Sunday, January 27, 2008

The ethics of liver transplants for alcoholics...

Read an article on the front page of the Citizen, about Discovery Health (Bongi's favourite) refusing to fund a liver transplant on what seems like suspicion of alcohol abuse.

So I want to debate transplants. And the ethical eligibility to receive one. Liver transplants spring to mind.

Many conditions cause end-stage liver disease that would then require a liver transplant for survival. Livers are a scarce resource that do not become available everyday. For instance, in the UK, 17000 people are waiting for a liver transplant. If you're lucky, between 50 and 200 become available every year.

So, how do you allocate organs appropriately and fairly?

Do you want to give a liver to a person, who through large consumption of alcohol caused cirrhosis? Or do you want to give it to a child, who through no fault of their own, has biliary atresia. Or to a woman who developed auto immune hepatitis?

Most international guidelines say that for a person who has alcohol-induced liver failure to become eligible for a transplant, they need to have shown a period of abstinence and/or a period of rehabilitation. Usually 6 months.

After this period - does that make them deserving of a liver transplant? Should the guidelines be abolished as people who are alcoholics have a disease "that they are not in control of"? Even if you will continue to drink and destroy your new liver?

Should self-induced liver disease be deserving at all (taking into account the more deserving children and adults out there, who have had no control of the cause of their liver failure)?

What do you think?

Personally, I will tell the Organ Donation Society NOT to give my liver / organs to anybody who has not been substance abuse rehabilitated. Full stop.

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22 comments:

Bongi said...

interestingly enough, a liver transplant is one of the surest ways of curing alcoholism. it seems that if you have had a self inflicted brush with death, you look after liver number two better. also it the end the liver goes to the best match, so it wouldn't go to a so called more deserving candidate if the alcoholic didn't get it.

having said the above, if one of my children died and we donated his liver and i heard manto got it, i would be devastated.

SA Doc said...

Bongi, I hear you, but you'd be suprised at the number of post transplanters out there that have continued to drink (or at least restart with the aim of only having 1 or 2 drinks) :)

In terms of allocation (and this I remember from my days at medical school - so it is state guidelines) they allocate on blood compatibility first, then on size, then on need...

All i'm saying is that if you have two people, one who is alcohol induced and one who isn't who BOTH are a great match... who should it go to????

I believe that if the patient went through the guidelines of abstinence and rehab, then they are both deserving.
But the question for many transplant centres in the world is: do they vigorously uphold the guideline??

Bongi said...

i'm sure some would accuse me of being judgmental, but i agree. i'd give it to the non alcoholic.

Rosi said...

well, i dont know about that.
although it is certainly unfair to give a liver or any other organ to people who didnt deserve it, i think they should get a chance to they are humans like us after all.

On the other hand, they destroyed themselves. it their own responsibility,

Lala said...

Its a tough one.


Would you let a reformed child abuser adopt?

Would you give a lung transplant to someone with metastatic cancer?

Are these even comparable?

Amanzi Down Under said...

I had a patient recently in End Stage Liver Disease due to alcoholic cirrhosis. He also had Hep C and was on the methadone program. The locum physician thought he was a great candidate (!) for a transplant, she was going to treat the Hep C and transplant him ASAP, because he had been off booze for about 3 months already. What she failed to take note of was the fact that he was now drinking de-alcoholized beer instead ie. 0.5% alcohol, so in actuality he had failed to actually kick the addiction.
Nevertheless the usual physician came back and kicked him right off the transplant list.

Anonymous said...

I am a recovering alcoholic, if it was between me and the non drinker (especially a child) I would say they are more deserving. Alcoholism is a ugly thing, and although it is a sickness, there is no guarentee of recovery, and the organ transplant may be a waste should the second chance be abused. If between me or a child or someone with a disease they had no control over, I would say them! This is because sickness or not, I always new liver issues could result and I "choose" to drink and I knew the out come could be bad.

Andy Hadfield said...

@Anonymous Powerful words!

Anonymous said...

My brother is dying from liver failure. A transplant would save his life and even though he is an alcoholic he has been in recovery for some time.

This week I was told by his consultant that he has been turned down for transplant because of his past alcohol abuse. It's a death sentence because he will have less than six months to live now. He's 50 years old and the only family member I have left.

Don't you dare judge him because he's a good person, a kind person and he fought his alcoholism. He doesn't deserve to die and I don't deserve to watch him die. He effectively became a father to me when he was only 12 years old and I was a baby, after watching our own father die of a long illness.

So sit at home and write your comments and post your blogs. I'll be at the hospital again and then I'll come home and cry some more because my heart is breaking and there's no help or compassion from anyone.

I hope none of you ever have to endure what I'm going through or that if you do, then you don't meet the prejudice I've encountered.

Anonymous said...

If you're going to talk about "resource allocation" you are moving into dangerous waters. Why transplant any organ or prescribe any medication for anyone who smokes, is obese, never exercises, eats processed food, etc. Anyone who does not take care of themselves, drives up our health care costs indirectly. Alcoholics are people with addictions. They can not think clearly. The first use of drugs or alcohol is always a choice, but the habit that leads to addiction is swift and chemical. Once the brain chemistry is changed, you can not talk people out of their addiction. Quite often, you have to physically remove them from their surroundings to a rehab center, and it usually takes more than once. Society approves alcohol as an adult, cool, happy-hour kind of thing. We relax with it, we socialize with it and it lends an air of sophistication to the drinker. Its a legal and sanctioned addiction. Death by liver failure is one of the most god-awful ways to die. Doctors tell us to let the alcoholic "hit bottom", but the bottom is death. Until we legislate for a "presumed donor law" as in europe, or at least make motorcycle riders mandatory donors because of the head trauma risk, allow family members to donate a split liver to the alcoholic, raise the drinking age again beyond the impressionable early twenties, ban all advertising, esp. in sports, as we did cigarettes, and use the alcohol tax monies to fund rehabs in every town, this epidemic will continue. Death due to alcoholic cirrhosis, ranks 7 in the causes of death in the U.S. Only in places like India, can you receive a split-liver transplant for alcohol induced liver failure. Take your brother overseas if you want him to live and give him half of your liver if possible. If not, let him die at home with morphine, instead of in hospital on a ventilator. You will only receive judgement from the medical community in the US, not healing.

Anonymous said...

Personal responsibility... You f up your body you should deal with the consequences. It would be one thing if there was an unlimited supply of livers but there is not. Also, if u are going to call alchoholism a disease which you can't control then you just proved why they shouldn't get a liver transplant - they'll just have more time to drink and increase the possibility of hurting someone else, driving drunk, etc.

What's interesting if we didn't have the medical technology or no one donated organs this issue would be mute. People would probably cherish life more and/or accept the consequences of their actions. Many people live who deserve to die, others die who deserve to live. I don't care if u r a saint... No one gave your brother a death sentence except for him. As for being judgemental, well if we had livers for everyone then no worries, but since there is a shotage we have to be...

william said...

i think it is fair for people that drink or not to get a liver trans .
as you all know we as a cicity are not perftic at all so there is no reason that all people that are in need of a liver should not be givin the chance to live. this is y i say dont let your gov tell you that drugs are bad when they promote the worst drug ever achole . it kills more people than any drug knowen to man ever more that both world wars combind just think about that one !!!!!! sorry about the spelling

Modigliani said...

Well, my father is a raging alcoholic and is now in need of a liver transplant. I remember very vividly standing in the hospital room with him and my mother & sister when the doctor told him he needed a transplant. My father look bewildered and couldnt understand why. He then said "ok" get me a liver and will have the surgerey. I looked at him and told him "your not getting a liver, you dont qualify" he said what do you mean qualify, then the doctor said yes, what do you mean? What I didnt know was that the doctor had been strung along by my father for quite some time and no idea that he was an alcoholic. I then told my father that you dont get one because your a practicing heavy alcoholic and there are others that are more deserving. I signed my fathers death warrant right then & there, the doctor said, your not getting on the list. Anyone that wants to destroy there own bodys with chemical toxins get what they deserve. So, I have my opinions and they are quite simply that drug addict's dont deserve organ donations, period! There way to many people who are in need of transplants that lead much cleaner lives. Call me cold if you wish but such is life.

tannyar said...

To Anonymous who said their brother was not eligible to be on the list, don't give up. I've known alcoholics who got on the list somehow. Go to a different hospital, ask for a transfer to a new hospital. Or demand to talk to the doctors superiors or the chief of staff. Let them know there's been a mistake, because your brother WAS an alcoholic but has been in recovery and sober for over six months (or longer). You can actually fight this. If possible get a lawyer as a last result. But try at least two sufferer hospitals first. And if you do get him on a list, come as often as possible to the hospital and make yourself known and visible to the staff. Ask tons of questions, demand face to face conferences with the doctors and surgeons, but always be extremely
polite and respectful. If possible, bring food and treats to the staff every day or as often as possible. You'd b surprised how that makes a difference. But most importantly, fight the doctor that said he can't get on the list. Do your research on eligibility, dig up past patients who are on the list, maybe by seeking out support groups. Fight! Even on the list, chances are he may not make it and pass away before he gets his transplant, but at least you will know you did everything you could and if he's on the list he has at least a chance.

sdh said...

Well ... It turned out that in Britain many people waiting for liver transplant surgery reached 17,000 people, the figures were for me a big enough share of each year while only about 50 to 200 people who can perform liver transplant surgery. Later in your article I found that one cause of cirrhosis is consuming too much alcohol. Thank you for the information, hopefully it can be useful.

Anonymous said...

I would bet my life that everyone who posted here does not have the ability to walk on water...with that being said no one here is qualified to judge anyone for what they have or have not done...it is easy for many to sit and say that people who have chosen to drink it is their fault...with that being said I invite everyone to first educate themselves about these illnesses then, and only then, speak from a place of knowledge on who should or should not receive a transplant. Respectfully, if we are to say that one who drinks is not permitted a transplant, then as far as I am concerned one who speeds in a car and recks does not deserve treatment as they knowingly drove over the speed limit.

I repeat, everyone take some time, educate yourself about what you speak of and then make recommendations but NONE OF YOU - NONE OF US - have any right nor will the right ever be given to us to play God...there is only one and I am betting none of you are He.

Anonymous said...

"Don't you dare judge him because he's a good person, a kind person and he fought his alcoholism."

Big fat hairy deal. The chances are high that he will destroy the second liver, too.


If we had plenty of livers to go around, fine, give him one.

We don't.

It should go to someone who is going to get the most benefit from it, not to someone who has a high probability of throwing it all away.

JENNY said...

i have my dad who is an alcoholic and has been in the waiting list but for the past seven months he has returned to drinking after being sober for little more than three years. I do feel bad because it seems that he is selfish in drinking and still going to the doctor. but recently he got offers to get the transplant and my aunt told the doctors he was drinking..i dont know if hes getting off the list but what i think is that just like everyone else alcoholics are seek and should be treated..i know that my dad want a transplant but it has been really hard to stop drinking especially bcz he is depressed and under a lot of stress. i think that alcoholics should have the same chance as everyone to recovery..but may need extra help

Anonymous said...

My wife just passed away and they asked me to donate her organs. I said yes but I have a six month waiting period.

messiejessie said...

I just wanted to add that I understand both sides of this argument. Of course I am going to be bias because my father is a recovering alcoholic dying of cirrhosis of the liver. I am 25 years old and the oldest of four children. My youngest sister is 17. My father is not a bad person, and has always been there for us. He was a functional alcoholic who earned a more than decent paycheck, showed up to all school events and supported us through everything. I am currently in medical school and fully understand the procedures and regulations and agree with them. The only thing that bothers me is the fact that in our society we are so ass backwards. A human who has done harm to others can be sentenced to death, only to walk free 15-25 years later(if not less), essentially given their life back. My father and many other alcoholics harm only themselves and therefor are given a death sentence? Do not take from those who have done nothing to deserve this, but have compassion for all human life. I love my father and if they will allow me I will put my life at risk for him, and give a part of myself. We are all human, and all make mistakes. I believe in second chances. The only reason I commented is because I read all comments and no matter how much you argue amongst each other, neither side will win. It is what it is. Do not dwell on the bad, but treasure what is good, you never know if today is your last!

Anonymous said...

If doctors only treated people who had not done harm to themselves, there would be a lot more dead people. The stigmatization of alcoholics on here is incredible since most of you probably interact with people who drink all the time. Don't act like you can predict who will become an alcoholic and who won't. We as a society condone getting drunk (I went to a top 10 university and post football games was just a lot of people purposely getting smashed), we call pot the gateway drug when any intelligent human being knows it's cigarettes and alcohol. What a bunch of hypocrites you all are. Hope you never have to watch someone you love die from a disease that can in ANY way be linked to their own habit, behavior, obsession etc. Let he who is without sin......

everyone desrves a second chance said...

whether or not you agree with me, I personally think that everyone deserves a second chance. try putting yourselves in their shoes, you think its selfish and wrong to ask for a second chance in life because of what they've done, imagine if it was you and people made all those comments about you. I have a lot of respect for those who have decided to donate their organs for another to live. just think... if you were the one waiting for a transplant and people have judged you and said how your not "worthy" for one, how would you feel??