Should doctors be allowed to transplant a liver to an alcoholic?

[Noctosphere]

Hello
Another subject I want to bring in the EOF, a subject i heard this morning at an open mic radio show
Should an alcoholic (still active) be allowed to receive a liver transplant?

Here's the context, the guy is (was) still drinking and now he's on the verge of death because of a liver disfunction.

Personally, I wouldn't
Not because "that'll teach him a lesson" because if he dies, then there's no lesson learned.
What I mean is that organs good enough for transplant are rare, and I'd either give it to someone who has chances to make that liver live longer
Which wouldn't happen with a still active alcoholic who would destroy that liver within very few years
OR, I'd give it to a FORMER alcoholic. I know that alcoholism is a life-long disease, so when I say former alcoholic, i mean an alcoholic who managed to not drink any alcohol for a certain period (6 months or so)

What do you say?

 

[Creamu]

To be consistent you would have to apply this to other things that are comparably damaging to the liver such as fructose consumption.

 

[CoolMe]

But the doctors are only doing the operations, not giving body parts (in this case liver), providing or choosing who deserves a transplant or not. Also this seems to be heading more towards the moral side, so..
Also from what i know, the liver can regenerate on its own, so i think these transplants they're only taking a half of it from the donor and putting it on the recipient. So there's no risk to the donor.

 

[Noctosphere]

But the doctors are only doing the operations, not giving body parts (in this case liver), providing or choosing who deserves a transplant or not. Also this seems to be heading more towards the moral side, so..
Also from what i know, the liver can regenerate on its own, so i think these transplants they're only taking a half of it from the donor and putting it on the recipient. So there's no risk to the donor.

actually, in pretty much all modern countries, comittees that determines which patient will get an organ are led by doctors

 

[CoolMe]

actually, in pretty much all modern countries,

Uuh..?

 

[Noctosphere]

Uuh..?

sorry, started writting the message, then my phone alarm rang telling me to give Zelda her medecine, i came back and the message was sent (wtf???)

 

[CoolMe]

sorry, started writting the message, then my phone alarm rang telling me to give Zelda her medecine, i came back and the message was sent (wtf???)

Then give her the medicine. Poor Zelda.. Is she sick?

 

[Noctosphere]

Then give her the medicine. Poor Zelda.. Is she sick?

already gave her when i wrote that message
She has hyperthyroidia (dont know if i spell it correctly)

 

[CoolMe]

She has hyperthyroidia (dont know if i spell it correctly)

Didn't know they can have it too. I hope it's only temporary..

 

[Noctosphere]

Didn't know they can have it too. I hope it's only temporary..

according to the veterinarian, no its permanent (well, she has to take this medicine until her death at least)

 

[flo]

If he pays for his medical insurance he has the right to receive it . Without medical insurance many people would not have acess to surgeries or transplants . Without the alcohol industry and etc many people would not have jobs and maybe resort to criminality . It's just the world we live in..

 

[Noctosphere]

If he pays for his medical insurance he has the right to receive it . Without medical insurance many people would not have acess to surgeries or transplants . Without the alcohol industry and etc many people would not have jobs and maybe resort to criminality . It's just the world we live in..

I forgot to mention that this very case happens in the province of Quebec, which means everyone pays for the very same medical insurance.
That means that everyone who needs it has equal right to have this liver and its up to the comitee to decide who gets it

 

[x65943]

Nocto is right doctors decide who gets it

As for the liver - if you give it to an active alcoholic the problem is not only that he may ruin the liver from alcohol - but that he may not even take the anti rejection medication and therefore will lose the liver much more quickly from rejection

In my hospital anyway we will give them a new liver before 6 months of abstinence only if they have never been warned continued alcohol use would lead to their death

 

[FAST6191]

Ever the fun debate. Risk of future rejection because further damage or because they don't take anti rejection meds (alcoholics are not always the most diligent about their health, particularly if they have reached the point of needing a transplant by virtue of that) would mean it is in some ways a wasted operation (tools, time, talent, limited source material for implantation that could have all been used for someone that might live a longer life or stand a greater chance of success).

Some more modern stuff is done from sectioned from living donors that can go onto regrow as opposed to someone losing a game of beat the bus on their motorbike (the case for most other organs save perhaps kidneys) but most things being largely intact.
"No risk to the donor" is a bit off -- you are still doing a major surgery (have seen some modern stuff do more keyhole surgery and maybe not local but epidural/spinal block rather than general anaesthetic, though open up your guts and poke around under a general is still common enough) and taking some considerable time to heal (regrowth measured in months after all and that is without the usual problems of slicing you up -- I would not jump back into lifting heavy things post that which could be fun if that is your job or your hobby).

At the same time close living relatives is still how a lot of it is done (while the liver is not as bad as some things the lowest risk of rejection there still coming from that) and living donor options means that opens up directed donations as an option which is its own kettle of fish as far as ethics discussions are concerned. At that point you are not necessarily taking one off the market as it were like you would be in other scenarios.

There is also the not considered in normal scenarios option that further complicates things -- so some alcoholic will be dead in 2 months/already nicely jaundiced but someone does the lose a game of beat the bus on a motorbike, however the liver gets disqualified because of take your pick of fairly mild but justifiable reasons (maybe they have a disease that would be transmitted to the recipient, giving people diseases often being quite hard to justify under the "do no harm" principle that is supposed to govern medicine). If it would normally then be chucked in the furnace or perused by a medical student then the debate becomes whether giving the alcoholic a fairly mild condition but perhaps years more life is justified.

Medical ethics be hard yo. For my money the complete abstinence policy and woe betide he who has a half pint of shandy 4 months before d-day reeks of the same rank stupidity that underpins the usual 12 step addiction treatment that is so favoured by Americans. Granted I would highly encourage such a thing and I am not sure responsible handling of substances (as well as underlying issues -- while some are more genetically predisposed than others nobody becomes an addict without some underlying issues, see also how the best treatments for all manner of such things operate) gives me any easy answers in this scenario. Similarly while medically it might not make any difference you do face the pragmatically thing (chance of relapse into bad habits and all that). The directed donation is fine ethically given informed consent of the donor, though whether insurance or nationalised health services should be compelled to pay is something I can stand to hear more arguments on.

 

[x65943]

Ever the fun debate. Risk of future rejection because further damage or because they don't take anti rejection meds (alcoholics are not always the most diligent about their health, particularly if they have reached the point of needing a transplant by virtue of that) would mean it is in some ways a wasted operation (tools, time, talent, limited source material for implantation that could have all been used for someone that might live a longer life or stand a greater chance of success).

Some more modern stuff is done from sectioned from living donors that can go onto regrow as opposed to someone losing a game of beat the bus on their motorbike (the case for most other organs save perhaps kidneys) but most things being largely intact.
"No risk to the donor" is a bit off -- you are still doing a major surgery (have seen some modern stuff do more keyhole surgery and maybe not local but epidural/spinal block rather than general anaesthetic, though open up your guts and poke around under a general is still common enough) and taking some considerable time to heal (regrowth measured in months after all and that is without the usual problems of slicing you up -- I would not jump back into lifting heavy things post that which could be fun if that is your job or your hobby).

At the same time close living relatives is still how a lot of it is done (while the liver is not as bad as some things the lowest risk of rejection there still coming from that) and living donor options means that opens up directed donations as an option which is its own kettle of fish as far as ethics discussions are concerned. At that point you are not necessarily taking one off the market as it were like you would be in other scenarios.

There is also the not considered in normal scenarios option that further complicates things -- so some alcoholic will be dead in 2 months/already nicely jaundiced but someone does the lose a game of beat the bus on a motorbike, however the liver gets disqualified because of take your pick of fairly mild but justifiable reasons (maybe they have a disease that would be transmitted to the recipient, giving people diseases often being quite hard to justify under the "do no harm" principle that is supposed to govern medicine). If it would normally then be chucked in the furnace or perused by a medical student then the debate becomes whether giving the alcoholic a fairly mild condition but perhaps years more life is justified.

Medical ethics be hard yo. For my money the complete abstinence policy and woe betide he who has a half pint of shandy 4 months before d-day reeks of the same rank stupidity that underpins the usual 12 step addiction treatment that is so favoured by Americans. Granted I would highly encourage such a thing and I am not sure responsible handling of substances (as well as underlying issues -- while some are more genetically predisposed than others nobody becomes an addict without some underlying issues, see also how the best treatments for all manner of such things operate) gives me any easy answers in this scenario. Similarly while medically it might not make any difference you do face the pragmatically thing (chance of relapse into bad habits and all that). The directed donation is fine ethically given informed consent of the donor, though whether insurance or nationalised health services should be compelled to pay is something I can stand to hear more arguments on.

Another side to all of this is that liver transplant takes place at specialized centers - and they are watched like hawks. If a large proportion of the overall patients do poorly, then the program may be shut down.

For this reason many many factors go into deciding (at least in the US) who gets a liver. If too many are failing the program will end and then no livers for anyone.

This opens up another ethical debate. Not only are alcoholics often excluded, but also people with poor social support and no one to look after them when they are recovering from potential surgery, or no access to a car to come back for appointments.

 

[Noctosphere]

Another side to all of this is that liver transplant takes place at specialized centers - and they are watched like hawks. If a large proportion of the overall patients do poorly, then the program may be shut down.

For this reason many many factors go into deciding (at least in the US) who gets a liver. If too many are failing the program will end and then no livers for anyone.

This opens up another ethical debate. Not only are alcoholics often excluded, but also people with poor social support and no one to look after them when they are recovering from potential surgery, or no access to a car to come back for appointments.

I agree with you it should be the same here in quebec
For example, you want a liver transplant, then no alcohol for the previous 6 months before the surgery
You want a barometric surgery to lose weigth, then lose some weigth on your own BEFORE the surgery to prouve us that you really want to lose weigth and not just go "the easy way"

 

[FAST6191]

Interesting aspect to the stats obsession of modern surgeons. Probably going to get even more fun with serious AI being used to monitor things there (if you thought being denied a credit card/getting a rather lower limit was fun then... yeah).

 

[x65943]

I agree with you it should be the same here in quebec
For example, you want a liver transplant, then no alcohol for the previous 6 months before the surgery
You want a barometric surgery to lose weigth, then lose some weigth on your own BEFORE the surgery to prouve us that you really want to lose weigth and not just go "the easy way"

A big part of that with the bariatric surgery is that surgery is more dangerous when you are larger - so by losing some weight you are decreasing your risk of complications

The other aspect is that bariatric surgery requires life long follow up, vitamin supplementation, regular labs because of the effects on gut physiology - so if someone doesn't have the wherewithal to try to lose even a little weight they will probably be worse off after the surgery (as they won't follow with doctors)

 

[cracker]

Only from an alcoholic.

 

[Noctosphere]

A big part of that with the bariatric surgery is that surgery is more dangerous when you are larger - so by losing some weight you are decreasing your risk of complications

The other aspect is that bariatric surgery requires life long follow up, vitamin supplementation, regular labs because of the effects on gut physiology - so if someone doesn't have the wherewithal to try to lose even a little weight they will probably be worse off after the surgery (as they won't follow with doctors)

TROLOLOL, yea i meant bariatric and not barometric my bad