 What is up guys Karma Medic here and welcome back to another dose. This video is going to be part two of the ethical dilemma series I'm doing for the MMI. We're going to be looking at the second half of the kidney transplant ethical dilemma that we looked at in part one. If you guys haven't seen that video already do check out the card over here or find it somewhere on my channel and watch that video first. Alright without further ado let's continue on to part two. So generally in the interview for ethical MMI scenario questions you're going to get the main question you're going to give your answer and then they'll ask you follow-up questions to sort of see how you would change your answer based on new information. Something else that's important to think about is the age of the patient and a lot of the time in MMI interview questions they will ask you the scenario and then they'll say what if the person was 39 instead of 29 or what if the person was 29 instead of 39 and they will always try and catch you out on this they always ask this age angle and the answer to that question is that age has absolutely no factor in determining who should get these organs. Remember that list I told you five seconds ago age was not on it. Age, gender, beauty, income, religion all these factors are not important when deciding who gets a kidney. Everything is based on clinical evaluation, logical decision-making, rational decision-making. For example if you're deciding to give a kidney to a 15 year old or a 70 year old it might be easy for you to say well obviously give it to the 15 year old because they have their whole life ahead of them but the truth is you don't know any of that. The 15 year old could overdose from drugs at the age of 20 the 70 year old could go on to live until they were 100. So in that case if you give the kidney to the child it would only last it for five years whereas if you gave it to the elderly person they could have lasted for 30 so you never know and age just is not taken into account in these decisions. Like I said they often try and catch you out with these questions in the MMI so do be careful. Another thing that they could potentially act is would you feel differently if the patient had a live donor who is willing to donate a kidney to them? So this is a very good question because it brings into light two of the four medical ethics pillars autonomy and non-melevalence. So autonomy is the idea that each person is their own individual and they should decide what they want to do with their own body and non-melevalence is the idea of doing no harm is that doctors should not inflict harm on any of their patients. So let's talk about autonomy first. If the person who wants to donate the kidney is a fully autonomous person that meaning that they have full competency full mental stability and they also have informed consent so they know the situation they understand the risks and they still want to donate the kidney they are still fully autonomous then that is within their right even if doctors might not think it's in their best interests however we need to take into account the idea of non-melevalence. So if doctors are going to remove a kidney from this patient that patient is going to have one less kidney and with that patient having one less kidney their life is going to change they're not going to be able to do things the same way they used to be and that also has inherent risks with the procedure and following the surgery. So really this is a cost-benefit ratio situation we have to weigh up all the pros and cons of allowing this donor to donate their kidney. Now regardless of whether this person is able to donate that kidney like we said before the woman has a GFR of 28 and we would need to wait until the patient gets down to a GFR of less than 20 before we can put them on the transplant list so that we can maximize the amount of lifespan that they have after the procedure. Okay so now in the case I'm going to give you some more information about this potential donor and then we're going to reassess if we think this specific donor should be able to donate their kidney. So let me give you guys a little bit more information. She's a 65 year old woman and you take a history which reveals she is a hypertensive smoker on one medication for successful blood pressure control. So successful meaning that her blood pressure is below 140 over 80. She has a family history of type 2 diabetes and her daughter's cause of kidney failure is Anca vasculitis. There's no other significant family history or kidney problems or significant medical history. Blood tests show no cause for concern. Okay so do we think that this woman should be allowed to donate a kidney and if yes or no what are some of the factors that we would take into account when making this decision. So first things first let's break down this woman's history. First of all she's a 65 year old woman. So as we've established one of the things we take into account when deciding whether someone should receive a kidney is the age difference between the donor and the recipient and the reason for that is that you don't want to give a 20 year old a 70 year old's kidney and that's because over time of course the 70 year old's kidney is going to have degraded infunction and if they have other risk modifying factors like smoking, hypertension, diabetes that's also going to affect that person's kidney function. So she's a 65 year old woman probably not the best to give a 30 year old person that kidney because you want the younger woman to live a full long happy, healthy life so you want to give them the healthiest possible kidney that you can. Second thing we know that she's a smoker and smoking as I'm sure you know has many harmful effects on the body one of which is definitely to also affect the kidneys. Smoking can restrict blood flow to the kidneys it of course can have many effects on the vasculature of the body. Smoking can also affect the blood pressure medication that she might be taking to control her hypertension so smoking overall is definitely bad and it's probably having an effect on her kidney function and in addition to that we know that this person is already hypertensive they already have high blood pressure which as we've said before is one of the biggest risk factors for developing kidney disease even though now it's controlled it could have been really high in the past and it will have probably done damage to this woman's kidneys. So these three points definitely don't make this person an ideal candidate for kidney donation there's no point in donating this kidney which is not at its optimal to somebody who's 30 years old if five or ten years down the line they're going to develop some major complications and maybe need a new kidney. Now let's talk about not doing harm or non malevolence to the donor so if we're going to remove this kidney from the donor that donor is going to have one less kidney for the rest of their life and that's obviously going to affect them in many ways if they're already at risk for developing any kind of kidney problems we don't want to remove one of their kidneys because then they're much more likely to end up having kidney disease and kidney problems in the future however if this person is fully autonomous has full mental capacity and is mentally stable and is able to with informed consent still know that they want to go through this procedure then they are an autonomous human and the answer to this question of whether they should or should not be able to donate their kidney is really really tough and I don't know basically you have to weigh up all the pros and cons of the conditions that we talked about that the person has and their ability to want to give up that kidney and this is something for an ethics board to decide but this is why we have an entire medical ethics board an entire team that meets up to discuss a single patient all the different factors that are relevant to help them make that decision on whether they should receive a kidney or not and who they should receive that kidney from and hopefully what you've taken away from this is that even if you don't have a concrete conclusion or answer at the end of the video showing your thought process your decision making and how you reached your conclusion or I guess all the factors that you took into account is what is really important ethical decisions are rarely going to be easy to make even though we have so many guidelines to follow and so many people to refer to and get expert opinions from it's usually down to a case by case basis and it can be very very difficult and that's something that I think you should definitely acknowledge in your MMI interviews you know just acknowledging that these are very very difficult decisions and that it takes a lot of people to be able to make them is something that's important that you should mention in interview so another follow-up question that they might ask you is that you tell all this information to the potential donor who we've said we don't think is a good candidate to donate their kidney and they come back to you and say you know what I really want to donate this kidney to my daughter I would do anything for her I just want to improve her life I want to save her I want to make her feel better please please please let me donate my kidney so how would that affect your decision and obviously the answer at the end of this is that it would not affect your decision you've made your original decision based on clinical evaluation very rational logical factors and you're not going to change that decision based on an emotional plea or a social desire but what you definitely should mention and talk about is that this is obviously very difficult you want to do what's best for your patient and you can definitely mention in interview how this is a very difficult decision how you want to do the best thing for both of your patients you want to make the mother happy because obviously this is affecting her not being able to help her daughter and you want to do the best thing for the daughter by giving her the best possible kidney that she can get and one last follow-up question that they might ask you is they might say what if the donor had a gene that made them at high risk for having hypertension or high blood pressure and how would that affect your decision so in this case of course if the donor has a very high risk of developing high blood pressure later in their life we want to make sure that they keep both of their kidneys because if they were going to donate one of those kidneys to the recipient and now only be left with one kidney and they developed high blood pressure and that was going to cause them kidney damage that's obviously going to lead to a lot of problems for them in the future so if they did have this gene that would increase their risk of blood pressure in the future you would want to make sure that they do not donate as they need both of their kidneys all right guys and I think that's it for this video this has been a really long case to cover quite a big ethical dilemma I hope you've enjoyed learning about the different factors that we might consider or take into account when looking at an ethical dilemma like this organ transplantation is something that does often come up in MMI interviews so it's something you probably want to prepare for if you guys have any questions do feel free to leave them in a comment down below do like this video if you enjoyed it and do consider subscribing to my channel if you want to see more videos like this from me in the future until next time I'll see you guys later peace