Posted on 07/14/2003 8:36:39 AM PDT by Cinnamon Girl
The failure of footballer of George Best to refrain from drinking alcohol despite a life-saving liver transplant just 12 months ago has prompted questions about the merits of offering transplant surgery to alcoholics.
Some say it is a waste of a precious and scarce resource, but others say there is no reason why people suffering from such a debilitating disease should be discriminated against.
The George Best case may give the impression that people suffering from alcoholism take their place in the transplant queue like any other person with severe liver disease.
In fact, this is not the case. Many units operate a vigorous screening policy to determine whether there is a good chance that a patient will give up dangerous drinking following surgery.
If the signs are bad, then they may very well be denied a transplant.
The Scottish Liver Transplant Unit in Edinburgh is one which takes this line.
It is headed by Mr John Forsythe, vice president of the British Transplantation Society.
He told BBC News Online: "You could say no patient with alcoholic liver disease should receive a transplant, but that would be pretty harsh on the truly reformed alcoholic who would do very well.
"Alternatively, you could say that that these patients should always be considered for a transplant, but that is plainly ridiculous.
"In cases where the likelihood of recidivism is high that would mean a vital resource given after a lot of thought by a donor family is likely to be wasted.
"That leaves us with something in between. We have a robust procedure to assess whether there is a good chance that a patient will not return to harmful drinking.
"If there is, then we will consider surgery. After all we have a duty of care to the recipient which is obvious, but we also feel we have a duty of care to the donor family."
Mr Forsythe said the chances of a patient returning to dangerous levels of drinking following surgery were low. Around 15-20% of patients do drink following surgery, but only about 2% of these do so at levels which could damage their new liver.
Long-term commitment
Dr Robert Lefever, who runs the Promis Recovery Centre for addicts in Kent, believes that patients with alcoholic liver disease should only be offered surgery if they have made a tangible commitment to staying off drink.
"People need to go to Alcoholics Anonymous and demonstrate that they understanding that they have to make a long-term commitment to tackling their problems," he said.
"Just simply saying 'I'm never going to drink again' is not good enough - anybody could say that."
Many would question whether George Best was a suitable candidate for surgery.
But his surgeon is not one of them. Professor Roger Williams said Best's weekend drinking session - which included a scuffle with a photographer, was a temporary lapse.
"Up to about a week ago he had been in extraordinarily good form," he said.
"He was at a House of Commons reception to launch a joint parliamentary group on liver disease and I had never seen him look so well, or talk so well. He was altogether a transformed person."
Sympathy required
Eric Appleby, of the charity Alcohol Concern, agreed. He stressed that Best needed sympathy - not criticism.
He said: "This isn't like swapping over a component in your car. If you get a new liver, it doesn't stop the problems you had which got you into trouble in the first place.
"I'm sure George Best was absolutely sincere in his wish to stop drinking.
"But drinking in this country is almost how you define yourself, and sitting at home with a glass of orange juice is not what a guy like him has been used to.
"How he leads his life, where his mates are, what he does is down the pub, and it's a tough call to cut that out of your life."
Mr Appleby rejected the idea that alcoholics should be made a low priority for a liver transplant.
"Whatever aspect of health you look at there is always some contributory factor.
"What we need to ensure is that those people who do get transplants actually get the help and support they need to make the most of it."
Deepak Mahtani is from the organisation Transplants in Mind, which works to increase public awareness of the benefits of organ donation.
He said everybody deserved equal treatment from the NHS - including George Best.
"When he received the liver transplant a year ago he made a resolution to stop drinking, and I do believe he was sincere in that.
"Nevertheless, drinking is part of the society in which we live, and he is only human with human frailties."
Mr Mahtani accepted that the negative publicity surrounding Best might put some people off donating their organs.
"I have heard people saying 'why should we register on the organ donor register if our organs are going to be wasted in this way'. But I don't think this is the rule, this is an exception."
Media criticism
Best also won support from Labour MP Helen Clark, a member of the all-party hepatology group, which the footballer helped to launch last week.
She criticised the media for adding to the pressure on Best by camping outside the pub in which he was seen drinking.
"George hadn't touched a drop of alcohol for three years, and nobody knows what caused this blip.
"He is not an evil, wicked person behaving in a terrible, bad way, he is ill, and he does need help."
No, just using common sense in the distribution of a scare resource.
So nice of you to be an advocate for the poor little alcoholics. However I'd like to point out the following: 1) Prolonged alcohol use (such as alcholics) is bad for the liver. 2) Livers are in short supply. 3) There are people that need livers through no fault of their own (i.e. no lifestyle issues that is causing their liver to fail).
People who ruin their livers through alchol abuse should NOT be allowed to take a precious resource away from those that didn't self destruct. What you're advocating is the liberal ideal of non-responsibility.
If you personally want to give your liver or one of your kidneys to a guy who drinks like a fish, go for it. I'm sure the thought that your 'sacrifice' is being wasted on booze will be very comforting. (As opposed to having your organs given to, for example, a mom of 2 young kids who would actually take care of the gift you've given her.)
But organs which are generally donated should never be given to someone who is still drinking.
I am basing my comments on the way I think it should be handled. I am making the more important point IMO.
Once you start talking about who should be allocating things which do not belong to them, you have conceded the point that they have the legitimate power to do so in the first place.
The truth is, the only ones who should be making the decisions are the people who own the organs.
The way it is now, donors don't choose the recipients, and people who need a transplant are put on a waiting list.
The way it is now is BS.
I like it, that's the way it should be. But it's not.
I'm sure the thought that your 'sacrifice' is being wasted on booze will be very comforting. (As opposed to having your organs given to, for example, a mom of 2 young kids who would actually take care of the gift you've given her.)
Cheap emotionalism misses the point. The point is, it's none of your business.
But organs which are generally donated should never be given to someone who is still drinking.
Good thing God has people like that to take his place.
Yes, the person who donates the organ.
True, it is none of my business if you'd prefer to see your organs liquified due to over-consumption of alcohol, whether they are in your own body or in that of another.
"Good thing God has people like that to take his place."
Either you leave things in God's hands as it were and do not donate your organs at all, or you believe that God has given us the ability to make decisions, and we should do so wisely.
It is not wise to allocate a scare resource to someone who is simply going to destroy it through purposeful actions.
Like I said, if you want to personally donate an organ to someone who is drinking like a fish, go for it. But organs generally donated shouldn't be wasted on those who are trying to kill themselves anyway.
Yeah, that sounds about right.
Bingo. I love it when people "get" it, even if they feel compelled to add irrelevant nonsense at the end of the admission.
Either you leave things in God's hands as it were and do not donate your organs at all, or you believe that God has given us the ability to make decisions, and we should do so wisely.
Yes, and the only question is WHO makes the decision. "WE" don't rightfully make these decisions, the organ donor does.
It is not wise to allocate a scare resource to someone who is simply going to destroy it through purposeful actions.
I agree, but the "scarce" resource in question belongs to an individual, not some group of people.
Like I said, if you want to personally donate an organ to someone who is drinking like a fish, go for it. But organs generally donated shouldn't be wasted on those who are trying to kill themselves anyway.
"Generally donated" organs merely give some other group of people the power of life and death. And these people aren't trying to kill themselves, if they were, they wouldn't try to live longer. Their behavior may be killing them, but they wish to continue in it, not end it by death.
The problem is when you give other people the power to do the right thing, they seldom do.
Everyone who "donates" an organ should be given the opportunity to say what happens to it. In an ideal situation, they should be compensated if they choose.
I appreciate your honesty and your views, for it makes an excellent example of "seat-of-the-pants-morality". Concerning each good point you made, in seriatim:
Point (1): So is hepatitis. Presently the US is experiencing a huge increase in immigrant population with hepatitis. Before any medical services are provided, are you willing to staff the Bureau of Deserving Need with judges that will perform an extensive valdiated background examination that confirms that hepatitis came about by no fault of their own, or that they were unaware of the damage that they were doing? How about Fatty liver caused not by alcoholism, but through obesity? Are you going to build an elaborate screening process that determines whose fat is excusable and whose wasn't? How about a motorcyclist or skateboarder or some other moderate risk-taker who injures themsevles in such a way that their liver could use replacement? Are you going to judge those activities, or are you just pulling a typical Liberal jihad against those who drink alcohol? (BTW, I don't drink as a matter of principle).
Point (2): Because market solutions are not applied to organs. The alternative to establishing a profit motive, is for the government to "donate" the organs of prisoners like they do in enlightened countries like China. Perhaps you would want the government to use their police powers to force everyone in this country to be an organ donar? The Pro-Choice crowd ought to love that prospect.
Point (3): You are not calling yourself god, and making organ transplants an entitlement to those who you seem more noble. In a country that seems to hate a system of merit, you are establishing a system of where more people are equal than others. The problem with your supposed solution in that you enact a Santa Claus Organ Donar Program where a list of Naughty and Nice is kept, is that this is a program that begs to be thoroughly corrupted both politically and through money.
What you're advocating is the liberal ideal of non-responsibility.
I am sure that if this country's founders were alive today, they would cough up their own liver in response to such brazen Statist elitism and claims to another person's health and organs. Clearly you have no faith in the free market system to solve this, and you want the Morality Police to autocratically insert themselves into every organ transplant procedure. That's not liberal or conservative, that is megalomaniacal and the epitome of self-righteous arrogance.
Right.
And smokers should be denied chemotherapy and anti-cancer medicines.
And fat-asses with diabetes (because they can't control their eating habits) should be denied insulin.
And gays should be denied treatment for AIDS.
And so on, and so on...
I think you should be posting in DU. For those who set up a special Morality Police and Department of Need Based on Political Correctness seems to be your guiding source.
Since you feel that scarce resources should be divied up based on who can provide the most heart wrenching tale of woe and personal misery, we should extend this to all other kinds of scarce resources.
Housing should be rationed according to an assesment on a person's altruism, safety, generosity, tolerance, kindness and other life long acheivements of social conduct. That means people who are like Mother Theresa should have her choice of Ocean Front property, and those who may have tortured animals in their childhood should live under bridges.
Food Caviar, Champagne, Prime Steaks and lobster should only be made available to those who care the most about the environment, are kind to children, and have been in noble careers such as teaching, nursing, or firefighting. Salesmen, businessmen, people celebrating anniversaries should be barred from such scarce resources until a panel of judges can determine if their personal lives live up to the "deserving" status.
Education Based on the MEGoody principle, only those who have struggled through a childhood within a dysfunctional family, poverty, hardship and a certain skin color should be given preference over those who have earned high grades and have proven themselves capable of maintaining high academic standards. Oops. That is already happening with blessings by the Supreme Court.
From each according to their ability, to each according to their ranking on a popularity poll.
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