Medicine: Which Life Should Be Saved?

A shortage of transplant organs raises ethical questions

Jamie Fiske, 11 months old, had one thing in common with three-year-old Justine Pinheiro, and that disappeared on an operating table in Minneapolis. On Nov. 5 the baby daughter of Charles and Marilyn Fiske of Bridgewater, Mass., underwent six hours of surgery that gave her a new liver and a good chance to recover from biliary atresia, a congenital liver defect that generally leads to death before the age of four. Justine Pinheiro is still waiting for a transplant to give her the same chance. The disparity in their fates raises one of the thorniest ethical questions facing modern medicine.

Jamie Fiske had received her liver because of a remarkably skillful publicity campaign launched by her parents. Says Charles Fiske: "We thought we had a license to make Jamie's needs known by any means we could." As a hospital administrator, Fiske knew just where to turn. He telegraphed 500 pediatricians. He placed an appeal in a newsletter that reaches emergency room staffs in 1,000 hospitals. Then, with lobbying assistance from Senator Edward Kennedy, House Speaker Tip O'Neill and CBS Anchorman Dan Rather, all of whom he contacted, Fiske persuaded the American Academy of Pediatrics to allow him to make a plea before 1,000 academy members at their annual meeting in New York City. "I ask you to keep your eyes and ears open for the possibility of a donor," urged Fiske, the only layman ever to address the group. "Jamie wants to survive."

The tactic worked. Fiske's plea was covered by all three networks and newspapers across the country. The families of some 500 would-be donors phoned the University of Minnesota Hospital, where Jamie lay waiting. Two offers turned out to be useful. One, a liver from a three-year-old on the East Coast, was not suitable for Jamie, but it saved the life of an older transplant patient at the Children's Hospital of Pittsburgh. The second organ came from a ten-month-old boy killed in a car-train collision in Utah. His father, Laird Bellon, had seen Fiske on television and specified that his son's liver should go to Jamie.

No one could begrudge a dying baby the means of survival. But Debbie Pinheiro, Justine's mother, admits, "We really get jealous over it." Debbie, 20, and her husband Jose, 24, a welder, have tried to match the Fiskes' effort to focus attention on their daughter's plight. The Pawtucket, R.I., couple have also petitioned their Congressman and been headlined on the front page of the Providence Journal. "I hope that the same thing that happened to the Fiskes happens to us," says Justine's mother. "I'm nobody important, but I'm determined to fight."