1. ACCEPTING THE GIFT OF LIFE
A mutual friend arranged a blind date in a cabin in Minnesota for Dorothy Zauhar and Richard McNutt in 1994. Both were in their late 50s. One account said that within a week of their meeting the two were inseparable. Dorothy was soon sporting a $21,000 engagement ring, and she and Richard began making plans to marry.
Richard was a millionaire businessman, charming and handsome. Dorothy was a maternity nurse and real estate agent and, like Richard, attractive. She was particularly close to her four siblings, all of whom had spent years together in an orphanage when their alcoholic parents were unable to take proper care of them.
Shortly after they fell in love, Richard's kidneys began to fail. Soon he was forced to go to a dialysis center where, three times a week, he would spend hours attached to a dialysis machine. The machine purified his blood, doing mechanically what his kidneys were no longer able to do. If Richard were ever to resume a normal life and not spend his time tethered to a machine, he would need a new kidney.
Dorothy offered Richard one of her kidneys, but for medical reasons she was not acceptable as a kidney donor. Then, Dorothy's brother, John Dahl, volunteered to donate one of his kidneys.
John was a suitable donor. He asked Richard for three things in exchange for the kidney: $5000 to cover the paychecks he would miss while he was having the operation and recovering from it, a life insurance policy to protect his family in case he died during the transplant procedure, and a promise?a gentlemen's agreement?from Richard that Richard would always devote himself to Dorothy. Richard readily agreed.
On July 2, 1996, one of John's kidneys was removed and transplanted into Richard. The operation went smoothly, the transplant was a success, the kidney worked fine. John had a serious?actually, life-threatening?allergic reaction to one of his medicines, but in the end he too was okay.
As Dorothy and Richard were driving out of the hospital parking lot and heading home after the surgery, Richard stunned Dorothy. He said that their marriage, scheduled for the end of that month, would have to be postponed. He said that his doctors warned him that he "couldn't be under any stress for three months." Dorothy later said that what immediately flashed in her mind was that he was dumping her, that, somehow, now that she'd gotten him a kidney, he didn't need her any more. For the next year, Richard concocted other excuses for postponing the wedding and finally Dorothy realized that her suspicions about him were correct: Richard was involved with someone else and, in fact, had been even before he accepted her brother's kidney. Indeed, in June, 1997, Richard married the other woman, a nurse from the dialysis center.
This story made the headlines in October 1997, when Dorothy and John sued Richard. They claimed that they were swindled by Richard, that he stole Dorothy's heart and John's kidney. Richard had never paid the $5000 or bought the insurance policy for John, and he clearly hadn't honored his commitment to make Dorothy happy.
- Washington Post, 1997, 21 October, A1.
- Duluth News-Tribune, 1998, 22 January.
- Wither Thou Goest, Richard Selzer, from Imagine a Woman, Random House, 1990.
Students should understand the following:
- How kidneys function and the role of dialysis in maintaining homeostasis after kidney failure
- The surgery, procedures, and the risks involved in kidney transplantation for both donors and recipients
- The life-long restrictions placed on both the kidney donor and recipient after transplantation
- How organ procurement occurs and pertinent legal issues
- The UNOS registry system
- What determines donor suitability and the current rate of success for kidney transplants
- Problems that arise due to organ shortages
- Divergent opinions about directed donation
Suggested questions for discussion
- What is the role of the kidneys in maintaining homeostasis? What happens when kidneys stop functioning? How is hemodialysis used as a treatment for kidney failure? What are the quality-of-life issues for dialysis patients?
- Organ transplantation differs from all other new biomedical technologies, because it alone relies on the generosity of a donor. How significant is this difference?
- What are the laws that govern organ donation? Should it be possible for people to buy and sell organs? If payments were legal, what would be a fair system of compensation? What is the cost to the concept of human dignity of making body parts commodities?
- Should other people besides John and Dorothy have been involved in the decision for John to donate a kidney? If so, what people should have been consulted? What criteria might be established to protect the potential donor?
- Directed donation is another name for what John did for Richard. What are the pros and cons of directed donation? What other types of donation options are available?
- The normal procedure for becoming a transplant recipient is to be listed on the national registry and then wait for a suitable donor. It is allowable, under UNOS (United Network for Organ Sharing) rules, to be listed at more than one transplant center. Not all patients are aware of this or have the means to take advantage of this option. Do you think economics plays a role in receiving a transplant?
- What obligations, if any, does the recipient of an organ have to the donor or the donor?s family members (when the donor has died)?
- What should or could Richard do now, if anything, to ease the suffering that he caused to Dorothy and John?
Topics for discussion/written assessment
- The participants in organ transplantation are a "donor" and a "recipient." The donation or gift that is given by the donor is generally the gift of life. Does receiving this gift obligate the recipient to follow the long term medical care that is prescribed after the organ is transplanted? Are the obligations of the recipient of an organ to comply with treatments and medications greater than the obligations of those who have other surgical and medical treatments, such as heart bypass surgery?
- Most people are born with two kidneys, but people can live a normal life with only one. This makes kidney donation from a live donor possible. Could you imagine donating a kidney to someone? Who would that person be?your parent, your sibling, another relative, a friend, a stranger? If you decide to be a living donor for a kidney, should you consider others, besides the recipient, in your decision?
- The current U.S. system for distributing organs developed out of the Organ Procurement and Transplantation Act of 1984. According to this law, organs cannot be bought or sold. Organs are distributed by UNOS, a private company that is under contract with the federal government. UNOS divides the country into 11 regions and uses 63 local organizations to procure organs. Find out about the criteria that UNOS uses to determine who gets an organ. Evaluate the system?what are its best features and what improvements are needed?
- John chose to give Richard his kidney out of a heartfelt desire to do a good deed, to help Richard and Dorothy. His selflessness expressed the true spirit of giving?altruism. How is altruism subverted when organs are taken without the donor?s consent?
- When kidney dialysis was first available in Seattle, criteria were identified for determining who was qualified to use the dialysis machines. The selection considered such factors as marital status, employment status, contributions to the community, etc. Compare those criteria with criteria used today for allowing people to get on the UNOS recipient list.
- Research the publicity surrounding the transplantation experiences of Walter Payton (retired running back for the Chicago Bears from the mid-1970s to the mid-1980s) and the daughter of Rod Carew (outfielder for the Minnesota Twins in the same years). What are the facts of each case? How did the celebrity status of these men affect the outcomes? How did the personal wealth of each affect the outcome?
- Richard never signed an actual legal contract with John and Dorothy, but he did have a gentleman?s agreement with them. What he did could be understood as a breach of this moral contract. Should a nonlegal agreement of this sort be binding?
Topics for teacher preparation
- Physiological function of the kidneys
- History of transplantation, including the changing importance of matching tissues of donor and recipient
- Kidney transplant surgery and use of immunosuppressive therapy
- UNOS system
- Organ procurement
- Directed donation