche to cut off any criticism of an inequitable system? It might be uncharitable, but I don't think it's unreasonable when there's no comment about how to change that. (I'd also argue that 150% more votes is a step off of slight, fwiw)

              Since they were explaining said system, why was that not mentioned there? It came off as if it was the fault of these minority communities for not donating more that they would be bumped down the list due to socioeconomic factors.

              A simple "I don't support this, but" instead of "I'm not saying its fair" would go a long way towards indicating that they do not accept this system or think it is good, especially when odds are they're someone who would benefit from the status quo as far as those rules go.

              It's still a gross system and gives me a lot of pause as far as being an organ donor, since it looks like whether I'm a registered donor or not, I'm perpetuating this system in one way or another. Either my organs are most likely going to go to someone who's wealthy and privileged, or I'm going to limit the available supply even more by going off the list, and all the while knowing that a lot of more well-off folks, including a large portion of this site, would be ahead of me in line if I needed a transplant, simply because they could afford to finish formal education, while I could not. It's hard to feel charitable in a situation like that.

              1. cfabbro
                (edited )
                Link Parent
                "I'm not saying it's fair" implies they think it's unfair. But if you were unsure of what they really thought, or wanted clarification, why not just ask them instead of assuming the worst and...

                "I'm not saying it's fair" implies they think it's unfair. But if you were unsure of what they really thought, or wanted clarification, why not just ask them instead of assuming the worst and going off on a tirade?

                Same goes with your interpretation of the votes. It's a one dimensional data point and people vote for myriad reasons, so trying to determine the intent behind them often isn't possible without making all sorts of potentially faulty assumptions. E.g. I actually voted for both yours and pl's top comments, because I thought you had a very valid point that education level being a determining factor was gross, but at the same time I still appreciated pl's explanations of the system so gave them a vote as well. My vote for their comments wasn't made in support of the system they were describing, it was merely in appreciation for the explanation, despite you clearly assuming otherwise.

                p.s. I'm not saying you don't have a right to be angry at the system, or question whether it's something you should participate in anymore as a result. You have every right to that, and your feelings on this are totally relatable and understandable. However, I just think that when it comes to other people's comments and votes it's worth trying to be a bit more charitable, especially when nuance is required, and ambiguity is involved. Not every person here has the time, energy, or even ability to write essays with crystal clear intent for every one of their comments. And not every vote is done in support/agreement of what is being discussed.

                6 votes
              2. patience_limited
                Link Parent
                You've completely misconstrued my intent here. It's absolutely a shitty way to deal with allocating a life-and-death resource. I'm personally dealing with the shortcomings of the U.S. health...

                You've completely misconstrued my intent here. It's absolutely a shitty way to deal with allocating a life-and-death resource. I'm personally dealing with the shortcomings of the U.S. health system - a six-figure bill dispute for the spouse's heart valve, the same insurance company denying me adequate care for inflammatory arthritis and the joint replacements I need to keep functioning. I'm not spending as much effort as I used to on Tildes because it's no longer a good use of my time and limited energy to provide essay-length posts with the intention to address every question or dispute that might arise.

                So I hope you'll forgive my failure to explicitly condemn, at sufficient length, the unfairness that you find particularly grating.

                6 votes
  4. simplify
    Link

    A Boston hospital says it won't consider performing a heart transplant on a patient who refuses to get vaccinated against COVID-19, CBS Boston reports.

    DJ Ferguson, 31, is fighting for his life at Brigham and Women's Hospital and in desperate need of a heart transplant.

    His father, David Ferguson, is speaking out passionately on behalf of his son who, he told CBS Boston, "has gone to the edge of death to stick to his guns and he's been pushed to the limit."

    DJ's family says he was at the front of the line to receive a transplant but hospital policy stipulates that he's no longer eligible because he hasn't received the vaccination.

    14 votes
  5. [15]
    teaearlgraycold
    Link
    Is it wrong to feel so much schadenfreude?

    Is it wrong to feel so much schadenfreude?

    11 votes
    1. [3]
      lou
      Link Parent
      I believe it is, yes.

      I believe it is, yes.

      9 votes
      1. [2]
        teaearlgraycold
        Link Parent
        https://www.nytimes.com/2022/01/30/opinion/culture/covid-death-mental-health.html?referringSource=articleShare

        https://www.nytimes.com/2022/01/30/opinion/culture/covid-death-mental-health.html?referringSource=articleShare

        Indulged in regularly, schadenfreude ends up warping the soul. It robs us of empathy for those with whom we disagree. It lessens our compassion. To use some language from both the Old and New Testaments, it “hardens” our hearts. No matter how much I disagree with anti-vaxxers, I know that schadenfreude over their deaths is a dead end.

        9 votes
        1. lou
          (edited )
          Link Parent
          Great quote, thanks. I think feeling joy for others misery does bring some kind of existential dread, you know? It's a momentary pleasure, but in the long run it leaves a bitter taste in the mouth.

          Great quote, thanks.

          I think feeling joy for others misery does bring some kind of existential dread, you know? It's a momentary pleasure, but in the long run it leaves a bitter taste in the mouth.

          3 votes
    2. [5]
      clem
      Link Parent
      I have to agree with lou or Iou. It's wrong in an understandable way--I think a lot of us feel it, and I wouldn't blame anyone for feeling it--but yeah, I think it's wrong. I can say from...

      I have to agree with lou or Iou. It's wrong in an understandable way--I think a lot of us feel it, and I wouldn't blame anyone for feeling it--but yeah, I think it's wrong. I can say from experience that these people who believe this have simply been mislead. I don't think they're totally wrong to distrust "the establishment" (whatever that means), but this distrust led them to loud people who took them far in the opposite direction. The conspiracy echo chambers are loud and fairly convincing if you're not well-educated enough to see how shallow they are.

      The world is complex and difficult to understand. If you feel like you have to understand it, I can see the appeal of people who seem to have all of the answers. Blame the people who mislead these "sheeple" (I'm not a fan of the term, but the irony of it seems pretty good here), not the victims like this one.

      Then again, these people's ignorance has amounted to the deaths of a lot of innocent people, so I sure can't blame you for hating them and enjoying their deaths. I can't do it, though. I have family who believe this shit, so I have seen both sides for most of my life.

      9 votes
      1. [4]
        rogue_cricket
        Link Parent
        I don't know, I don't think I buy ignorance or victimhood so much any more. Over the last six years I've read so many times about how poor, poor radical right wingers in general are simply anxious...

        I don't know, I don't think I buy ignorance or victimhood so much any more. Over the last six years I've read so many times about how poor, poor radical right wingers in general are simply anxious (who isn't anxious??) and being mislead. Over the last six years their behaviour and rhetoric has only become more radical and detached. I get the impression that more of them are becoming abusive in their everyday lives, especially towards nurses and retail workers.

        I think quite a lot of them are wilfully indulging in it as something that is kind of analogous to a violent fantasy: they claim to believe whatever will serve them to justify an escalation of hostility (real or imagined) versus people they already hated.

        As an example, there is an oft-repeated belief that eventually these vaccines will kill the people who have had it. That is billions of people, an absolutely unimaginable scale of death the likes of which we have never seen before. It would of course cause society as we know it to completely collapse back to subsistence farming and life for those who remained would certainly be nasty, brutish, and short. Corpses would be burnt in the streets. The emotion I see most associated with the people espousing this belief is not terror, not grief, but smugness and glee.

        Ultimately I think a lot of them just like telling us to our faces that they would love to gloat over our corpses. I don't think that it's a sincere belief so much as it is a convenient one that serves the purpose of trying to achieve some kind of domination over others. Maybe an intellectual failure is part of it, maybe anxiety is part of it, but so is character.

        11 votes
        1. [3]
          lou
          Link Parent
          This may seem counter intuitive, but whether one should derive pleasure from the pain of another is not a direct function of how much the other is responsible for their negative outcome. That's a...

          This may seem counter intuitive, but whether one should derive pleasure from the pain of another is not a direct function of how much the other is responsible for their negative outcome.

          That's a conscious choice we all make regarding the kinds of emotions we must harbor in order to improve our mental health.

          That doesn't mean that we should not appreciate that actions have consequences, and sometimes should have lawful consequences. But we can do without the existential dread of wishing or applauding harm.

          5 votes
          1. [2]
            rogue_cricket
            (edited )
            Link Parent
            Oh, I don't feel any pleasure in the sense of desiring their suffering - kind of got away from that. It's not exactly schadenfreude, but I do in some sense just want them to stop. It'd be better...

            Oh, I don't feel any pleasure in the sense of desiring their suffering - kind of got away from that. It's not exactly schadenfreude, but I do in some sense just want them to stop. It'd be better if they stopped on their own, instead of predictably succumbing to the consequences of refusing to get a vaccine against a potentially deadly disease, but... well. It is what it is at this point.

            I want to be very clear here that I don't just think they're unpleasant. They're often actively dangerous, and not just in terms of spreading disease or misinformation or unnecessarily using medical resources they wouldn't have otherwise used had they been vaccinated. Two of my family members in the medical field have had to be locked down in their individual workplaces due to threats from some of the bolder ones. The escalating rhetoric and dehumanization pushed by these vaccine-denial communities has gotten to the point where calling into a hospital and threatening to kill the nurses and doctors who work there seems justifiable to at least a couple of them. It is really, really bad.

            So... yeah. I guess I don't know how to feel when one of them dies. I have plenty of other people in my life to feel bad and scared for - people who wouldn't do well if they got sick, people who need health care but can't get it because of hospital capacity, people who are being actively threatened and more frequently abused by people galvanized by horrible lies. I'm at capacity. I'm on defense.

            Sorry, this turned into kind of a vent. These people upset me a lot. I am tired of feeling BEING threatened.

            6 votes
            1. lou
              (edited )
              Link Parent
              No problem, buddy! I agree with your sentiments. Some of these people are not just irresponsible, they're actually criminal and should receive strong penalties for their actions. There's really no...
              • Exemplary

              Sorry, this turned into kind of a vent. These people upset me a lot

              No problem, buddy!

              I agree with your sentiments. Some of these people are not just irresponsible, they're actually criminal and should receive strong penalties for their actions.

              There's really no contradiction here, abstaining from schadenfreude does not equate to being a sucker. We should defend strong sanctions against these people. But nothing good will come from letting hate fester in our minds.

              Justice and vengeance are two very different things.

              6 votes
    3. bkimmel
      Link Parent
      No, these people have by-and-large placed everyone at risk by overwhelming the health care system with their ignorance: Safe in their smug knowledge that when they get afflicted (and they know...

      No, these people have by-and-large placed everyone at risk by overwhelming the health care system with their ignorance: Safe in their smug knowledge that when they get afflicted (and they know they will) doctors and nurses will do everything can to take on the burden of their own "act of defiance".

      If they were as brave as they think they are, they would all stay home and die instead of filling up the hospitals... But we know they're not doing that.

      This crisis would be over in a week if hospitals said they won't treat people who refuse to get vaccinated and these people had to actually face consequences that their privilege has shielded them from for most of their lives.

      It's really a case where making a few public examples like this would probably save more lives in the long run. They all say "I'm willing to die" because no one calls their bluff... And it's killing thousands of people... So call their bluff.

      6 votes
    4. [2]
      skybrian
      Link Parent
      How you feel about some stranger in the news doesn't hurt anyone, so I'll allow it. :-) Maybe it's distracting, though?

      How you feel about some stranger in the news doesn't hurt anyone, so I'll allow it. :-) Maybe it's distracting, though?

      3 votes
      1. lou
        (edited )
        Link Parent
        In the long run, I think feeling like that on a regular basis might actually harm myself!

        In the long run, I think feeling like that on a regular basis might actually harm myself!

        3 votes
    5. psi
      Link Parent
      I just kinda feel pity? Here's a person who will literally die on the antivax hill. How did he delude himself into thinking that vaccine complications are somehow worse than a failing heart? Or...

      I just kinda feel pity? Here's a person who will literally die on the antivax hill. How did he delude himself into thinking that vaccine complications are somehow worse than a failing heart?

      Or does he think he can win a game of chicken against the hospital's ethicists? If so, isn't that more proof of self-delusion or, at least, a warped risk calculus?

      I'm sure at least some of his friends and family are vaccinated. Now they'll have to watch their loved one die from stubbornness.

      3 votes
    6. wycy
      Link Parent
      I don't think it is. The people for whom we feel schadenfreude are dangerous to the stability of society and have a reckless disregard for anyone but themselves. I'm happy in their demise because...

      I don't think it is. The people for whom we feel schadenfreude are dangerous to the stability of society and have a reckless disregard for anyone but themselves. I'm happy in their demise because their absence means others may live.

      2 votes
    7. nukeman
      Link Parent
      A little bit of schadenfreude is fine. I do think a lot tends to warp the mind.

      A little bit of schadenfreude is fine. I do think a lot tends to warp the mind.

      2 votes
  6. trueterra
    Link
    Not that I'm actively rooting against this guy, but it's hard not to marvel at the irony of his predicament. For the last few years, the irony concentration in the news with stuff like this has...

    Not that I'm actively rooting against this guy, but it's hard not to marvel at the irony of his predicament. For the last few years, the irony concentration in the news with stuff like this has been at a point where it feels like it's part of a poorly written TV show.

    5 votes