Astor Posted July 20, 2009 Share Posted July 20, 2009 Story. A 22 year-old man from London died yesterday after being denied a liver transplant, because he did not meet criteria of being clean of alcohol for six months. While, of course, this is a tragic case, it also raises questions about whether it was the right decision to deny a man with an alcohol addiction a new liver, when there are arguable more 'deserving' people with the same need. (Note: I'm not saying that this man deserved to die, but it is easy to see how someone could make that argument, especially considering the highly publicised struggle of the late footballer George Best.) In addition, this also highlights the chronic lack of organ donors, and that people are beginning to binge drink from an ever younger age (although, that's not too surprising). So, did the NHS make the right decision? Link to comment Share on other sites More sharing options...
jrrtoken Posted July 20, 2009 Share Posted July 20, 2009 Quite a morally ambiguous argument, if I might say. Seeing as he was an extreme alcoholic, that definitely gives a reason for the liver to be given to someone with conditions that weren't self-inflicted. At the same time, seeing as he was only 22 when he required a new liver, it might have seen fit to allot him the new liver, if only in hopes that he might break the habit. I can see denying the liver to a 50-year-old alcoholic, as he might have had several opportunities to free himself from alcoholism throughout his life, whereas a 22-year-old man is only out of adolescence, and is subject to foolhardiness. I'm not trying to broadcast a notion of "he got what he deserved", as alcoholism, like any other addiction, can become completely free from the addict's control, to the point where it manifests itself as any other communicable disease. This affliction, along with Reinbach's relative youth, might have actually been a legitimate reason for a liver transplant, in hindsight. Link to comment Share on other sites More sharing options...
Darth Avlectus Posted July 20, 2009 Share Posted July 20, 2009 Maybe if he wasn't so young I might not have somewhat of a disagreement with the decision right now. Having said that, binge drinking is never a good thing...especially so young. I'm sorta in the same boat...I understand how someone could reach that conclusion. Can I assume there were at least attempts to intervene and help? I understand some are just not help-able since they don't even have will enough to help themselves. Still... Kind of disheartening. This is a rather tragic case indeed. That's one reason why there are sayings about "moderation is best" --as opposed to indulgence. Link to comment Share on other sites More sharing options...
Totenkopf Posted July 20, 2009 Share Posted July 20, 2009 It is most unfortunate. What exactly are the NHS's criteria for granting such transplants (aside from the alcohol-free time req)and how long is the list of hopefuls? Link to comment Share on other sites More sharing options...
JediAthos Posted July 20, 2009 Share Posted July 20, 2009 I couldn't find the full criteria, but I did find some here: http://www.organdonation.nhs.uk/ukt/about_transplants/organ_allocation/liver/national_protocols_and_guidelines/protocols_and_guidelines/adults.jsp It looks like they were simply following their own guidelines in denying him a transplant if I understood the protocols correctly. I don't think it was done maliciously, and unfortunately this is the result. Link to comment Share on other sites More sharing options...
Master Shake Posted July 20, 2009 Share Posted July 20, 2009 Good, he did it to himself after all. Link to comment Share on other sites More sharing options...
urluckyday Posted July 20, 2009 Share Posted July 20, 2009 While it's unfortunate that the man died...if he needed it due to his own actions...there's nothing that should be argued. People that really need it due to disease and other health problems deserve it more... Link to comment Share on other sites More sharing options...
SW01 Posted July 20, 2009 Share Posted July 20, 2009 I can see how that would pose quite the ethical quandry...on the one hand it's very easy to say 'Oh he did it to himself, he didn't deserve transplants' etc., on the other the prospect of denying life-saving treatment. As Astor points out, the George Best situation raised the issue a great deal, and I would say brought both sides of the problem into the minds of a lot of people here, because he was so recognisable, from a tightly knit community and that. But then there was the undeniable truth of his excesses, and foolishness in squandering the chances to change he was given. Though, it would be a much more difficult question, I think, if transplants were easily come by. As urluckyday mentioned above, where there are people who have come by terminal liver diseases through no fault of their own, they would have to take precedence. I would never go so far as saying 'he deserved it', though. Link to comment Share on other sites More sharing options...
CommanderQ Posted July 20, 2009 Share Posted July 20, 2009 I think that the NHS should change their policy on these transfers. The idea of making a requirement for a new organ does not sound good to me, as not all medical cases are the same. Rather, they should put the patient through a close examination, and from there ascertain their decision. Dismissing someone from the transfer simply because they were not alcohol-free for 6 months is just asking for an unfortunate event such as this. Still, if they're operating with a very little amount of donated organs, they should get the organs to those who need it more. That's just a given. We just need more donations, or find a cloning solution {okay, maybe not entirely sound, but it could work}. Link to comment Share on other sites More sharing options...
Darth_Yuthura Posted July 21, 2009 Share Posted July 21, 2009 A person who did an injury to himself is not deserving of a new organ. Of course that raises the question of someone who was just lazy all their life and needed a new heart. An alcoholic is easier to diagnose, but I would say that anyone who gets ill because of such an obvious self-inflicted cause doesn't deserve to get a healthy organ that is in such short supply. You only have one liver, heart, and a few other vital organs, but people can more easily spare a kidney or even a lung. If more people donated, these would not be in such short supply; but the issue is with an organ denied to a person who willingly damaged his own liver... causing what brought his illness about in the first place. The incentive should be that one who donates an organ such as that should automatically put them at the top of any medical list for transplants... increasing the odds for more donors and giving more security to those who give an organ willingly. I would like two kidneys for security, but if I knew that I could get a replacement if I donated; I might be more likely to do so. Link to comment Share on other sites More sharing options...
Totenkopf Posted July 21, 2009 Share Posted July 21, 2009 A person who did an injury to himself is not deserving of a new organ. I'd say is less deserving than others. Perhaps the people who can't pay for the procedure are undeserving too. I'm sure people can always find ways to justify denial of others. Having said that, though, if there is a waiting list for the organs.....those that self-inflict their injuries through stupid behavior should have to go to the back of the line. Is the reason for 6 month alcohol free period a behavioral precondition or based on medical reasons? Does the body require that much time off of alcohol to properly facilitate the bodies acceptance of the new organ (afterall, you don't want to waste them when there's a shortage)? Link to comment Share on other sites More sharing options...
Darth_Yuthura Posted July 21, 2009 Share Posted July 21, 2009 I'd say is less deserving than others. Having said that, though, if there is a waiting list for the organs.....those that self-inflict their injuries through stupid behavior should have to go to the back of the line. I'd agree with that. Less deserving. I'm not knowledgeable with the way organ lines work, but I was under the impression that everyone starts at the bottom of the list and those in front of them either get replacement organs first, or die waiting. I think that a system would work better if alcoholics start at the bottom of the list and that certain people could have their names put in front of them because they didn't inflict the injuries upon themselves. Then that goes on to the supply of organs, blood, and who they will be given to. O+ blood is a universal type, which means that it is the most desired blood to have because it can be accepted by anyone. The problem is that there are A+ blood types who can accept many other kinds of blood that are not so easy to transfuse. If you have a supply of B+ and a patient with A+ needs a transfusion, you will use that B+ first and preserve the O+ until last. The same thing may go for organs, where someone who can only accept a rare kind would be pushed up the list because one such organ is available. Or someone at the top of the list will not be given a more 'universal' kind of liver or kidney because they can accept many other kinds that become available. There will always be a shortage of organs, so long as we keep donating as we have been in the past; so the best thing is to try and optimize the most donors with the most specific kinds of organs. What I mean by that is to use the most 'A+,A-,B-,B+' blood whenever you can and preserve the more universal blood/organs for last. Link to comment Share on other sites More sharing options...
Web Rider Posted July 21, 2009 Share Posted July 21, 2009 It is unfortunate that the man died, however, to have destroyed his liver so young with alcohol, I have little sympathy for him. Link to comment Share on other sites More sharing options...
Jae Onasi Posted July 21, 2009 Share Posted July 21, 2009 Well, let me explain a bit about organ transplants and what all's involved. It's not so simple as the article makes it. First, the recipient has to be eligible and in good enough health to survive the operation. There's no point in doing the transplant on someone who's going to die on the table or only a few hours/days later. That's a waste of a precious organ, hard as it is to say that. Looking at this kid's picture, and how quickly he died after being admitted to the hospital (only 10 weeks after initial diagnosis), I suspect he had major organ damage that extended beyond just liver damage--pancreas, stomach, brain, lungs, and kidneys are all likely to have been damaged badly as well. People can live years with cirrhosis if it's not too far advanced. His must have been so bad that he had no liver left at all, and clearly he hadn't been getting any medical treatment (or he ignored it) in his teens or it would have been caught in a far less advanced state. Further, if he'd been binge-drinking for 9 years to the point that he destroyed his liver entirely, it is highly likely that he wouldn't be able to kick the alcohol habit. It's standard not to give an active alcoholic a liver transplant because they'll just end up killing the second liver, too, and in a relatively short period of time because the alcohol interacts badly with the cocktail of drugs needed to prevent organ rejection. I know the news wants to sensationalize this "OMG a 22 year old got denied a liver!!!!" but I'm wondering if the guy would have made it through the surgery and recovery process in the first place. Second, a team of professionals is involved in every organ transplant. There are a number of specialists involved--transplant surgeons, immunologists (to determine if the recipient's body will reject the organ or not and work on preventing that), psychologists (because you have to make drastic lifestyle changes after a transplant and comply with a strict medication regimen), and the ethics team, among many other people. It's the ethics team's very difficult job to determine who is the best candidate to receive the limited number of organs we have available. I have no doubt an ethics group discussed this guy's case at length before coming to their decision, and I'm sure it wasn't done lightly. The ethics team looks at the overall health of the person, in the case of alcoholics, the likelihood that they'll return to drinking, and the person's willingness to comply with after-care. For liver transplants, those that are the sickest but can still survive the surgery, and won't drink after a liver transplant, go to the top of the list. If the ethics team knows someone is going to drink after a liver transplant, there's no point in putting him on the list at all--all you're doing is extending his ability to drink himself to death, which is no favor to him, to be honest, while denying someone else a liver who would get real quality of life improvement. The positions on the transplant eligibility list are very fluid because level of illness can fluctuate dramatically. Also, the person at the top of the list may not receive the donor organ if it's not going to be a good tissue match--in that case, the person with the best match nearest the top of the list may get the organ instead. The size of the donor organ and the recipient are also factors--the donated organ has to be big enough to function properly in the recipient, but small enough to fit into the person properly. Even the location of the patient can be a factor. If you have one patient who's within an hour of going to the surgery table and another who's 8 hours away, they may well choose the closer patient because of the limited time the donor organ can survive outside of the body. @GTA--my guess is this guy went to the hospital only when he became so sick that he pretty much collapsed. By the time he was admitted, he was pretty much done--the article said he was too sick to go home after that, and I believe it. What we don't know is what kind of care, if any, he had in the past--for instance, was he seen by a doctor at age 18 and he was told to stop drinking, and he refused to comply? Did he just ignore his health and not go to a doctor at all until it was way too late? It sounded to me like the diagnosis of his cirrhosis was a new diagnosis, which leads me to think he just hadn't sought any kind of medical care in the past. However, if he had seen a doctor in the past, had been told to quit drinking, but had not complied, that demonstrated lack of compliance would have weighed heavily against him with the ethics committee. @Totenkopf--my guess is the 6 months is behavioral to make sure the person isn't going to drink. The body can clear the alcohol pretty quickly, even with advanced cirrhosis. @Darth_Yuthura--typing for organs is more involved than just blood-typing. The blood types of organs have to match, yes, but that's only the beginning. The HLA/tissue type also has to be compatible, so there are not really 'universal organ donors' like there are 'universal blood donors'. You can have a compatible blood type but an incompatible HLA that will lead to rejection. In addition, while blood can be stored for some time, thus allowing the idea of a 'universal blood donor', organs cannot. They need to be transplanted as quickly as possible after removal from the donor, ideally within minutes, or the organ dies. Lung transplants--this is a pretty risky surgery for the donor compared to kidney donation, and it looks to me like living donors are only allowed to donate one lobe of one lung rather than an entire lung. Link to comment Share on other sites More sharing options...
Nedak Posted July 21, 2009 Share Posted July 21, 2009 All of you guys that are saying that you don't have sympathy for him are sick. ALCOHOLISM IS A DISEASE. Link to comment Share on other sites More sharing options...
JediAthos Posted July 21, 2009 Share Posted July 21, 2009 Alcoholism is many times a self inflicted disease. Yes, there are some people who genetically predisposed to such things, but for the most part people bring it upon themselves. My brother-in-law is a perfect example. The kid is barely 25 and he's had four DUI's, been in and out of rehab, and refuses to admit he has any sort of problem. Were he to have the same problem, I would be very sad for my wife, and her family, and I genuinely like the guy despite his faults, but at the same time he brings it on himself. For somebody to start binge drinking at 13 and require a liver transplant at 22 is incredibly extreme. I'm sorry, but you're not an alcoholic at 13, that is something that developed because of the life he chose to lead. Am I sorry the guy had to lose his life? Sure. At the same time did he make the choices that put him in that situation? Yup, he sure did. Link to comment Share on other sites More sharing options...
Astor Posted July 21, 2009 Author Share Posted July 21, 2009 Jae, your medical knowledge and expertise never ceases to amaze. For somebody to start binge drinking at 13 and require a liver transplant at 22 is incredibly extreme. I'm sorry, but you're not an alcoholic at 13, that is something that developed because of the life he chose to lead. While I agree that he did indeed bring about his own unfortunate end, something about the age he started drinking makes me think that it may have been as a result of something in his life (troubled homelife, for instance). As you say, it was ultimately his decision to keep drinking, but I have trouble believing that someone at that age would just start drinking without a reason. Link to comment Share on other sites More sharing options...
Darth_Yuthura Posted July 21, 2009 Share Posted July 21, 2009 All of you guys that are saying that you don't have sympathy for him are sick. ALCOHOLISM IS A DISEASE. That as may be, it was a disease that could have been prevented. This guy may have been addicted, but he chose to continue doing his self-inflicting behavior. That was the reason why this guy had his liver shot, because of actions he took. Therefore he doesn't deserve to be on the top of a waiting list if there are others who just had their liver shut down for reasons not directly related to their actions. I would have sympathy for such people, but I would not like to see a healthy liver be denied to someone who didn't abuse that organ in the first place. This guy may not have abused his donated liver, but he was the cause for needing a replacement in the first place. Link to comment Share on other sites More sharing options...
Nedak Posted July 21, 2009 Share Posted July 21, 2009 Obviously none of you have been alcoholics or had to deal with alcoholics. Alcoholism is many times a self inflicted disease. Yes, there are some people who genetically predisposed to such things, but for the most part people bring it upon themselves. My brother-in-law is a perfect example. The kid is barely 25 and he's had four DUI's, been in and out of rehab, and refuses to admit he has any sort of problem. Were he to have the same problem, I would be very sad for my wife, and her family, and I genuinely like the guy despite his faults, but at the same time he brings it on himself. Alcoholism is a CUNNING disease. Alcoholics believe that there is nothing wrong with them. Even if everybody in the world told an alcoholic that they had a problem they wouldn't believe it, it takes an alcoholic to hit a bottom before he can come to any sort of understanding of the seriousness of their disease. Your brother-in-law does not think he's an alcoholic, he thinks he can stop at any time. It's not his choice. For somebody to start binge drinking at 13 and require a liver transplant at 22 is incredibly extreme. I'm sorry, but you're not an alcoholic at 13, that is something that developed because of the life he chose to lead. YES, you can be an alcoholic at 13. For whatever reason he probably got curious, decided to drink and hit the bottom extremely fast. For some people it takes a long time to hit bottom and for others it's a quick process. Before I give any retort to the rest of the posts, I ask you all to read up on Alcoholism. http://ncadistore.samhsa.gov/catalog/facts.aspx?topic=3 Link to comment Share on other sites More sharing options...
Q Posted July 21, 2009 Share Posted July 21, 2009 I'll try to put the way I view this situation into perspective. If I were to contract lung cancer and die due to my 20 years of smoking, I know that I would have no one but myself to blame for it. This is no different. Link to comment Share on other sites More sharing options...
Darth_Yuthura Posted July 21, 2009 Share Posted July 21, 2009 I suppose the issue isn't so much who's to blame as it is whether you can give an organ to someone KNOWING that they've stopped drinking/smoking. If a person would have continued, then that automatically drops them as a suitable candidate; but what of someone who had ceased years before the organ failed? Clearly they were responsible for what happened, but that doesn't mean they should be denied because their future actions are not expected to follow their past behavior. What do others think of this? Link to comment Share on other sites More sharing options...
Det. Bart Lasiter Posted July 21, 2009 Share Posted July 21, 2009 I don't think he should have received the liver, but I also don't believe anyone else with a chronic illness that kills his liver should get a donor liver before someone without that sort of illness. Link to comment Share on other sites More sharing options...
Darth Avlectus Posted July 21, 2009 Share Posted July 21, 2009 @ Nedak: I understand. However there are just too many unknowns. While alchoholism IS a disease with debatble genetic ties and inheritance, it is still a disease of disposition and choice. Not that it necessarily justifies this tragic turn of events. However, people with liver conditions other than alcohol are more than likely not afflicted by some choice in the matter, or at least not nearly as directly affected as in the case of alcoholism. That's the rationale, anyways. @GTA--my guess is this guy went to the hospital only when he became so sick that he pretty much collapsed. By the time he was admitted, he was pretty much done--the article said he was too sick to go home after that, and I believe it. What we don't know is what kind of care, if any, he had in the past--for instance, was he seen by a doctor at age 18 and he was told to stop drinking, and he refused to comply? Did he just ignore his health and not go to a doctor at all until it was way too late? It sounded to me like the diagnosis of his cirrhosis was a new diagnosis, which leads me to think he just hadn't sought any kind of medical care in the past. However, if he had seen a doctor in the past, had been told to quit drinking, but had not complied, that demonstrated lack of compliance would have weighed heavily against him with the ethics committee. Pretty much my thoughts on the matter, just that I'm trying not to make any bold statements which might be incorrect. (Drove my college professors *nuts* that way! --Especially in the area of research.) There are just too many unknowns to make a judgement, but I think you summed it up quite nicely. So I second this. Link to comment Share on other sites More sharing options...
Brin_Londo5 Posted July 21, 2009 Share Posted July 21, 2009 Enough. I registered after two years of lurking just in order to respond to this thread. While Alcoholism may be a disease, it is a mental disease, and one that millions of people have successfully recovered from. One of the people in our RPG gaming group is one, she runs a local AA group here in town. I know several people with alcoholism, I have an uncle on my mother's side of the family who has it, as well as a cousin on that side, and I lost an uncle to it from my father's side several years ago, he died of exposure in a gutter in Seattle one winter a decade ago. That being said, anyone who would do enough damage, SELF-INFLICTED damage at that, to require a liver transplant at TWENTY-TWO, should in NO WAY **EVER** be allowed a liver transplant! For god's sake, doing so would result in THREE DEATHS (the DONOR'S, who had to DIE in order to make the liver available in the first place, another patient who may have needed a transplant due to an auto-accident or cancer, and the 22-year old IDIOT who apparently WANTS TO DIE IN THE FIRST PLACE for abusing a TOXIN that is known to destroy the very organ that now needs to be replaced) instead of just TWO. Because this person blatantly and obviously lacks the self-control to NOT reach for that bottle. If given another chance, one with a new liver, someone else's liver, he will ALMOST CERTAINLY lack the self control to not destroy THIS one as well. It's not about who is "more deserving", it's about how to save a life that CAN be saved, as opposed to a life that is self-terminating to begin with. Link to comment Share on other sites More sharing options...
Brin_Londo5 Posted July 21, 2009 Share Posted July 21, 2009 Which he was. The criterion for having "beaten" his disease was to be sober for 6 months. Which there are endless numbers of programs to help with. Just as I would need medicine to cure meningitis, his medicine was to not drink, which he did not do. Therefore, he did not get the liver. THIS. It isn't cruelty, or man's inhumanity to man, it is BASIC TRIAGE, saving a life (as I said earlier) that CAN be saved, instead of one that cannot be. Or did anyone here think that the person the liver DID go to someone who didn't "deserve it" over this person with "a disease"? And remember, someone else DIED to give this liver. This isn't Kamino we're talking about, after all, it is EARTH, and here we don't have handy-dandy cloning facilities to magically grow someone a new liver. Someone had to LIVE and GROW UP, someone with a FAMILY of their own, LOVED ONES OF THEIR OWN, AND HAD TO DIE TO GIVE UP THIS VITAL ORGAN. Giving it to such a self-destructive individual would not just be insane in a triage situation, it would be a grave and mortal insult to the person (and their family and loved ones) who had to DIE to produce it. Link to comment Share on other sites More sharing options...
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