A YOUNG MAN with advanced leukemia is seeking a bone marrow transplant from a woman who is known by a hospital to have a possibly matching tissue type. The woman has said she does not want to donate to anyone but a close relative, and the hospital refuses to divulge her name. The young man takes his case to court, where a state judge rules that the hospital should approach the woman again and describe to her the patient's plight. Is this a good way to handle the increasingly difficult ethical questions posed by advances in medical science?
This is, of course, a real and tragic case. The young man in question, William Head, is understandably desperate. The transplant operation has not been successful thus far in advanced leukemia cases where an unrelated donor supplied the needed marrow. But to Mr. Head, any chance for a longer life is clearly worth pursuing. The operation would entail a trip to Iowa, a short hospital stay, anesthesia, and some pain for the donor, but the risk of permanent effects is not large. It is not surprising that the judge, faced with the particulars of the case, sought some way to allow another appeal to the only known potential donor.
Still the judge's decision is a troubling precedent. Courts have generally recognized that there is no legal obligation to be a Good Samaritan, even in cases involving a less personal act of charity than donation of one's tissues or organs. If the woman is approached again, she is almost sure to realize, because of the publicity, that Mr. Head's case is in question. The pressure on her will be enormous.
From a more general perspective, the case threatens the desirable development of donor information banks. If potential donors believe there is a chance they will be hounded by potential recipients--who may even be requesting the contribution of relatively major organs--people are much less likely to sign up. Realizing the potential implications, the judge sought to narrow his finding by basing it on a technicality in the state freedom of information act. But once set, legal precedents tend to expand, and the next judge to whom such a case comes may reach the same finding on broader grounds.
There is no fully satisfactory way to decide cases such as this. But medical institutions--guided by government regulations--have been developing mechanisms that strike us as the most suitable for the task. These are the institutional review boards, panels of experts in medicine and ethics that serve as the hospitals' conscience on matters such as this.
Judges may rightly review whether these boards are following appropriate procedures, but a judge should not get into the resolution of a specific case as the judge has done in this case. In setting rules in the uncharted area of tissue transplantation, the collective wisdom of the review boards is likely to strike a better balance among the personal interests of patients and donors and the larger interests of the society in encouraging medical progress.