Baby Barbie's older siblings both died from an inherited condition that prevented their livers from functioning effectively. Each was placed on the hospital's list for a liver transplant, but no suitable donated organ could be found. As an infant, Barbie already has indications of liver failure that seriously compromises her. Children with her disease have never survived their first year without a transplant. Barbie's quickly worsening condition suggests that, without a transplant, she is unlikely to live out the year. But it is very, very difficult to find a suitable donated human liver for a baby. Further, her parents both have milder versions of the condition and cannot donate parts of their livers.

Dr. Doe heads the hospital's transplantation unit. He proposes to do a xenotransplant - namely, to transplant a part of a piglet's liver into Barbie - with the hope that it will function until a suitable donated human organ can be found. Dr. Row heads the hospital's genetic medicine unit. She has permission from Barbie's half sister to use her embryo, "left over" from a human fertility treatment, to clone a human liver for the child. Each of the physicians argues that it is morally preferable to attempt the experimental procedure than simply to let the child die without taking any action at all.

You are the hospital's bioethicist.

The hospital administrator asks you to write a report advising her on the following matters:

a. News of this proposal has leaked out and the hospital has received a complaint from the Executive Director of the Society for the Prevention of Cruelty to Animals, who is outraged at the idea of killing a healthy pig and transplanting its liver into a sickly child. How should the hospital respond to this letter?

b. The hospital also has received a complaint from the Executive Director of the Society for the Prevention of Human Cloning, who is outraged at the idea of using a human embryo to create a body part for another human. How should the hospital respond to this letter?

c. Both physicians argue that it is preferable to try an experimental procedure than to do nothing and let Barbie die. Are they right? Is the hospital obligated to try something new that might work if no tested procedure can be implemented? Does the possibility of gaining knowledge that might benefit other children justify an experimental procedure even if Barbie is not saved? Who should decide? What principles and considerations should the hospital's Institutional Research Board bring to bear?

d. What ethical considerations arise if the embryo is not an existing, donated one but instead created with a purchased human egg, and selected for the process using PGD?

e. What about the risks these procedures pose for other people - are there any biological or social risks and, if so, how should these be weighed?

f. If either of the experimental procedures is attempted and succeeds, the hospital and the physician who executes it will receive favorable publicity. How should the hospital's and the physician's self-interest be weighed against the interests of Barbie and her family?

g. Should the hospital permit the xenotransplant, or permit the cloning and transplant of a human organ, or do a transplant only if a suitable donated organ becomes available? Give the reasons for your decision!