Liver transplant ethics - should alcoholics be sober first?

[orangeblossom]

Jan 30, 2015 22:52:07 GMT -5 mofongo said:

Jan 30, 2015 22:50:24 GMT -5 orangeblossom said:

I know you said you have personal experience with this, so I can see where your feelings come into play and color your view. I'm sorry you had to experience that.

However, Hep C is not always the result of alcoholism, in fact baby boomers are told to consider getting tested for it, as there are a lot of undiagnosed patients in that age group, so, IMO, people with Hep C, shouldn't automatically be disqualified.

Hep C is never a result of alcohol abuse.

You're right. It's late, and I was getting my liver diseases and addictions mixed up. IV drug users are at risk though.

ETA: I'll edit. Don't want to leave misinformation out there.

[SallyJ]

Jan 30, 2015 22:50:24 GMT -5 orangeblossom said:

Jan 30, 2015 20:46:01 GMT -5 SallyJ said:

Both my parents died of cirrhosis of the liver. My mom's was alcohol induced. My dad's was alcohol abuse for years compounded with hepC. In both cases the doctors offered info on how to get on the transplant list. I was abhorred that it would be a possibility for either of them, given the circumstances.

So, I don't think even those who are sober for 6 months should get an option for a new liver. I would feel differently with a longer waiting period. I don't know how long it should be though. And the idea that someone with hepC could get a transplant is crazy talk in my mind.

ETA: my relationship with my parents strongly colors my opinion on this matter.

I know you said you have personal experience with this, so I can see where your feelings come into play and color your view. I'm sorry you had to experience that.

However, Hep C is not the result of alcoholism, in fact baby boomers are told to consider getting tested for it, as there are a lot of undiagnosed patients in that age group, so, IMO, people with Hep C, shouldn't automatically be disqualified.

Oh I don't mean to imply alcoholism causes HepC. In my personal experience with my dad his liver was already in bad shape before the hepC diagnosis, due to years of heavy drug and alcohol abuse. He didn't respond to HepC treatment, but the doctors discussed the transplant list anyhow. In that situation I was really confused how my dad would ever be a candidate.

[overture]

How long to do people typically wait on the list? Does it ever happen that someone who's abstained since they were told they would need a transplant is passed over because it hasn't been six months yet?

[FloFTW]

Jan 30, 2015 8:54:19 GMT -5 asdfjkl said:

Yes. They should be sober first. I believe in the US, they have to be.

I believe so too. Medically.

I admit I'm too emotionally attached to this because both my siblings have a liver disease that will require a transplant. (Unrelated to alcohol - they've had it since adolescence). But thinking that someone that injured their own liver would get a new one before them...makes me cry. Logically in my head it is much more complicated. But emotionally it's not.

[orangeblossom]

Jan 31, 2015 1:07:25 GMT -5 SallyJ said:

Jan 30, 2015 22:50:24 GMT -5 orangeblossom said:

I know you said you have personal experience with this, so I can see where your feelings come into play and color your view. I'm sorry you had to experience that.

However, Hep C is not the result of alcoholism, in fact baby boomers are told to consider getting tested for it, as there are a lot of undiagnosed patients in that age group, so, IMO, people with Hep C, shouldn't automatically be disqualified.

Oh I don't mean to imply alcoholism causes HepC. In my personal experience with my dad his liver was already in bad shape before the hepC diagnosis, due to years of heavy drug and alcohol abuse. He didn't respond to HepC treatment, but the doctors discussed the transplant list anyhow. In that situation I was really confused how my dad would ever be a candidate.

Ah , got it. I misunderstood. Sorry.

[CurlyQ284]

My dad was an alcoholic and his last drink was the day before his liver failed. He spent two weeks in ICU on life support and was in and out of the hospital for the next 6 months (many ICU visits). He went through withdrawal while he was on life support. It took a while for him to get on the list but in the 7th month he got a liver transplant. I couldn't believe he got one so fast but during his treatments he had to speak with addiction counselors constantly as a condition of getting on the list. He couldn't get out of bed so a counselor came to the house. It continued after the transplant. He still hasn't had a drop of alcohol since March 2012 when his liver failed.

I agree with the wait. I'm assuming the waiting period is why he wasn't on the list right away, it could possibly have been 6 months I don't recall. I was pregnant, working full time, part time grad school and trying to deal with my dad being sick. I definitely think they should make sure the patient is sober so they don't use an organ on someone who might destroy it. I know a lot of alcoholics don't stop like my dad did and it would be awful for those organs to go to waste and have people die who could have used them.

[ttt]

I think this whole discussion is so dependent on how we view alcoholism. Is it a disease or medical issue that people need treatment for, or is it a character flaw, something that people could choose to stop at any time and just don't want to? If it's the latter then the decision is easy - obviously if people can choose to stop being an alcoholic, they shouldn't be given precious organs they're just going to choose to treat carelessly. If it's the former, it's a whole lot trickier.

It really comes down to how we define "deserve" - do we choose who deserves organs based on how many years they will likely get out of them? Do we choose based on how innocent the person was in the disease that caused them to need the transplant? Or is it something else?

[auntie]

Jan 30, 2015 10:40:36 GMT -5 doobeedoo said:

I can't even believe this is a question. I think, ethically, it would be wrong to give the liver to someone who hasn't demonstrated the ability to "care" for themselves properly.

It kind of reminds me of Frank from Shameless--it's just not a good idea!

What if that person can't care for themselves because of a developmental or intellectual disability?


www.cbsnews.com/news/23-year-old-denied-heart-transplant-by-u-penn-hospital-because-of-autism-mom-says/

[omgzombies]

Absolutely they should, and I say this as someone who has a father who does not meet the lifestyle requirements for a kidney transplant. If organs where easy to come by, that would change my answer, but right now organ donation is a gift, and I don't think it's too much to ask that the person they are entrusted to treats that gift with the respect and responsibility it deserves.

[Deleted]

Feb 1, 2015 17:34:15 GMT -5 auntie said:

Jan 30, 2015 10:40:36 GMT -5 doobeedoo said:

I can't even believe this is a question. I think, ethically, it would be wrong to give the liver to someone who hasn't demonstrated the ability to "care" for themselves properly.

It kind of reminds me of Frank from Shameless--it's just not a good idea!

What if that person can't care for themselves because of a developmental or intellectual disability?


www.cbsnews.com/news/23-year-old-denied-heart-transplant-by-u-penn-hospital-because-of-autism-mom-says/

Having an intellectual or developmental disability doesn't automatically disqualify one from receiving a transplant. There must be other factors at play in that case (I didn't read the article). My cousin has Prader Willi Syndrome and received a kidney transplant almost 12 years ago. She will never be able to care for herself but she has 100% compliance with her meds thanks to her mother and grandmother, her primary caregivers.

[auntie]

Feb 1, 2015 18:07:07 GMT -5 @mrsspunky said:

Feb 1, 2015 17:34:15 GMT -5 auntie said:

What if that person can't care for themselves because of a developmental or intellectual disability?


www.cbsnews.com/news/23-year-old-denied-heart-transplant-by-u-penn-hospital-because-of-autism-mom-says/

Having an intellectual or developmental disability doesn't automatically disqualify one from receiving a transplant. There must be other factors at play in that case (I didn't read the article). My cousin has Prader Willi Syndrome and received a kidney transplant almost 12 years ago. She will never be able to care for herself but she has 100% compliance with her meds thanks to her mother and grandmother, her primary caregivers.

That's great for your cousin.

The young man in the article is a complex situation. His mom tends to present the situation as being related to ASD, but the young man also has a mood disorder and low IQ. There's a concern, that his psychotropic meds could interfere with his anti-rejection meds or that the load would be too great for his liver. There's also the concern that his ID renders him unable to understand and manage the complex medication regime a transplant would require. At this point mom manages the 11 medications he takes pre-transplant; he can't even name them. Once mom passes on, who will step in to make sure he remains compliant.

It's a difficult situation.