Interesting Debate

[murf]

Currently in my home state of Western Australia, there is a raging debate about a liver transplant patient. Previously, this girl had received a liver transplant but due to drug abuse lost its use. She applied for a second transplant but the doctors refused as they said she was not a good candidate. The government stepped in and gave her family a loan of $250000 to have the procedure in Singapore. Unfortunately she passed away soon after the operation. The debate now rages about who is worthy to receive a transplant (kidney included). The general consensus is that donors only want to give it someone who they consider worthy of their organ. What thinks you?

[RichardMEL]

I'm sorry but I'm with the doctors on this one.

She was given the gift of an organ, and was non compliant with her (perscribed) drug regimen and/or affected her transplanted organ with her (illegal) drug abuse. To me that shows she is non compliant. I am all for giving folks a second chance, but I think she should have gone to the end of the queue for another organ, baring a life threatening situation(and then again, if that was brough on by drug abuse??).

You can certainly see the docs point of view - if there's say 2 organs to give away, this one candidate with a history that destroyed one transplant, and another patient also waiting for that organ that has been compliant... well who would you give it to? One of those ethical binds that doesn't really have an easy or clear cut answer.

It's so hard, though, to make a blanket call on this sort of thing. We do not know any real details of the case - did she realise the errors of her ways and have an psych evaluation etc? If she could demonstrate her remorse and understanding how important it would be to treat a transplant properly I'd be willing to give her a second go.

I find it interesting that the state govt. would PAY to send her to Singapore - does that mean she had an organ from a singaporean? that seems a bit unethical to me somehow but I can't quite put my finger on it.

I'm sorry she passed away obviously, but it sounds like some of it was her own doing. We need to take responsibility for our own actions and the reprocussions....

In response to the last bit: "donors only want to give it someone who they consider worthy of their organ" - hmm... how can you tell who is "worthy"? what criteria does one use? And if you elect to donate you won't KNOW who the organ goes to (I am presuming this is in regard to cadaveric donation rather than live donation). I understand WA is starting paired donation? is that right?

hadn't heard anything about this over east I must say. Got any media links on the story?

[Jean]

I feel the same way Richard does. What a waste of a good organ.

[KICKSTART]

We dont get that choice over here  The doctors decide who goes on the list and stupid to say , you need to be as fit as a fiddle to get on it ! I have high BP (through no fault of my own , i take my meds , dont miss sessions, watch my fluid) but was told they 'Wouldnt touch me with a barge pole !' charming! So someone with any kind of a drug habit would not even get chance to go on the list over here. The work-up nurse told me there are 9,000 people on the list over here ..so they are only going to pick the best ! Which is a shame for people like me with things that are beyond our control !

[Stoday]

Same for me, kickstart.  No matter how good my health, I'm too old 'cos I'm over 60.

The policy's quite right too. With fewer kidneys available than can meet the demand, something has to give; the line has to be drawn somewhere between the gets and the rejects. I've more or less had my life, achieved all the ambitions I had. If I got a kidney it would be at the expense of someone who, unlike me, has not yet had the opportunity to live a full life.

I consider myself lucky to live in an age where dialysis and lots of other therapies are available even if I can't afford to pay for them. Had I been born a couple of generations earlier, I would be dead now...

[Jean]

 I feel the same as Stoday does. I am 71 now, and not in the best health and very low energy. Also have high BP and have had a heart attack. Better a kidney should go to some on who has not lived their lives than to some one like me.

[MooseMom]

Deciding who is worthy is a minefield.  So what if you are over 60?  How does that devalue you?  And if you are younger, who is to say that you will live your life in a "valuable" way?  You may be 60 but what if you are taking care of a disabled adult child or an elderly parent?  What if you volunteer every free moment of your life but the young person next door has amounted to nothing more than a dismal disappointment?  If you are talking about cadaveric donation, an available organ should go to the person who is the best match...no other criteria should enter into it except for accrued waiting time.

This issue of "worthiness" was a topic that I was addressing in an earlier thread regarding websites where people needing a kidney post their profiles and hope a potential donor would come along and deem them worthy enough to donate to.  It's rather unsettling.  What if a potential donor contacted you and offered the possibility of a new kidney but then decided he didn't like your political views or your religious preference or your lifestyle or your choice of nail polish?

People are very quick to judge at the best of times, and to put yourself in a position to be judged must be excruciating.  I'm so sorry that that young girl lost her life because she destroyed her kidney.  Didn't social workers pick up on an addictive personality?  They are so strict about this particular issue here in the UJS.

[galvo]

Interesting thread, Murph! And, being an old coot, I agree with Stoday (for once).

[murf]

Richard, I am real novice with my computer so I am not sure how to provide you with a news link. Perhaps if you google search in "Google News". BTW, her donation came from her aunt. Apparently in a liver transplant, you take a small piece of a good kidney and give it to the recipient.

[murf]

Me again. I just typed in "Claire Murray" in Google News and got heaps of response. Hope that helps.

[Stoday]

These issues have been debated before, when hemodialysis machines first became available. Who should get the use of them? That was decided by a 'Life or Death Committee' until 1967 when enough machines became available.

For several years, a committee composed of a minister, housewife, lawyer, banker, state government official, labor leader and surgeon were given the unenviable task of deciding which applicants would be admitted to the kidney center. The committee, whose members remained anonymous, came to be known as the "Life or Death Committee." (It dissovled in 1967 because its function was no longer necessary. Home dialysis had taken off, freeing more beds in the center.)

On one occasion, the committee denied treatment for a 16-year-old high school honors student. Scribner and Babb couldn't live with the prospect of the student's death, but they didn't want to circumvent the authority of the committee--which was set up by the King County Medical Society. So they worked up a typically academic solution. They would develop a home unit to treat the honors student as a UW research project. Since it was experimental, it would not be subject to the committee's rule.

[Ang]

agree  with  all  the  above, but  where  does  the  w.a govt  get  off  loaning  any body  250k  of  tax  payers  money

[KICKSTART]

Stoday ..i would just like to add ..im no where near 60 !!!

[Rerun]

agree  with  all  the  above, but  where  does  the  w.a govt  get  off  loaning  any body  250k  of  tax  payers  money

Yeah, that sounds like something the U.S. would do.  Give money away for us to go to some other country to have a transplant!  Stupid!

You don't even get on the transplant list if you have a drinking problem take drugs or smoke, so why make it easier the second time?

[glitter]

haven't there been liver transplants in the us to chronic alcoholics? Recovered yes.

Pat Summerall, the veteran broadcaster comes to mind- but with google I am sure there are many others.

[wolfken]

The age thing comes into play,older people well enough to recieve and
 younger people who are not resposible enough, while the waiting games plays for others...
I am still in my forties and live on peritoneal dialysis and if I meet that one, I will be ready
 SO NO ONE PERSON HAS A SAY, WHO IS NEXT OR WHO IS NOT GOOD ENOUGH,
 CANT WE ALL JUST PLAY THE GAME......WOLFKEN

[Lillupie]

As far as I know here in the states they are very strict on who they give a transplant to. Some centers wont even give you a kidney if you smoke. I think it is fair because there are so few organs to go around, and if you cant take care of yourself before a transplant, are you really capable of keeping a organ? Or should they only give it to someone that they know it is going to last?

Lisa

[RichardMEL]

Interestingly our unit just did a transplant a few weeks ago to someone who was 68. They seem to be willing to do that sort of thing. i understand in this case the organ was not in great shape, perhaps from an older donor, but clearly they figured if it gives the 68 y.o. five years that's better than being stuck on D. I don't know the full details on that, just heard it from a nurse, but that's at least something positive for one person and their family, I think.

Re the liver thing - yes thanks Murf! I actually had a friend call me the other night and she had all the details on this case. Must have been on Today Tonight or ACA or something (which I don't watch).

I guess the liver thing is different since you only need to take a bit of it, and it regenerates, so it's not as sort of final as something like a kidney or a heart.

I still think that the girl should have gone to the end of the list - both to give more worthy people the chance ahead of her, and to really give her a kick up the backside in terms of her NEEDING to be compliant. If she just got another one it could have gone on and on. I'm sad she passed away- that's a risk we all take with such surgery.

it really is a minefield.

[Stoday]

Stoday ..i would just like to add ..im no where near 60 !!!

KS, Sweetie — of course you're not yet 60.

You can be any age you choose in cyberspace.