HCS 335 Week 4 Biomedical Case Analysis Using the Seven-Step Decision Model Example

Two Days on the List: The 1995 Mickey Mantle Liver Transplant Worked Through a Seven-Step Ethical Decision Model

[Student Name]

University of Phoenix

HCS/335: Health Care Ethics and Social Responsibility

Week 4 Assignment

[Instructor Name]

[Date]

Case facts come from the news report and sources listed; the analysis is written for a model paper.

In June 1995, Mickey Mantle, one of baseball's most famous players, received a liver transplant two days after being placed on the waiting list. He was 63. Public reaction was swift: many people asked whether a celebrity had been moved ahead of others who had waited months. This paper analyzes the case with a seven-step ethical decision model: facts, issues, stakeholders, principles, alternatives, evaluation and decision.

Step One: The Facts

Mantle was admitted to Baylor University Medical Center in Dallas on May 28, 1995, placed on the transplant list on June 6 and given a new liver on June 8. His doctors linked his liver failure to a small malignant tumor, more than 40 years of heavy drinking and a long-dormant hepatitis C infection ("Outcry over his transplant," 1995). He had completed treatment for alcoholism the year before. Within weeks, tests showed that his cancer had spread, and he died in August 1995, about two months after the transplant.

Separating Report From Allegation

Critics alleged that fame had bought speed. The transplant center responded that Mantle was the sickest patient waiting in its region, and that patients classified as that ill waited only a few days on average. The case materials also note that the national organ-sharing network reviewed the case and found the organ had been allocated according to its policy. The analysis has to begin with what was documented, because the most repeated version of a case is not always the most accurate one.

Step Two: The Ethical Issues

Two issues stand out. First, was allocation fair, or did celebrity affect who received a scarce organ? Second, should a scarce liver go to a patient whose disease followed decades of drinking and who had liver cancer that might limit the benefit?

Step Three: The Stakeholders

Stakeholders include Mantle and his family; the other patients on the regional list, some of whom might die waiting; the donor's family, who gave the organ expecting it would be used well; the transplant team; the national allocation system; and the public, whose trust in fairness sustains donation.

Step Four: The Principles

Persad et al. (2009) reviewed principles for allocating scarce medical interventions and grouped them into four categories: treating people equally, as in lotteries or first come, first served; favoring the worst off, including the sickest first; maximizing total benefits, including lives saved or life-years saved; and promoting social usefulness. They argued that no single principle suffices and that each captures something important. The authors observed that sickest-first, used alone, can direct resources to those least likely to benefit, and they proposed a system that combines several principles, giving priority to younger people and weighing prognosis alongside other considerations.

Applying the Principles

Under sickest-first, Mantle's rapid transplant was consistent with policy if he was the most urgent patient. Under maximizing benefits, the cancer raised a real question about how much life the organ would add. Under equal treatment, fame should play no role at all. Social usefulness, rejected by most ethicists for clinical allocation, might tempt some to favor a public figure, which is exactly the danger critics saw.

Step Five: The Alternatives

Transplant as done. Decline the transplant because the cancer limited benefit. Delay the decision for further evaluation, which his condition would not allow. Offer the organ to the next patient on the list.

Step Six: Evaluating the Alternatives

Transplanting was defensible under the sickest-first rule then in force, and the review found no violation. Declining on moral grounds because of past drinking would have been unjust, since he had completed treatment and abstinence policies serve clinical rather than punitive purposes. The harder question was prognosis: an organ given to a patient whose cancer had already spread might have given another patient more years. The team's evaluation had to rely on what it knew before surgery.

The Transplant Team's Position

The team carried two duties at once: to its patient, who would die within days without a new liver, and to the wider list, whose members trusted that organs would go where the rules directed. The surgeons could not choose to decline a qualifying patient because he was famous any more than they could favor him for that reason. Their proper role was to apply the criteria as written, document the patient's status and let the allocation system work. Any doubts about prognosis belonged in the medical evaluation, not in a judgment about his fame or his past.

Step Seven: Decision and Justification

The transplant decision, made within the rules and on the information available, was ethically defensible. Its weakness lay in the system: allocation depended heavily on physicians' judgments of illness severity, which left room for suspicion.

The System Lesson

Kamath et al. (2001) developed the Model for End-Stage Liver Disease, a score built from laboratory values that estimates short-term survival for people with end-stage liver disease. The score was adopted for adult liver allocation in 2002, replacing categories that relied more on clinical judgment. An objective score makes allocation more transparent and harder to suspect, which answers the trust problem the Mantle case exposed.

What Managers Can Take From the Case

Health care managers rarely allocate organs, but they allocate beds, appointments and staff time. The Mantle case shows that a fair process must also be visibly fair, with clear criteria, documentation and review, especially when a famous or powerful person is involved.

The Donation Legacy

Before his death, Mantle urged the public to become organ donors, and his family later supported donor awareness efforts in his name. The case that raised doubts about the system also drew public attention to the shortage of organs that made those doubts possible.

Conclusion

Worked through seven steps, the case appears less a story of favoritism than of a system whose rules were followed but could not easily prove their fairness. The lasting answer was a more objective allocation score, a lesson for any manager who distributes scarce resources.

References

Kamath, P. S., Wiesner, R. H., Malinchoc, M., Kremers, W., Therneau, T. M., Kosberg, C. L., D'Amico, G., Dickson, E. R., & Kim, W. R. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 33(2), 464-470. https://doi.org/10.1053/jhep.2001.22172

Outcry over his transplant has Mantle puzzled. (1995, July 3). The Spokesman-Review. https://www.spokesman.com/stories/1995/jul/03/outcry-over-his-transplant-has-mantle-puzzled/

Persad, G., Wertheimer, A., & Emanuel, E. J. (2009). Principles for allocation of scarce medical interventions. The Lancet, 373(9661), 423-431. https://doi.org/10.1016/S0140-6736(09)60137-9