Treatment decisions in complex cases depend on a variety of factors: parental (or patient) wishes, informed medical judgment, and the predictions of the physicians about the results of any given treatment. But contextual factors, such as what treatments are available or feasible, are crucial as well. In the three cases in this part, only very complex, invasive, and high-risk interventions can postpone the death of a pediatric patient. The availability of such treatments influences the goals of medical treatment of this patient in this situation. In different ways, each of the authors meditates on the impact that the very availability of such options has on treatment decisions. Two of the three cases in this section involve transplantation, and provide useful insights into the current success rates of various organ transplantations, as well as sensitive discussions of the various factors taken into consideration in the allocation of organs.

The stage is set in Chapter 7 by an English physician, Robert Burne, who introduces William, the sixth of eight children. After what appeared to be a normal birth, William was discovered to have a complicated form of congenital heart disease. His hypoplastic heart was surgically treated, and his parents were informed of his poor prognosis and the likelihood of his developing problems leading to heart failure in his early adulthood. His condition worsened at the age of two following a major stroke, and when he was five his shunt was modified to halt progressive cyanosis.