Questions are being raised about the case of a 36-year-old Ontario woman who died of liver failure after she was rejected for a life-saving liver transplant after a medical review highlighted her prior alcohol use.
I’ve known entirely too many alcoholics that have had too many wake-up and come-to-Jesus moments, only to go back to drinking as soon as the immediate crisis is over. Change only comes when the alcoholic wants to change for their own reasons, not due to external factors.
Livers are a limited resource. Wasting a donor’s liver on a person that usis unlikely to stop drinking–despite their protestations–means that another person doesn’t get one. It may seem like a cruel calculus, but it’s the only reasonable way to ration a scarce resource. It doesn’t matter if alcoholism is a disease, or you think that it’s a moral failing; the end result is the same.
This was my initial opinion until I read the whole article.
“I got my blood tested, I had MRI scans, I had a CT scan, I had ultrasound and blood compatibility test with her. I was a match,” said Allan.
Transplant guidelines in Ontario and much of Canada require patients with ALD to first qualify for a deceased donor liver. If they don’t meet that criteria, they aren’t considered for a living liver transplant, even if one is available.
Her partner was a willing, compatible donor, wanted to give her his liver and was prevented from doing so. So yes, this is a cruel take.
If you keep reading it gives a reason why this is a requirement. Now whether you agree with the doctors or not is up to you but there is at least a reason for this.
But doctors say that people with severe liver disease from alcohol use may need more than just a partial living liver donation to thrive.
“The sicker someone is, the more they benefit from getting an entire liver from a deceased donor, as opposed to part of the liver from a living donor,” said Dr. Saumya Jayakumar, a liver specialist in Edmonton and an Associate Professor in the Faculty of Medicine & Dentistry at the University of Alberta.
“On the off chance their (living) liver doesn’t work, they urgently get listed for a deceased donor,” said Jayakumar. "We need to make sure that everyone who is a candidate for a living donor is also a candidate for a donor graft as well, " she added.
From this, the reasoning appear to be this: there is a high risk that the living liver transplant will not take. In this case the patient may be at risk of dying instantly and thus need another liver transplant. Since the candidate doesn’t not qualify for this other transplant, in the case where the transplant does not take, the patient will die instantly. This is in contrast with the patient being terminally ill however given time to live out the remainder of their life.
I guess then the question should be is that worse than definitely dying now, and where does this cross into the patient having the right to request their own treatment?
I will always defer medical guidance to medical professionals, I know nothing in comparison to them.
If the living partial liver doesn’t take hold, it dies off and becomes necrotic, and would need another surgery to take out or it’ll become necrotic and they’ll die of sepsis. It’s also unlikely they’d survive such second surgery, due to the already existing liver failure + first surgery trauma.
In this case, you’d be asking doctors to directly kill the patient in a more painful way for a very tiny chance that it may save them, on top of if they do survive, assuming they don’t relapse into alcoholism and die anyway. All while technically injuring someone else (the live donor).
Thank you, that does sound like an awful way to die.
I try to never assume I’m smarter than others for seeing the “obvious” path. I had a coworker in another department once call me out for saying “why don’t you just” and it’s stuck with me since.
This is a bunch of CYA from the hospital that got a woman killed. The article talks about how transfer success rates are up around 80-85%. That’s just for the 6% of people who magically fit through all the “qualifications” the hospital has decided determine whether you get to live. This lady had a doner tested and lined up, but was rejected on the “off chance” (read: low probability) that IF the transplant failed, she would almost certainly die without an immediate whole liver transplant. So the fuck what? Her options were to maybe die from surgery or absolutely 100% die an agonizing slow death from liver failure. The hospital took away her ONLY chance at life. This is murder by committee and I hope the estate sues the entire hospital into the ground.
As someone else already pointed out, if the transplant from the living donor failed or had complications, now you have two people that need livers. It puts a healthy person at risk for a very low chance of a positive outcome. If they were paying out of their own pocket, then I’d say sure, go ahead, blow your own money on it, risk your own life and health. But they aren’t.
I don’t know enough to be able to answer your question.
However, even if you did find a country you could do this in, you’d have to deal with the cost and time required to travel there, consult with the local doctors, get the surgery scheduled, perform the surgery, and remain for post-op care - all of which would be likely out of their own pocket.
Canada has universal single payer health care system and I have no idea how they deal with medical procedures done outside the country. I highly doubt they would cover unless they were on private insurance that allowed it.
Not everyone has the means to do what you suggest unfortunately.
Healthcare is for profit. Doctors, nurses, surgeons, consumables, hospitalization, antibiotics, follow ups all get charged to OHIP at a profit for the healthcare provider.
If we had actual public healthcare, where hospitals and doctors are not private businesses, maybe we could spend more mony on treatment and rehabilitation for problem cases.
IIRC, there are ongoing experiments with organs are being grown in cloned animals; the animal is slaughtered, and the organ is harvested. Maybe someday they’ll be more readily available and renewable than they are now.
…At least for the wealthy that can afford to have farms of cloned animals.
It will always be insane to me that today’s rich people would rather be less wealthy as long as they are more wealthy than everyone else as opposed to being even more wealthy with everyone else if we all just worked together and had the freedom to create and be innovative.
I’ve known entirely too many alcoholics that have had too many wake-up and come-to-Jesus moments, only to go back to drinking as soon as the immediate crisis is over. Change only comes when the alcoholic wants to change for their own reasons, not due to external factors.
Livers are a limited resource. Wasting a donor’s liver on a person that
usis unlikely to stop drinking–despite their protestations–means that another person doesn’t get one. It may seem like a cruel calculus, but it’s the only reasonable way to ration a scarce resource. It doesn’t matter if alcoholism is a disease, or you think that it’s a moral failing; the end result is the same.This was my initial opinion until I read the whole article.
Her partner was a willing, compatible donor, wanted to give her his liver and was prevented from doing so. So yes, this is a cruel take.
If you keep reading it gives a reason why this is a requirement. Now whether you agree with the doctors or not is up to you but there is at least a reason for this.
From this, the reasoning appear to be this: there is a high risk that the living liver transplant will not take. In this case the patient may be at risk of dying instantly and thus need another liver transplant. Since the candidate doesn’t not qualify for this other transplant, in the case where the transplant does not take, the patient will die instantly. This is in contrast with the patient being terminally ill however given time to live out the remainder of their life.
I guess then the question should be is that worse than definitely dying now, and where does this cross into the patient having the right to request their own treatment?
I will always defer medical guidance to medical professionals, I know nothing in comparison to them.
It is worse.
If the living partial liver doesn’t take hold, it dies off and becomes necrotic, and would need another surgery to take out or it’ll become necrotic and they’ll die of sepsis. It’s also unlikely they’d survive such second surgery, due to the already existing liver failure + first surgery trauma.
In this case, you’d be asking doctors to directly kill the patient in a more painful way for a very tiny chance that it may save them, on top of if they do survive, assuming they don’t relapse into alcoholism and die anyway. All while technically injuring someone else (the live donor).
Thank you, that does sound like an awful way to die.
I try to never assume I’m smarter than others for seeing the “obvious” path. I had a coworker in another department once call me out for saying “why don’t you just” and it’s stuck with me since.
This is a bunch of CYA from the hospital that got a woman killed. The article talks about how transfer success rates are up around 80-85%. That’s just for the 6% of people who magically fit through all the “qualifications” the hospital has decided determine whether you get to live. This lady had a doner tested and lined up, but was rejected on the “off chance” (read: low probability) that IF the transplant failed, she would almost certainly die without an immediate whole liver transplant. So the fuck what? Her options were to maybe die from surgery or absolutely 100% die an agonizing slow death from liver failure. The hospital took away her ONLY chance at life. This is murder by committee and I hope the estate sues the entire hospital into the ground.
15% failure rate is not low, it’s a dice roll essentially on par with Russian roulette.
Is a 15% chance of death during the surgery lower than the 100% chance of death if she doesn’t get the surgery?
Yes. Yes it is. It is THE lowest possible chance of death she had among her remaining options.
It’s the lowest, but it’s not low. If it was 95% chance of being unsuccessful, it would still be the lowest.
As someone else already pointed out, if the transplant from the living donor failed or had complications, now you have two people that need livers. It puts a healthy person at risk for a very low chance of a positive outcome. If they were paying out of their own pocket, then I’d say sure, go ahead, blow your own money on it, risk your own life and health. But they aren’t.
Question: are there any countries where this is allowed? Would they have been able to go abroad and do this operation?
I don’t know enough to be able to answer your question.
However, even if you did find a country you could do this in, you’d have to deal with the cost and time required to travel there, consult with the local doctors, get the surgery scheduled, perform the surgery, and remain for post-op care - all of which would be likely out of their own pocket.
Canada has universal single payer health care system and I have no idea how they deal with medical procedures done outside the country. I highly doubt they would cover unless they were on private insurance that allowed it.
Not everyone has the means to do what you suggest unfortunately.
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Healthcare is for profit. Doctors, nurses, surgeons, consumables, hospitalization, antibiotics, follow ups all get charged to OHIP at a profit for the healthcare provider.
If we had actual public healthcare, where hospitals and doctors are not private businesses, maybe we could spend more mony on treatment and rehabilitation for problem cases.
i think they’d fall under renewable resource
I don’t think renewable excludes it from being limited.
It was a dumb joke and you’re right
Hey, I appreciate your candor and humility. Good on you.
IIRC, there are ongoing experiments with organs are being grown in cloned animals; the animal is slaughtered, and the organ is harvested. Maybe someday they’ll be more readily available and renewable than they are now.
…At least for the wealthy that can afford to have farms of cloned animals.
It will always be insane to me that today’s rich people would rather be less wealthy as long as they are more wealthy than everyone else as opposed to being even more wealthy with everyone else if we all just worked together and had the freedom to create and be innovative.
Same, it actually astonishes me
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