1. Contemporary Science Issues Lesson 2: Organ transplants – the choice © 2006 Gatsby Technical Education Projects

2. The Choice is yours James or Jessica? The choice is yours Royal Western Trust Hospital Cardio – thoracic specialist ward Established 1978

3. – the facts Heart disease is one of the most common causes of death each year in the UK Many people have bypass, pacemakers and valve surgery This still leaves a large number requiring a new heart Some types of heart disease are inherited Smoking, drinking and obesity increases the risk

4. Royal Western Trust Hospital Cardio – thoracic specialist ward Established 1978 Transplanted 65% On waiting list 26% Withdrawn 4% Dead on waiting list 5%

5. As clinical director of the local NHS hospital, make a life & death decision The Choice is yours

6. The patients in your charge James Silverman 48 years old Jessica Carmel 17 years old They both need a new heart to survive

7. Artificial Heart Human Heart valves Prone to fatal clots Trials in the USA show longevity of patient only 112 days No need for immunosuppressant drugs The donor must die! Next of kin must consent The organ must match Immunosuppressant drugs must be taken for life

8. Transgenic heart – from a pig A pig’s heart - compatible with a human

9. Jessica Faye Carmel 5/1/89

10. James Silverman 17/9/59 Peter

11. Active Problems Patient Details Clinical History Notes Medical Records

12. About James: James has smoked. He has 3 children, divorced and now involved in another relationship. His heart disease seems to be due to his lifestyle - he had a stressful job as a car salesman. He worked long hours and ate take-away foods at irregular times. He admits to doing no exercise. James has had bypass surgery just over two years ago. He has given up smoking

13. About Jessica: A typical teenager who just wants to fit in and be normal. Go out, have fun and enjoy music, boys and friends. Unfortunately born with problems with her heart and as a result lived with constant worry and depression. So much so, that she has attempted to commit suicide.

14. It’s not as simple as you think. Making ‘life & death decisions must be backed by scientific (medical) evidence and ethical reasons– not just ‘gut feelings! What is their medical history? What is their current health situation? What are the chances of success? Are there any ethical issues? Use the materials provided and make your choice

15. Life and Death – The Choice Your task: In groups of 3/4 produce two record cards that itemise information on the following patients - be prepared to discuss the facts with the whole group. One set is needed for each recipient. Use the information sheets provided and some enthusiastic imagination from TV programmes like ‘Holby City’ and ‘ER’, etc. It is important to include facts, evidence and some ideas and opinions. You send your mini report to the Hospital Managers with your final decision – Which patient gets the heart, and who will probably die? Fill in the Clinical Director Decision cards and stick into your books.

16. The Patients Teenage girl: – Jessica Carmel (aged 17) Family GPs notes & patients personal, family and social background (e.g. sets the scene – congenital heart disease, attempted suicide, ecstasy drug misuse, school results, friends, habits, religion, parents, social background) Cardiac teams test results and prognosis (include information from anaesthetist, dietician, cardiac surgeon (consultant), ward sister and cardiac tests team) Middle–aged man: – James Silverman (aged 48) Family GPs notes & patients personal, family and social background (e.g. set the scene – heart disease, originally a smoker, heart bypass 3 years ago, three children, elderly dependent parents, diagnosed with a very rare benign cancer of the heart) Cardiac teams test results and prognosis (include information from anaesthetist, dietician, cardiac surgeon (consultant), ward sister and cardiac tests team)