The University of Southampton

Author: Florence Dixon

Who would you choose to put on a ventilator?

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Ethics in the sciences has always been something that I have been interested in. During our first lecture, we watched a clip from a professor of research saying that he thought ethics was nonsense. The idea that scientists weren’t willing to look at and understand the ethical implications of their work surprised me.

Learning about how over many years philosophers have viewed and explained ethics in such different ways and how in each theory there are flaws. So how do we know what the right theory is? I ponder this question and decide to investigate how ethics are used in decision-making around the allocation of medical devices. How does a medical professional decide who gets what? A specific example of this was the allocation of ventilators during the Covid-19 pandemic. Ventilators are machines, known as artificial lungs, that pump air into the lung. This occurs in a normal breathing pattern allowing for inhalation and exhalation of air. How a ventilator works is demonstrated in the video below. They are used when a person cannot do this themselves. Ventilators are expensive, with the average price being £18,300, and require a high level of training to operate.

The nature of the pandemic meant that there was a huge strain on medical services globally and all the companies developing devices that could be used to help treat this disease. One of the major devices that could be used to help people who were very sick with Covid-19 was a ventilator. Before the pandemic, the NHS had 7,400 mechanical ventilators with models showing that they would need up to 90,000 beds with ventilators to be able to treat the expected number of patients just for Covid-19. This number did not include any other illnesses that might require ventilators, such as accidents, strokes, or flu. With this huge difference between the number of ventilators available and the expected amount of patients needed the decision of who gets them was put onto the doctors.

When I think about having to make these decisions it seems overwhelming and a big responsibility. To try to understand more about how these decisions are made by doctors I spoke to a friend of mine who is a doctor at Plymouth Hospital. We spoke about how decisions are made around treatments for patients. It was interesting to hear the way he spoke about how they take a holistic view of each patient. Asking questions like, how likely are they to survive? What will their quality of life be like after the treatment? And very basic questions such as can they walk up and down stairs, cook for themselves or do the shopping? To get an overview of the patient’s lifestyle before making these decisions. After talking about this it made me understand that to trained medical professionals these decisions weren’t as daunting, they were part of everyday working life. In saying it was clear that if there was an alternative to having to make these decisions that would’ve been better.

During the pandemic engineering researchers at the University of Canterbury, New Zealand alongside medical professionals in New Zealand, Belgium, and Malaysia designed an adaptation to a ventilator that would double the capacity, allowing two patients to be treated by one ventilator. Demonstrated in the video below. This ventilator works in series so the amount of air doesn’t half when delivering to two patients. In series means they pump at different times. A life-saving invention that would help to prevent doctors from having to make decisions about who receives the ventilator. With this technology implemented into the NHS, it would double the number of ventilators available. Going from about 30,000+ ventilators with the potential to treat 30,000 patients to 60,000 patients. This adaptation is low cost as well which also means that it is not met with the issue of expense as ventilators can be very expensive.

With the pandemic in the past and all the lessons we have learned from treatment and management at the forefront of everyone’s mind, I think that technologies like the one from the researchers at the University of Canterbury will become more common. But with this comes a whole new set of ethical questions that will need to be discussed moving forward. As learn more about science and technology I understand that ethics will always be an important part of this industry and I believe it should be a topic that is more widely discussed to ensure that ethics are upheld in all aspects of research.

Have you ever heard of Hand Transplants?

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Protistic limbs are life-changing technology for those who have lost limbs through various causes. It became clear that there was a lot of focus on protistic legs and technologies to make them as comfortable and life-like as possible. The engineers have managed to design such a personalized model for making the legs, they can alter the types of legs for the different lifestyles and needs of the patients.

Arm and hand protistic seemed to be a lot more complicated due to the nature of hands having such complex sensory and dexterity properties. This got me thinking about how they can improve the technology, with sensors to help with gaining back complete function. While looking online about the research going on into hand and arm protistic, I came across a man who had recently had a double forearm and hand transplant. I was surprised and interested in this, the fact that they can transplant arms from donors and that this works giving patients back the use of hands that they have lost.

Mechanics of Hand Transplant

In the UK there is a specialist hand transplant team located at Leeds hospital. In a BBC documentary that has just come out called “Saving lives in Leeds”, in episode one they follow a story of a man who has a double hand transplant. In the documentary, the surgeon talks about the complexity of the surgery and the risk of rejection. Organ donors have always been something that I have known about, so many people would give consent for loved ones to donate a kidney or liver, or heart when they pass away but it had never occurred to me that someone would donate their hands.

The intricate nature of the function of the hands is important to maintain when doing a transplant otherwise it isn’t worth it for the patient. In Saving lives in Leeds the head surgeon talks about how they must connect the blood vessels and replace and sew together bones to allow the donor limb to become part of the recipient’s body. The hands regain sensory over a minimum period of 3 years. The nerve regeneration takes up to 6 weeks before patients start getting feeling in their new limb.

In the documentary, the mother of the patient touches on the impact that this will have on her son’s life. The ability to have full functioning hands again, the doors that will re-open for him, and the quality of life he will now be able to have. The significance of someone’s family allowing the donation of hands is also mentioned. Hands are a very personal feature of our bodies and to allow the donation of these to another person does not go unnoticed.

The UK’s first double hand transplant happened in 2016 at Leeds Hospital with a patient called Chris King. The YouTube video below is him talking about his experience of how a double hand transplant has changed his life.

Listening to these peoples’ stories and reading more about how these procedures are done, got me thinking about how I would feel if someone was to ask my permission for my loved one’s hands or if I would want someone to have my own. It is such a life-changing thing that some can do for another, it is like consenting to a kidney, liver, or heart but in some way, it feels a lot more personal. An interesting and thought-provoking transplant that will hopefully inspire more of these life-changing surgeries. It made me think of all the potential for other body parts that might be able to transplant in the future, such as legs, ones we’ve never thought of before.

Introduction

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I’m Florrie, I am an exchange student from New Zealand. My university in NZ is called Victoria University of Wellington. I am doing a whole year here in Southampton. I study Biomedical Science and am in my final year. Although I live in NZ I am originally from the UK, I moved to NZ when I was 5 years old. I have also lived in Sydney, Australia. I live in Wellington, which is the capital city. New Zealand is a beautiful country, it has a similar land mass to UK but only has a population of 5 million. One of the coolest things about New Zealand is that we have serval active volcanoes. I have attached a video below of things to do in New Zealand.

The topic I am most excited about in this module is stem cells and research ethics. I am looking forward to learning about how stem cells can be used to help cure diseases and aid in medicine. It will be interesting to learn about how ethics affect the work that can be done and how they are used in regulating research. I have done some lab work with Henrietta lacks cells back at my uni at home which was really interesting seeing how they develop depending on what chemical they are exposed to. It was also comparing the growth of cancerous stem cells to normal ones.

Henrietta Lacks Cells