As the health minister shared the limelight with 14-year-old Tee Hui Yee who underwent two heart transplants successively within a day after being on a ventricular assist device (VAD) for almost a year, the minister appears to have missed a giant ethical black hole staring right in the ministry's face which if the private sector was party to, would have been severely reprimanded and subject to various punitive measures.

The health minister who repeatedly harps on ethical issues especially when it is related to private practitioners, appears not to have asked a very vital question at the back of everyone's mind regarding this entire protocol. How is it a VAD meant as a bridge for a transplant allowed to be placed in this girl when the nation did not have an established organ procurement programme?

A VAD is usually placed when the heart has sustained massive damage pre or perioperatively while waiting for a heart to come by. Assist devices of this nature are usually on standby in active heart transplant programmes where heart procurement programmes will eventually yield hearts within days if not a few months. But if the procurement programmes are not successful or dormant, putting in a VAD to give it a go and hope a heart will just come by is not only highly irresponsible but unethical as these devices have a limited life span.

If the idiom "first do no harm" holds true, then surely conservative measures needed to be continued irrespective of the consequences instead of embarking on this potential venture to nowhere.

Fortunately, a heart, in fact two, became available within a day. Otherwise, placing this teenager with every paper in town wishing someone dropping dead would donate their heart doesn't appear to be a well-coordinated, planned transplant programme at all. This sort of lottery is surely not the right way to run a transplant programme as the trend for poor procurement was already patently obvious the Malaysian public was still unconvinced about organ donation.

Shouldn't some semblance of consistent organ donation be established before transplant surgery begins? Is the health minister, who was giving press statements, aware of the catastrophic consequences to this patient on the VAD if donated hearts were not available?

Indeed, Tee was lucky to have had organ donors available and more than the operation, the entire thought process leading to the surgery appears to be a rather risky and cavalier approach to treat her end stage heart failure.

One must ask - is this the way this programme is going to be run? If it is, then it is only fair that prospective patients be prewarned and counseled that the VAD is not a permanent solution and the danger to mortality is significant if a heart - or two - doesn't become available. It indeed becomes a game of chance, a game that depends on a hope that someone else dies.