Ethical Dilema

The awesome thing about working on a Transplant unit is that you get to see all these really sick, dying people recover from their illness after receiving a transplant. The not-so-awesome thing is when you see noncompliant people essentially waste the organ they've been given because they are too stubborn to make the necessary lifestyle adjustments needed following a transplant. Whats even worse? When we work up a patient for a possible transplant evaluation and the patient is already noncompliant - before any of the hard stuff has even begun.

We have this one kid (yes, kid. He's 19yo) and he's already had a pretty rough life -- pancreatic Ca, surgery to cure it, and b/c of the surgery, he has all these small bowel complications, thus he's being worked up for a small bowel transplant. Obv you feel for the kid b/c his situation sucks, but you would think that if he has the opportunity to get transplanted and possibly solve his problems (granted it definitely wont be easy), he would be grateful and willing to do whatever it takes. Instead, he refuses to have labs drawn, refuses to have his dressings changed (his PICC line dressing hasnt been change in a month! Hello, infection?!), he manipulates the nurses and doctors, he refuses to listen to anyone, and he is completely stubborn and noncompliant. And THIS is the guy you want to give an organ to?? Unfortunately the doctors/researchers are so concerned with the numbers that they just want to get as many transplants done as possible. It's a shame, isnt it? I'm not quite sure how performing a transplant that has a fairly decent probability of failing is good research, but what do I know. It seems like such a waste to give an organ to someone who is so unappreciative and unwilling to do the work. (Let me clarify: If this kid doesnt get a transplant, he wont die, unlike those in need of, say, a liver. Although not ideal, he can live with supplemental nutrition. So its not as if not giving him a transplant is a death sentence.)

Well the problem with this particular patient is that they recently found possible mets in his abdomen, which means if he does in fact have cancer again, he is no longer eligible for a transplant. Now, of course I dont wish cancer upon anyone. ...But I also don't want this kid to get a bowel...