German frau reports for liver transplant clutching bottle of vodka A German woman scheduled for a liver transplant presented herself at the hospital clutching a bottle of vodka, having spectacularly failed to lay off the booze in the six months leading to the op. According to Spiegel Online (in German), a nurse at the Göttingen University Hospital had to relieve the unnamed frau of her …
DE-livery.
I may be mistaken, but I would presume that as a condition of receiving the organ, the planned recipient would be tested a day or a week prior to the procedure, then, if failing, be de-prioritized and the organ given to the next-up matching recipient on the waiting list. The threat of not being allowed to have the organ, and hence, the increased likelihood of mortality coming sooner, might act as a "STE" Sudden Traumatic Event to wake up boozers who want to live and honor the organ specially found or tweaked for them.
The threat of not being allowed to have the organ…
You are wrong on two counts: firstly, it is against medical ethics to threaten sanctions on patients; alcoholics are addicts and rarely able to control their behaviour.
George Best infamously continued to drink after a liver transplant. Of course, he died in the end but he got a few more years of life. Smokers and morbidly obese people get treatment for illnesses directly related to their habits. But the same is true for many sports injuries. In the case of smokers and drinkers this is in theory partially funded by the duty collected. In a similar way that policeman cannot become judges, doctors cannot become the arbiters of treatment.
The scandal in Germany has led to a dramatic drop in the numbers of people prepared to be organ donors in an opt-in system. But something positive might come out of this yet: a bit like the ban on embryonic stem cell research, it may spur more research into therapeutic cloning. Transplants undoubtedly save lives but they are fiendishly tricky, expensive and often require patients to take immunosuppressants to prevent rejection. It will be better for all concerned if we can just use "one we prepared earlier".
Incorrect: From the NHS:
Additionally, a liver transplant will also not be offered if you are:
abusing alcohol – most transplant centres only consider a person for transplant if they have not had alcohol for at least three months
abusing drugs – most transplant centres would only consider a person for transplant if they attend a drug rehabilitation course and remain free from drugs for at least six months (some transplant centres will accept people who are currently taking the heroin substitute methadone)
.
Source:
http://www.nhs.uk/Conditions/Liver-transplant/Pages/Who-can-use-it.aspx
No, they just have to spell out that alcohol -- bad, drugs -- bad. You can even see them being driven to say 'beer -- bad, vodka -- bad, cider -- bad' for those who think some things are fine for livers and some aren't. I say this because I had a long chat with someone who insisted that cider was not 'booze' in any health sense.
Alcohol isn't regulated in the same way as other drugs, much like nicotine isn't either. Communication works best when both parties have the same understanding of what is being said - no doctor is going to advise their patient to avoid tobacco and alcohol by telling them to "stay off the drugs".
it is against medical ethics to threaten sanctions on patients; alcoholics are addicts and rarely able to control their behaviour.
Not only is it NOT unethical to choose who gets the limited number of organs based on who is most likely to benefit most from it, due to the limited number of organs available, it's unethical NOT to. It's not a threat of sanctions, it's a matter of allocating a limited resource where it can do the most good.
Wrong, at least by NHS guidelines:
http://www.dailymail.co.uk/news/article-1200692/Please-help-Mum-I-dont-want-die-Last-words-alcoholic-22-died-refused-liver-transplant.html
If there is only 1 liver available and 2 people need it badly, would you rather give it to the person who's going to use her second chance wisely? Or to someone who's likely to run it into the ground again?
Obviously not a easy ethical dilemma, but being blind to the receiver's lifestyle isn't good ethics, IMHO. The medical profession gauges treatment outcomes in terms of expected extra years of life, as it should.
It's not about punishing the unrepentant lush, it's about helping the next person in line. IF no one else is waiting, then your argument holds.
Therapeutic cloning: all for it, along with _embryonic_ stem cell research (as long as the embryos weren't created for research purposes). But that ain't gonna make these problems go away in the short term.
If she can't stay off alcohol prior to the transplant then we have no reason to believe she won't kill her replacement liver the same way as the first. Is far better to give the liver to someone else, preferably to a non-alcoholic.
Well, we could always take a marginally more proactive approach and opt everyone into organ donation unless they specifically opt out again via an official register.
Or we could be radical, and compel the donation of organs without opt out. This would achieve more societal good and save more lives than almost any other changes we can make and we have the technology right here and now to do it. Transplant queues would become a thing of the past in short order.
The part that saddens me the most is people not wanting to donate because of it. But why should they? "Puppy - free to a good home" - people don't want to think that their liver will be abused in it's new host (more than you've abused it yourself, naturally).
And as for synthesizing them, I can see it now - "Right love, I'm just off for my annual liver transplant - can you pick up some more beer at the store? 10 gallons should last me the night." How long before we become like Trig's Broom - every part replaced, but still just the same...
How long before we become like Trig's Broom - every part replaced, but still just the same...
A major part of our tissue is replaced naturally. Our outer skin basically regenerates entirely over a roughly 30 day period for example. Our livers typically regenerate as well, unless subjected to serious illness or abuse.
What a good idea, then maybe it can be expanded to include compulsory pre-death organ donation by people that aren't considered worth having around, like cripples and anyone else you don't like.
Doesn't matter what they want does it? they are only sacks of spare parts after all.
Personally I've always thought that anyone who objects to donating should not be eligible for a replacement organ.
Once someone reaches the age of legal responsibility they could be given the choice of going on the transplant register (and qualify for a transplant if they need one) or not. If they later wanted to change their mind there could be a qualifying period, maybe 2 years or so.
I'm willing to bet there won't be many wanting to be left off the list, and those who do out of principle, well it's their life after all.
It isn't always that simple. I would like to be an organ donor, but due to a bit of bad luck as a child, find myself in the position that I cannot be a donor, but could (in the future) require an organ from one.
Would I be ineligible because I can't be a donor?
Actually, the miracles of modern pharmacology mean that if I stay on the antivirals (at some not inconsiderable cost to the health service of my home nation) this will never happen, but a few years ago, that was a distinct possibility.
"..expanded to include compulsory pre-death organ donation by people that aren't considered worth having around.."
Funnily enough, that was close to the subject of a discussion on ethics at Uni.
Suppose transplant techniques have improved to the point where the success rate is approaching 100%.
A doctor has three patients; one, a gifted scientist, will die without a heart and lung transplant, another, a highly qualified neurosurgeon, will die without a liver transplant. The third, an ex footballer, is confined to a wheelchair and is under treatment for depression.
So in terms of A) quality of life and B) benefit to society, is it ethically acceptable for the doctor to cannibalise the third patient, who is in no immediate danger of death, in order to save the lives of the first two?
Leads to many a late night argument, especially when you start switching the patients' conditions around a bit.
Of course, if this ever happened in the real world, it would be the one with the most money who was saved.
I would make sure that anyone who opts out would be ineligible for a transplant. Full Stop. I have been on the organ donor list since 17 when I had my provisional driving license and a blood donor since 18 and being on the bone marrow donor list since about the age of 20 ( I am now in my 50's)
Obvious exceptions would be people who are unable to donate or be on a list due to illness or such restrictions.
Also in relation to deciding who gets a liver, there is the 'Triage' system as used in emergencies such as a crowded casualty ward, a huge accident with multiple casualties and similar, where the casualties are put into a 'queue' depending on various conditions.( Need urget treatment to keep alive, no chance of survival, will be ok for a while.)
That is the very simplified version we would use in casualty care situation in a multiple casualty situation with a SART team.
May not be politically correct and may annoy the Guardian readers but it works.
Yes, synthesizing organs: great idea... hopeful avenue for e.g. cancer patients with cancer in the liver where a transplant + the required immunosuppresants don't really bode well for the cancer prognosis if there's mets involved (i.e. everything except primary hepatic cancer).
I'll ehrm... drink to that.
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