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.
It’s incredibly sad to hear someone die of a preventable cause this young, but I can also somewhat relate with the people who reviewed her application.
If a living donor wouldn’t have been sufficient, they’ve now created two patients where they previously had one, and without improving the primary patient’s condition. It makes sense that a donor organ from a deceased donor would be preferable.
That said, the current requirement for the patient to meet deceased donor standards for transplantation to be eligible to use a willing living donor make no sense. Both situations should have their own unique criteria, given that a living donor situation involves different risks for both the patient and the donor than a deceased donor situation would incur.
Ultimately this whole situation boils down to a scarcity situation though. If we want to solve this, it will require more people to register themselves as a donor and a review of the eligibility criteria as soon as more donors are available.
Something interesting about the liver is that we can regrow it. So it might be possible to take a portion of a liver, put it in another person, and then both those pieces grow into a full or well-enough-functioning liver. I’m not a physician and I don’t know if such a procedure has ever been attempted.
maybe this is a joke going over my head but you just described a liver transplant. what blew my mind was learning that they don’t take the old liver out, they just squish the new one(the healthy liver sliver if you will) in and let it do it’s thing
My understanding is that’s the case with kidneys as well. If there’s enough room, they don’t bother removing the old organ because that just introduces more chances to make a mistake.
I believe that’s an established procedure. Both the donor and the recipient regrow full livers from the portion they have. You can only donate once though because of how the new liver tissue is structured. I believe the arteries in the new one aren’t in the same place.
Edit: if you read the article it actually tells you her boyfriend was willing to be a live donor.
Giving a donor liver to an alcoholic, who only quit drinking upon diagnosis? Hell no. There are people with 5+ years who still worry about relapsing. A year is a start. Being forced to quit? I’d have wished her good luck if they gave the liver, but the person who dies instead of her?
I’ve watched alcoholics die of liver failure. It is a horribly sad thing. But sobriety is a choice, and you don’t get to go back in time to make it. I’m not sure why this article is spinning this as cruelty from the transplant board instead of maybe, just maybe, highlighting the destructive role that alcohol plays in society. I wonder if a booze company pays their bills or something.
Did you bother to read the article? Her partner was a match, and could have donated a portion of their liver to her, if approved, as opposed to a donated liver.
Judge someone all you want for their previous life choices, but the decision referenced in this case should have been between the two of them and their doctor.
Yes, I read the article three times over, trying to chase down false info someone posted in here. His offer is irrelevant. The prognosis was not good enough for him to donate. They only included it in the article for the melodrama. It’s nothing more than an “I would die for her!” moment. Well, I’m glad the medical board did not condone assisting him with suicide.
Please quote the article where it states her prognosis was not good enough for him to donate. All I’m seeing is a statement that her prior alcohol consumption was a factor in that decision.
Second paragraph in: 'However, documents show the Alcohol Liver Disease (ALD) team at UHN rejected her in part because of “minimal abstinence outside of hospital.” ’
The article quotes Dr. Jayakumar making a general statement regarding alcohol diseased livers, but the University Health Network declined to comment on Amanda’s specific case outside offering their (patronizing) condolences.
Feel free to quote the article and back up your statement.
I’m sorry, maybe I’m just daft this week, but I missed the concept “the doctors believed her liver is so far gone, a partial would lot [sic] work” in that.
I quote: “Huska, he said, stopped drinking as soon as she was diagnosed with Alcohol Liver Disease on March 3 and had also registered for an alcohol cessation program to begin once she was discharged.” So where does the article state she kept drinking while waiting for the transplant?
I’m sorry, maybe I’m just daft this week, but I missed the concept “the doctors believed her liver is so far gone, a partial would lot [sic] work” in that.
This was posted like 5 times and I assumed it was the same article… I’ll find the link to the original one where they detailed this. In any case, she was not eligible because she was likely to go back to drinking and ruin the new liver…
So where does the article state she kept drinking while waiting for the transplant?
I never said that… what the article says is that she was an alcoholic since late teens and was never able to stop. She literally only stopped drinking after she found out she was going to die, and that was only like 3 months. She tried to quit before but never succeeded… that tells you she was a super high risk of relapsing
I completely disagree. People should be able to make mistakes. Stopping upon diagnosis is the best she could have done. If she continued drinking after getting a new liver, that would be a different story.
I hate this “get shunned out of society because you aren’t perfect” culture.
I completely disagree. People should be able to make mistakes.
You are allowed to make mistakes… What you are not allowed to do is skip the consequences
It’s not like you can pick a liver at Walmart and give it a try. That liver could save someone else, giving it to an alcoholic is likely to only buy her a tad more time untill she relapsed
That would be nice if we had an unlimited supply of livers to transplant. Give everyone a chance.
Unfortunately I’d still rather give whatever liver we have on hand to someone guaranteed not to wreck it immediately, because giving her a chance means taking away someone else’s.
No, not in this case, they weren’t taking away someone else’s chance. But you didn’t read the article. Her boyfriend was a match and wanted to donate part of his liver. Donar A wanted to give to recipient B, there was no recipient C losing out. It was a closed loop.
“No amount of determination from the (partner) could bend the decision,” said the physician. “There was no process for a second review or appeal. Just a harsh finality … goodbye.”
She many have not even been the drunkard you all are assuming she was. If you go out once a month, and have 3 or 4 beers, you’re not eligible for a liver transplant. That’s ridiculous. You may not drink the other 30 days of the month, but that one Saturday ruined it for you; you die.
A life was forfeit, because some bean counters in white coats -probably not teetotalers themselves- deemed her not worthy. Even though it cost more to let her die,
Using the most recent data from the Canadian Institute for Health Information on hospital bed costs (2016), Huska’s time at the Oakville hospital likely cost over $450,000 - ($3,592 per day for ICU care) with an additional 61 days in a ward bed which likely cost about $1,200 a day
A liver transplant in Ontario is pegged at about $71,000 to $100,000 in Ontario based on data from 2019.
Her partner is the one saying she had an alcohol substance use issue. It’s not “assumed” she was a drunkard, he stated it. I agree she should have been given the liver- she quit alcohol, she had a donor. We shouldn’t punish people with alcohol use issues by killing them.
The liver wasn’t thrown away, it was given to someone else. The liver still saved a life, unfortunately it wasn’t hers.
Unless you’re talking about the boyfriend’s liver, in which case the doctor determined her condition would not survive a partial transplant, and the attempt would just kill her sooner.
Cutting out someone’s liver to transplant isn’t easy nor risk free. You are risking death to have a low probability of saving someone. It doesn’t matter if they are volunteers.
Isn’t it about her chance to get one though? “There was no process for a second review or appeal.”
You have a window were you can’t drink any alcohol for biological safety reasons, but in this case the mere rule of not drinking alcohol was enforced. This makes it a punishment instead of some biological requirement.
Some time ago I had to go under general anesthesia to have some teeth pulled. Local anesthesia didn’t work. I wasn’t allowed to eat for 24 hours. But I was so hungry that I ate just enough to not have stomach pain anymore. In the hospital I said I ate a tiny bit, and they said that it wouldn’t be much of a problem if I only ate a bit. Compared to the OP story, I wasn’t punished because I was still within the safe window.
Why should somebody get punished by a hospital? They should be neutral. “Oh you drank alcohol? You’ll have to come back later because of safety reason”. They shouldn’t be the judge. Giving them that power is just stupid.
I assume you were not getting a transplant? The risks of regurgitation during surgery is in no way comparable to the risk of relapse in someone with hx alcohol use disorder in early remission. Addiction is a terrible beast. I am sad that she died too, but we have to blame the systems of addiction, not the medical board.
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.
It was perfectly possible with her partners liver. This is just “no you didn’t do what we want so we just let you die”, and you’re here trying to justify that.
That is because her boyfriend could only give her a partial transplant (he cannot donate his whole liver) and the doctors did not think it would work as her liver was too far gone to recover with a partial transplant
The rest of your comment is so far from reality or logic, I’m not going to bother addressing it
Medical notes suggest she started drinking in her late teens and had tried – unsuccessfully – to quit. After periods of sobriety, she returned to alcohol, which could increase the risk of continued use after the transplant.
Allen says Huska registered for an addiction program early on in her hospital stay to stop drinking after she’s discharged. Hospital records also say she suffers from anxiety.
From the first article CTV made about this, linked in in the first sentence they posted. Seems like we need to actually fund mental health care in this country or something, because she’s obviously been struggling for a while. You can see how the board would weigh previous failed attempts to quit against her.
You did not read the article. Her partner was a match and willing. The hospital blocked it because she didn’t pass the test for a liver from the donor list.
Lol I quoted something from not just this article, but a second article they link to from the one above, but sure.
They blocked her, at least in part, because she was an active alcoholic who had not shown any signs of changing her behaviour outside of time inside the hospital. Something that would have weighed on their decision included medical information such as previous attempts to stop drinking. Mental health care, including healthcare for addictions, is lacking in Canada. You can’t force someone to go into rehab, but offering better care and options might have helped her in the past.
As said in the main article as well as the one I read, in order to qualify for a living donation you need to qualify for a full donation, because if something goes wrong you’ll need a full liver ASAP and get bumped to the top of the list.
Are you trying to argue that alcoholism shouldn’t be a factor AT ALL for liver donations, or that living donations shouldn’t also need to meet the standard full liver donation standards?
There are more people who need transplants than there are organs, so the medical profession has to make decisions about who to deny. This was a reasonable decision, in my opinion.
In Canada, drinking more than 3 drinks per week is medically considered “high alcohol use” for a woman… (6 for a man). This limit keeps getting lower year after year
If this can prevent you from getting organ transplants, then it encourages lying to your medical doctor about your current habits… That lady was not considered alcoholic, she just used alcohol in greater amount than the limit considered acceptable by doctors.
Latest stats show that almost 4 out of 5 people has exceeds that limit at some point in their life. This woman died only because she was honest with her doctor about her alcohol use.
(Note that the article says her partner was a compatible donor but the system refused to accept him because she used alcohol. It’s not about lacking donors.)
The only genuine hint to the real reason of the refusal was “minimal abstinence outside of hospital”.
Let me ask you bud, if you needed a liver transplant to continue living, would you have even one drink per week, or would you just quit completely?
Very biased article.
Plus, regardless of her husband being compatible, it still costs the state tens of thousands for the operation. In no way would it be ethical to put a new liver in someone who refuses to completely abstain from alcohol.
That’s absurd. Refusing someone a transplant because they used to drink more than 3 drinks a week before they knew they even had liver problems is completely absurd. Calling her an alcoholic for that is even more absurd. What in the world are these people or you thinking?
The point the person you replied to made is that she didn’t completely stop drinking alcohol once she was diagnosed to have a terminal liver disease due to alcohol use.
So first of all, she must have drank a lot more than 3 drinks a week to have terminal liver disease in her 30s that’s due to alcohol (yes, all of that is in the article)
But the issue is she didn’t stop drinking after being diagnosed, she reduced her consumption but didn’t stop it.
If any of the above is incorrect, feel free to correct us, but making a point that’s completely missing the facts that are being talked about here doesn’t add anything to the discussion.
Just do what I do and put it in that deep cupboard above the fridge. Then forget about it for literal years by mistake. It’s doing wonders for my health. Just wish I could do a version of that for my bad sleep schedule.
Just remember if a doctor ever asks then lie and say only on friday, there’s a few things in life you absolutely have to lie about because the system is not designed to care about people.
Here in the uk never admit to smoking weed to a medical professional, never admit to even so much as thinking about any form of self harm, delusions, emotional regulation issues… it can come back decades later and fuck you over.
I mean I get where you’re coming from, and I cannot speak to what it is like in the UK (I can only speak as a man in the US), but you should not lie to your doctor.
If you see a doctor, and they start treating you differently after finding out that you smoke weed, then you find another doctor.
Unless you’re in Canada and there’s a doctor shortage and you can’t just shop around for a different family doctor if you don’t like your current one. If you’re lucky enough to even have a doctor here…
Wait what happens if you admit to smoking weed? I thought we had doctor patient confidentiality. I’ve had some mental issues in the past, though not to the point of self harm. What happens if I admit these? I also live in the UK and this is concerning.
I’m guessing you can stop at any time if you want to? I’ve known older healthcare professionals that have approved and even encouraged one drink a night, but our understanding of the effects of drinking has evolved. I doubt doctors keeping up with the science would encourage it at this point. It would be like having someone come in that’s overweight. It doesn’t mean you’re unhealthy now, but it may be a factor that needs to be kept in check and working on it could prevent issues in the future.
Yes I can and have stopped. I drink 2-5 times a week and it’s one 40 proof 1oz (not a shot 1.5oz) over rocks with a bit of soda. Same or less than a beer.
This isn’t two shots neat daily or a six pack of beer. Sometimes I go a week without. Other times it’s 5 times a week.
This woman died only because she was honest with her doctor about her alcohol use
No, and it even says so in the article
She quit about 5 months before her death when transplants require 6-12 months of sobriety. She was drinking regularly with the fucked up liver before that diagnosis, and liver damage isn’t something that just suddenly appears.
She kept drinking despite what would have been intense cramping pain and a slow death, thats why she was denied (addiction) and ultimately died
Note that the article says her partner was a compatible donor but the system refused to accept him because she used alcohol
And as the article also says it’s incredibly dangerous for someone to get a live-donor transplant when they’re in bad shape like she was, as failure of that means they’ll need to let her die on-table or transplant a good dead one into her (which she was denied for, due to her drinking)
It’s sad, but this woman died to alcohol abuse, pure and simple
That’s a lot of vague statements you’ve repeated from the article. What’s drinking “regularly” (this was before the diagnosis as you’ve stated)? “She kept drinking”, what does that mean? How much alcohol was she consuming? Did she have a sip of her friends wine and was honest about it so was rejected?
as the article also says it’s incredibly dangerous for someone to get a live-donor transplant when they’re in bad shape like she was, as failure of that means they’ll need to let her die on-table or transplant a good dead one into her
Where does it say that? You’ve completely twisted the statements.
“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.
Huska’s time at the Oakville hospital likely cost over $450,000 - ($3,592 per day for ICU care) with an additional 61 days in a ward bed which likely cost about $1,200 a day, A liver transplant in Ontario is pegged at about $71,000 to $100,000 in Ontario based on data from 2019.
In 2021, 15.6 per cent of Canadians over 12 engaged in heavy drinking – a term defined as five or more drinks for males, or over four for females, on one occasion at least once per month in the past year.
Heavy drinking is drinking ONCE per month in the past year. If this is based off of before her diagnosis, you’re gonna exclude like 80% of the working population who actually does go out for drinks or private occasions (unless they just lie which I guess they should’ve in this situation). Between the price of keeping them alive but not fixing the problem and there being no “review” process for decisions, I would categorize this as a bad system that allowed a preventable death from an alcohol related disease to continue.
I’d be inclined to agree, except that her partner wanted to donate HIS liver and was prohibited from doing so as a living donation due to the alcohol use determination.
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.
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.
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.
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.
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.
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.
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.
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.
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.
If you are going to make alcohol consumption a bar to a liver transplant without making alcohol illegal you should all go fuck yourselves. You had a drink and you should die should not be a thing.
This isn’t what happened though. She was addicted to alcohol, per her partner, got diagnosed with needing a new liver, she immediately quit alcohol, and they denied her anyway even though quite a bit of time had passed while she was sober. I am unaware if her liver disease was because of the previous regular alcohol use. It wasn’t just 1 drink though.
Yes, organ donation is messed up. I met a girl dying in hospice once. She needed a new kidney. Genetic stuff, and then when she was 15 she tried to kill herself with Tylenol. She got her first transplant before the suicide attempt. She was denied a second one due to the suicide attempt itself. There are only so many organs in the world. She died in agony in hospice, young and covered in calcium deposits.
We punish substance use and mental health so harshly in this country. No one deserves the death penalty for previous substance use, especially for alcohol which is ancient af. It’s horrible she was denied when there was a liver already available.
It’s horrible she was denied when there was a liver already available.
Any full cadaver liver that could have gone to this woman didn’t get thrown into the garbage — it went to someone else who would have died without it.
As for the living donor liver her boyfriend offered, even though he was a match her level of liver failure likely meant that the partial liver her boyfriend could have donated wouldn’t have been successful. Living donors still need a liver for themselves, and we each only have one full liver — so the best they could have done is given her half a liver. Her condition was too poor for this to have a likely positive outcome, which was why this was also denied.
It sucks, but there aren’t enough donor livers for everyone who needs one. The cadaver liver she was denied however would have gone on to save the life of someone else you’re not hearing about in the press — someone else who may have died without it.
If the unfairness of it all upsets you that much, then make sure you’ve signed your organ donor card, and make sure your family members know and understand your desire to be an organ donor. And encourage the people you know to do the same. This is only a problem because there aren’t enough donor livers for everyone — when you have n livers, at best you can save n lives — and thus having a larger number of donor livers allows for more lives to be saved, with fewer qualifications.
From my limited knowledge organ donation criteria are horribly restrictive on a personal scale but unfortunately make sense on the macro scale. Organs are such a scarce resource that as I understand there’s no other option.
This girl’s death was undoubtedly a tragedy, but as fucked up it’s to say if she lived someone else would probably die in a similar agony. Was she treated fairly - I don’t know, can we make this system better - I unfortunately also don’t know.
One easy way would be to make organ donation opt out instead of opt in. As in, if you do nothing, you’re an organ donor if you end up brain-dead, and if you don’t want to, you have to explicitly opt out. Alternatively, we could just say any brain-dead person may have their organs harvested, regardless of what they declared while still alive. After all, you don’t need the organs anymore once you’re brain-dead. (I’m specifying brain-dead, because if you’re completely dead, then the organs are also useless)
That would help to some extent with scarcity in opt-in countries. But there are already opt-out countries which still face the same dilemma. Because if you’re even one organ short how do you fairly decide who’s gonna die… Can you even fairly decide about someone’s life and death…
We punish substance use and mental health so harshly in this country
It’s not punishment, any chronic illness will make someone ineligible for an organ transplant. It’s not saying it’s that person’s fault, it’s a situation of “2 people need this organ, which ever you choose the other will die in agony, one is more likely to live twice as long as the other.”
My cousin was a raging alcoholic. He got clean, but not before he fucked his liver right up. I don’t know if they even allowed him on the liver transplant list or not, but if he was, he was very low on it. He died in early 2015 at the age of 43.
How has Polievre not tried to capitalize on this tragedy to pitch his “your bank is a better death panel than the transplant math” plan yet? American healthcare is half his platform!
As a former American, you do not want the American Health Care System unless you are very wealthy. It is an expensive bureaucratic disaster. BC Health may be imperfect but at least I am not paying us$700/month for family insurance that might be accepted by the doctor/hospital that sees me in an emergency.
Selkirk said she and Allan are both discussing a legal challenge to the liver transplant guidelines for those with alcohol use disorder “with people who have their own living donor.”
“It’s not fair and it’s not right, and hopefully we’ll change that policy,” Selkirk said.
Even if her partner could donate his own liver, it should still go to a better recipient. If anything he should be donating anyways to honor her and save a life
You (or the committee of doctors) don’t decide who is a better recipient for my goddamn organs. You can make whatever the fuck ethical decision you want when I’m dead, but not until then. And I’ve gotta say, it’s shit like this - treating patients & donors like you know better - that make me not want to be a donor anymore. If I wanna donate my lungs to Hitler because he’s my grandpa and I love him, that’s not something you get to have a decision on.
It’s a bit more complicated than that with transplants. Should people for example be able to sell their kidney to the highest bidder? That’s also “my body, my choice”. And should doctors be forced to participate in such a scheme?
A transplant system should consider fairness, equality and possible abuse. Obviously I think it should be possible to donate to a loved one, but we should also be careful not to create a system where the rich get priority, because they can pay more, and where poor people could be financially pressured to give up their bodily integrity by having to sell an organ.
Maybe he should, but maybe he is thinking “Fuck them, we tried to participate in the system. We had a living donor to go. What? Oh you have a ‘better’ recipient? Well, guess who doesn’t want to donate to a system that failed my loved one.”
The system didn’t fail, it worked as intended. If but mid 30s you’ve destroyed your liver with your alcohol addiction, it’s almost guaranteed you’ll slide back.
Recipients can’t drink ever, and have to take meds for life. She was not a good candidate for a transplant.
I agree. I understand the rules and it makes sense to me. The people going through it don’t care. The husband going through this loss doesn’t care about other people needing his living donor liver, or there being better recipients. He would view it (I imagine) as “why should I donate when they didn’t help my wife?”
Right? Like I would donate my liver to my kid, or my spouse, without even questioning it.
But if the doctor told me they can’t have it (for some reason other than incompatibility), and they died? Fuck them. I’d de-register as an organ donor out of spite.
Donating an organ is a pretty invasive operation that can have a lot of complications, doctors aren’t only taking the recipient health, but the donor too, in the equation.
Doctor here who has referred patients for transplant. No. You must be six months sober to be eligible for the transplant list. There’s so few livers to go around, they need to be sure the recipient isn’t going to just break the next one.
It’s rare to suddenly need a liver; they usually take months to fail and this gives the patient and doctor months of notice to try treating the failure first (including lifestyle changes and meds) before getting sick enough to go apply for a transplant.
I used to trust HCPs, but I know many of them now and have heard them shit-talk and judge their patients for mental health issues and drug use (among other things). I would NEVER, EVER tell a doctor or nurse about any form of drug or alcohol use now, or any kind of anger issues that could possibly be interpreted as aggressive. Especially not in a hospital where everything gets recorded in an electronic chart and may be used against you in the future. Fuck that.
I’m sorry you have such a low opinion, maybe you heard someone venting about their job after work?
You really think lying about your drug use is safe? It’s dangerous to give many types of anesthesia if you’re on drugs or alcohol. We don’t particularly care if you use or not, we don’t tell police or family, you just need to be honest so we can do our job correctly.
If I was going under anesthesia for a planned procedure, I would not drink or use drugs beforehand. If it was an unplanned emergency, I guess it would depend on the circumstances, but you are citing an extreme circumstance. If someone is actively high at the time they end up in the emergency department, well, that’s bad luck and it might be wise to disclose since the staff will figure it out pretty darn quick anyway. Same if you are a severe alcoholic or opiate addict. That’s not what I’m talking about, though. I’m talking about when doctors or nurses ask you about it as a lifestyle question.
You know as well as I do that the health care system classifies people in terms of their risk factors and then use that profile to make decisions about you. Once classified as a “drug user” in your chart, many doctors and nurses will treat you differently. They may or may not “care” from a moral perspective, and we know that they won’t tell family or police, but that won’t necessarily stop them from denying you necessary pain relief or deprioritizing you in triage. That’s the actual concern.
There is absolutely no reason to tell a doctor if you use cannabis or engage in moderate alcohol use or occasionally use cocaine, LSD, or psylocibin. If you are prescribed a medication that has an interaction with a recreational drug, the doctor can simply tell you that. They don’t need to know if you use that drug from time to time. Only you, the patient, need to know that so you can avoid the interaction. More extreme forms of drug use are a different story, of course.
Edit: Let me add one other overarching point. I think people are sick and tired of having doctors make decisions for them. I don’t need a nanny. I need information about risks and benefits in order to make an informed choice. Doctors rarely do that. Instead, they decide what should be prescribed, or not prescribed, regardless of the patient’s wishes. I know the reason is fear of liability, but here we are nonetheless.
Ah, you think you know better than doctors. Many people think this. Many have bad outcomes with nobody to blame but themselves.
I don’t care if you use cannabis, heck I can legally prescribe you some if you need it. Doctors are not law enforcement. I don’t bat an eye if you tell em you use cocaine, I’ll still give you morphine after surgery but I need to know you used cocaine so I can avoid beta blockers. You’re paranoid we’re judging you but you’re wrong. You’re not as rare as you think. We know you’re in pain regardless of your drug use and treat you anyway.
Only you, the patient, need to know that so you can avoid the interaction
Many idiots who died in hospital thought that too, which is why we make you sign consent forms so that your family can no longer sue us for your stupid mistake.
It’s like you have no idea how doctors work and have an outdated idea of them. Your loss.
You misunderstand me. I don’t think I know better than doctors. Far from it. What I want from a doctor is information and informed choice, not a gatekeeper who makes decisions for me. As a group, physicians have been slow to adopt the patient-centered informed choice mentality that, for example, nurse practitioners and midwives have more thoroughly adopted.
The fact that you’ve doubled down here on calling patients idiots for being somewhat distrustful of the typical arrogant physician attitude confirms what I’m saying.
Notice that they never state she was an alcoholic. They also never atate she was a “high level” alcohol user. Just that she was an alcohol user.
You can make your own assumptions about her alcohol use, but in general these rules would also excluse a “normal” alcohol user with a congenital liver failure…
She literally quit when she was told she had a failing liver that could not recover. Just to be clear, there is absolutely no way in hell that she didn’t know she was on the way to killing her liver with her drinking because there are a plethora of signs long before you get to the point where alcohol has destroyed your liver beyond its own ability to repair itself. (Which is incredibly prodigious. The liver is the single most regenerative organ in the human body)
So forgive me if I’m skeptical that she really would have stopped being an alcoholic after she received a liver transplant.
IMO this was a tragedy of her own making and the money and effort in transplanting a liver would have been a complete waste. (Even one offered by her SO.) Especially when there is such a deficit of available organs and the surgeons who do the transplanting are needed for patients who aren’t likely to go back on the sauce 6 months later.
the pain of a cramping liver is excrutiating. if you deal with that kind of unrelenting never stopping pain und don’t stop drinking, you are addicted for sure.
And for good reason, really. The supply of livers is too small to save everyone who needs them, so they give them to the people most likely to have a successful outcome. Basically every lived given to one person is sentencing another person to death. That’s just reality with supply being what it is.
I donated a kidney to a friend earlier this year. The reason his kidneys failed wasn’t anything he was at fault for, but even if it had been because of poor decisions he’d made in the past, I still would have given him one of mine. Because people deserve second chances. I can understand not wanting to give a recovering alcoholic a deceased donor’s liver, when someone else could receive that liver, instead. But this woman’s partner was a match and was willing to donate to her. What’s the harm in that? That isn’t a liver that could have gone to someone else who needed it. It’s a donation that would have either gone to her or no one else. No one could have lost out of the donation had been carried out. This was just cruelty, and now someone is dead. And for what? Because there’s a 15% chance (according to studies the article mentioned) that she might have started drinking again???
It’s not super clear, but the article makes it sound like if a partial graft from a live donor fails, then the recipient is automatically fast tracked for a new transplant from a deceased donor.
If that’s the case then maybe policy should be changed in the case of alcohol abuse.
The policy isn’t there just to be extra nice, it’s because otherwise the patient dies without a liver.
Since she was too sick for a partial liver transplant, and not eligible for a dead donor full liver transplant, she would have just died.
It might seem cruel but the same is done for a lot of other procedures; if the chance of you dying in surgery is way too high, doctors won’t take the risk, they’re not executioners.
It’s not a moral judgement about her alcoholism, the same would have been true if she had a cancer no surgeon would take on.
I totally understand the mortality aspect, I was just thinking if a patient is 100% going to die from liver failure without a transplant, any chance to live from a live donor seems worth it. Of course I don’t know any statistics so I have nothing to base it on.
Maybe euthanasia should be a legal option instead of a slow agonizing death that puts next of kin into medical debt.
The comparison is apples and oranges. They only include the cost of the surgery itself, not the cost of after-surgical care, the potential cost of complications to both the patient and the donor, etc. Then there’s the cost if the partial liver donation doesn’t take, or if the patient relapses.
Obviously, there’s also a lot of potential upside to having the patient survive, I just don’t think the odds of that were all that high.
Can’t just implant a 90 year old liver. And a lot of them are unsalvageable. Doesn’t mean it shouldn’t be mandatory, just that it will still be a limited resource.
In my country, people are automatically registered as a donor. If you don’t want to donate, you have to choose to opt out.
Ever since that law was passed, I see organ transport ambulances around my city’s hospital from time to time. Transporting a matching organ to a waiting patient. The bold letters spelling “organ transport” on a red band is a weird but good thing to see.
I dont know. Probably because it risks being abused. The US already has private prisons filled to the brim with trivial felons forced to work in sweat shops… im sure theyll love to sell their organs too after dying from heat stroke.
I see, that’s a valid concern. I wonder whether we could try to prevent such abuse by automatically excluding more prone groups like prisoners. It really seems crazy to me how many organs, which could literally save someone’s life, are going to waste.
I think opt out would be sufficient. Right now, its a compilcated to opt in and not many people thinks about it. In my state, the only time you see it, is a small checkbox when you get a drivers license.
But being opt out everyone is included unless they choose not to, for whatever reason. Which is think is more than fair. Its their body, they should have the right to do whatever they wish, regardless if they arent using it anymore. The amount of people opting out would be a minority, so it shouldn’t really be a concern.
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I thought this was about kidneys instead of livers and was very confused.
It’s incredibly sad to hear someone die of a preventable cause this young, but I can also somewhat relate with the people who reviewed her application.
If a living donor wouldn’t have been sufficient, they’ve now created two patients where they previously had one, and without improving the primary patient’s condition. It makes sense that a donor organ from a deceased donor would be preferable.
That said, the current requirement for the patient to meet deceased donor standards for transplantation to be eligible to use a willing living donor make no sense. Both situations should have their own unique criteria, given that a living donor situation involves different risks for both the patient and the donor than a deceased donor situation would incur.
Ultimately this whole situation boils down to a scarcity situation though. If we want to solve this, it will require more people to register themselves as a donor and a review of the eligibility criteria as soon as more donors are available.
And how prevalent and socially acceptable Alcoholism has become.
It’s not just acceptable, it’s encouraged by the province to keep people from rage quitting their lives here.
Somehow I read the article thinkingshe had a kidney problem which we have two of.
How can her boyfriend even donate his liver? Wouldn’t he die?
Something interesting about the liver is that we can regrow it. So it might be possible to take a portion of a liver, put it in another person, and then both those pieces grow into a full or well-enough-functioning liver. I’m not a physician and I don’t know if such a procedure has ever been attempted.
maybe this is a joke going over my head but you just described a liver transplant. what blew my mind was learning that they don’t take the old liver out, they just squish the new one(the healthy liver sliver if you will) in and let it do it’s thing
Seems like we knew about stem cells before we even knew what they were…
My understanding is that’s the case with kidneys as well. If there’s enough room, they don’t bother removing the old organ because that just introduces more chances to make a mistake.
I believe that’s an established procedure. Both the donor and the recipient regrow full livers from the portion they have. You can only donate once though because of how the new liver tissue is structured. I believe the arteries in the new one aren’t in the same place.
Edit: if you read the article it actually tells you her boyfriend was willing to be a live donor.
Giving a donor liver to an alcoholic, who only quit drinking upon diagnosis? Hell no. There are people with 5+ years who still worry about relapsing. A year is a start. Being forced to quit? I’d have wished her good luck if they gave the liver, but the person who dies instead of her?
I’ve watched alcoholics die of liver failure. It is a horribly sad thing. But sobriety is a choice, and you don’t get to go back in time to make it. I’m not sure why this article is spinning this as cruelty from the transplant board instead of maybe, just maybe, highlighting the destructive role that alcohol plays in society. I wonder if a booze company pays their bills or something.
Did you bother to read the article? Her partner was a match, and could have donated a portion of their liver to her, if approved, as opposed to a donated liver.
Judge someone all you want for their previous life choices, but the decision referenced in this case should have been between the two of them and their doctor.
Yes, I read the article three times over, trying to chase down false info someone posted in here. His offer is irrelevant. The prognosis was not good enough for him to donate. They only included it in the article for the melodrama. It’s nothing more than an “I would die for her!” moment. Well, I’m glad the medical board did not condone assisting him with suicide.
Please quote the article where it states her prognosis was not good enough for him to donate. All I’m seeing is a statement that her prior alcohol consumption was a factor in that decision.
Did you? Her liver was so far gone, doctors did lot believe a partial transplant would work
Second paragraph in: 'However, documents show the Alcohol Liver Disease (ALD) team at UHN rejected her in part because of “minimal abstinence outside of hospital.” ’
The article quotes Dr. Jayakumar making a general statement regarding alcohol diseased livers, but the University Health Network declined to comment on Amanda’s specific case outside offering their (patronizing) condolences.
Feel free to quote the article and back up your statement.
This means she kept on drinking while not hospitalized
The rest is standard boilerplate, they can’t speak about her detailed case in public
I’m sorry, maybe I’m just daft this week, but I missed the concept “the doctors believed her liver is so far gone, a partial would lot [sic] work” in that.
I quote: “Huska, he said, stopped drinking as soon as she was diagnosed with Alcohol Liver Disease on March 3 and had also registered for an alcohol cessation program to begin once she was discharged.” So where does the article state she kept drinking while waiting for the transplant?
This was posted like 5 times and I assumed it was the same article… I’ll find the link to the original one where they detailed this. In any case, she was not eligible because she was likely to go back to drinking and ruin the new liver…
I never said that… what the article says is that she was an alcoholic since late teens and was never able to stop. She literally only stopped drinking after she found out she was going to die, and that was only like 3 months. She tried to quit before but never succeeded… that tells you she was a super high risk of relapsing
“This means she kept drinking while out of the hospital”, which directly contradicts the statement by the boyfriend saying she stopped drinking.
Everything else is like, your opinion, man.
I completely disagree. People should be able to make mistakes. Stopping upon diagnosis is the best she could have done. If she continued drinking after getting a new liver, that would be a different story.
I hate this “get shunned out of society because you aren’t perfect” culture.
You are allowed to make mistakes… What you are not allowed to do is skip the consequences
It’s not like you can pick a liver at Walmart and give it a try. That liver could save someone else, giving it to an alcoholic is likely to only buy her a tad more time untill she relapsed
That would be nice if we had an unlimited supply of livers to transplant. Give everyone a chance.
Unfortunately I’d still rather give whatever liver we have on hand to someone guaranteed not to wreck it immediately, because giving her a chance means taking away someone else’s.
No, not in this case, they weren’t taking away someone else’s chance. But you didn’t read the article. Her boyfriend was a match and wanted to donate part of his liver. Donar A wanted to give to recipient B, there was no recipient C losing out. It was a closed loop.
She many have not even been the drunkard you all are assuming she was. If you go out once a month, and have 3 or 4 beers, you’re not eligible for a liver transplant. That’s ridiculous. You may not drink the other 30 days of the month, but that one Saturday ruined it for you; you die.
A life was forfeit, because some bean counters in white coats -probably not teetotalers themselves- deemed her not worthy. Even though it cost more to let her die,
A liver transplant in Ontario is pegged at about $71,000 to $100,000 in Ontario based on data from 2019.
Her partner is the one saying she had an alcohol substance use issue. It’s not “assumed” she was a drunkard, he stated it. I agree she should have been given the liver- she quit alcohol, she had a donor. We shouldn’t punish people with alcohol use issues by killing them.
The liver wasn’t thrown away, it was given to someone else. The liver still saved a life, unfortunately it wasn’t hers.
Unless you’re talking about the boyfriend’s liver, in which case the doctor determined her condition would not survive a partial transplant, and the attempt would just kill her sooner.
I was talking about the general disturbing nature of determining organ transplants, yes I know re: the live donation from her bf
So again: The liver wasn’t thrown away, it was given to someone else. The liver still saved a life, unfortunately it wasn’t hers.
Imagine being the person denied a liver because they gave it to someone with a chronic alcohol abuse problem to “give them another chance”.
Cutting out someone’s liver to transplant isn’t easy nor risk free. You are risking death to have a low probability of saving someone. It doesn’t matter if they are volunteers.
Isn’t it about her chance to get one though? “There was no process for a second review or appeal.”
You have a window were you can’t drink any alcohol for biological safety reasons, but in this case the mere rule of not drinking alcohol was enforced. This makes it a punishment instead of some biological requirement.
Some time ago I had to go under general anesthesia to have some teeth pulled. Local anesthesia didn’t work. I wasn’t allowed to eat for 24 hours. But I was so hungry that I ate just enough to not have stomach pain anymore. In the hospital I said I ate a tiny bit, and they said that it wouldn’t be much of a problem if I only ate a bit. Compared to the OP story, I wasn’t punished because I was still within the safe window.
Why should somebody get punished by a hospital? They should be neutral. “Oh you drank alcohol? You’ll have to come back later because of safety reason”. They shouldn’t be the judge. Giving them that power is just stupid.
Doctors are cops. Acab.
Adab
I assume you were not getting a transplant? The risks of regurgitation during surgery is in no way comparable to the risk of relapse in someone with hx alcohol use disorder in early remission. Addiction is a terrible beast. I am sad that she died too, but we have to blame the systems of addiction, not the medical board.
Nope. This seems like a stupid rule.
It was perfectly possible with her partners liver. This is just “no you didn’t do what we want so we just let you die”, and you’re here trying to justify that.
Oh, way to move the goal posts!
Basically - fuck this person, right?
That is because her boyfriend could only give her a partial transplant (he cannot donate his whole liver) and the doctors did not think it would work as her liver was too far gone to recover with a partial transplant
The rest of your comment is so far from reality or logic, I’m not going to bother addressing it
From the first article CTV made about this, linked in in the first sentence they posted. Seems like we need to actually fund mental health care in this country or something, because she’s obviously been struggling for a while. You can see how the board would weigh previous failed attempts to quit against her.
You did not read the article. Her partner was a match and willing. The hospital blocked it because she didn’t pass the test for a liver from the donor list.
Lol I quoted something from not just this article, but a second article they link to from the one above, but sure.
They blocked her, at least in part, because she was an active alcoholic who had not shown any signs of changing her behaviour outside of time inside the hospital. Something that would have weighed on their decision included medical information such as previous attempts to stop drinking. Mental health care, including healthcare for addictions, is lacking in Canada. You can’t force someone to go into rehab, but offering better care and options might have helped her in the past.
As said in the main article as well as the one I read, in order to qualify for a living donation you need to qualify for a full donation, because if something goes wrong you’ll need a full liver ASAP and get bumped to the top of the list.
So she was supposed to die because she had an addiction? What some call a disease?
Are you trying to argue that alcoholism shouldn’t be a factor AT ALL for liver donations, or that living donations shouldn’t also need to meet the standard full liver donation standards?
I’m wondering what you are arguing.
There are more people who need transplants than there are organs, so the medical profession has to make decisions about who to deny. This was a reasonable decision, in my opinion.
In Canada, drinking more than 3 drinks per week is medically considered “high alcohol use” for a woman… (6 for a man). This limit keeps getting lower year after year
If this can prevent you from getting organ transplants, then it encourages lying to your medical doctor about your current habits… That lady was not considered alcoholic, she just used alcohol in greater amount than the limit considered acceptable by doctors.
Latest stats show that almost 4 out of 5 people has exceeds that limit at some point in their life. This woman died only because she was honest with her doctor about her alcohol use. (Note that the article says her partner was a compatible donor but the system refused to accept him because she used alcohol. It’s not about lacking donors.)
The only genuine hint to the real reason of the refusal was “minimal abstinence outside of hospital”.
Let me ask you bud, if you needed a liver transplant to continue living, would you have even one drink per week, or would you just quit completely?
Very biased article.
Plus, regardless of her husband being compatible, it still costs the state tens of thousands for the operation. In no way would it be ethical to put a new liver in someone who refuses to completely abstain from alcohol.
That’s absurd. Refusing someone a transplant because they used to drink more than 3 drinks a week before they knew they even had liver problems is completely absurd. Calling her an alcoholic for that is even more absurd. What in the world are these people or you thinking?
Are you on purpose missing the point?
The point the person you replied to made is that she didn’t completely stop drinking alcohol once she was diagnosed to have a terminal liver disease due to alcohol use.
So first of all, she must have drank a lot more than 3 drinks a week to have terminal liver disease in her 30s that’s due to alcohol (yes, all of that is in the article)
But the issue is she didn’t stop drinking after being diagnosed, she reduced her consumption but didn’t stop it.
If any of the above is incorrect, feel free to correct us, but making a point that’s completely missing the facts that are being talked about here doesn’t add anything to the discussion.
The first point is correct. The second one is shown to be wrong in the second paragraph.
The issue here is you need to have stopped 6 months or more before, and she was only diagnosed 5 months before she died.
“minimal abstinence outside of hospital”. That means she was still drinking.
Given her condition it’s possible she never left hospital after her diagnosis
That’s total bullshit. As a IT professional I have a nightly drink after work for self medication. Never two. Just one.
Just do what I do and put it in that deep cupboard above the fridge. Then forget about it for literal years by mistake. It’s doing wonders for my health. Just wish I could do a version of that for my bad sleep schedule.
Just remember if a doctor ever asks then lie and say only on friday, there’s a few things in life you absolutely have to lie about because the system is not designed to care about people.
Here in the uk never admit to smoking weed to a medical professional, never admit to even so much as thinking about any form of self harm, delusions, emotional regulation issues… it can come back decades later and fuck you over.
This is generally pretty bad advice.
I mean I get where you’re coming from, and I cannot speak to what it is like in the UK (I can only speak as a man in the US), but you should not lie to your doctor.
If you see a doctor, and they start treating you differently after finding out that you smoke weed, then you find another doctor.
Unless you’re in Canada and there’s a doctor shortage and you can’t just shop around for a different family doctor if you don’t like your current one. If you’re lucky enough to even have a doctor here…
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Wait what happens if you admit to smoking weed? I thought we had doctor patient confidentiality. I’ve had some mental issues in the past, though not to the point of self harm. What happens if I admit these? I also live in the UK and this is concerning.
I’m guessing you can stop at any time if you want to? I’ve known older healthcare professionals that have approved and even encouraged one drink a night, but our understanding of the effects of drinking has evolved. I doubt doctors keeping up with the science would encourage it at this point. It would be like having someone come in that’s overweight. It doesn’t mean you’re unhealthy now, but it may be a factor that needs to be kept in check and working on it could prevent issues in the future.
Yes I can and have stopped. I drink 2-5 times a week and it’s one 40 proof 1oz (not a shot 1.5oz) over rocks with a bit of soda. Same or less than a beer.
This isn’t two shots neat daily or a six pack of beer. Sometimes I go a week without. Other times it’s 5 times a week.
No, and it even says so in the article
She quit about 5 months before her death when transplants require 6-12 months of sobriety. She was drinking regularly with the fucked up liver before that diagnosis, and liver damage isn’t something that just suddenly appears.
She kept drinking despite what would have been intense cramping pain and a slow death, thats why she was denied (addiction) and ultimately died
And as the article also says it’s incredibly dangerous for someone to get a live-donor transplant when they’re in bad shape like she was, as failure of that means they’ll need to let her die on-table or transplant a good dead one into her (which she was denied for, due to her drinking)
It’s sad, but this woman died to alcohol abuse, pure and simple
That’s a lot of vague statements you’ve repeated from the article. What’s drinking “regularly” (this was before the diagnosis as you’ve stated)? “She kept drinking”, what does that mean? How much alcohol was she consuming? Did she have a sip of her friends wine and was honest about it so was rejected?
Where does it say that? You’ve completely twisted the statements.
Huska’s time at the Oakville hospital likely cost over $450,000 - ($3,592 per day for ICU care) with an additional 61 days in a ward bed which likely cost about $1,200 a day, A liver transplant in Ontario is pegged at about $71,000 to $100,000 in Ontario based on data from 2019.
Heavy drinking is drinking ONCE per month in the past year. If this is based off of before her diagnosis, you’re gonna exclude like 80% of the working population who actually does go out for drinks or private occasions (unless they just lie which I guess they should’ve in this situation). Between the price of keeping them alive but not fixing the problem and there being no “review” process for decisions, I would categorize this as a bad system that allowed a preventable death from an alcohol related disease to continue.
I’d be inclined to agree, except that her partner wanted to donate HIS liver and was prohibited from doing so as a living donation due to the alcohol use determination.
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.deleted by creator
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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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.
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.
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.
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.
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.
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.
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.
If you are going to make alcohol consumption a bar to a liver transplant without making alcohol illegal you should all go fuck yourselves. You had a drink and you should die should not be a thing.
This isn’t what happened though. She was addicted to alcohol, per her partner, got diagnosed with needing a new liver, she immediately quit alcohol, and they denied her anyway even though quite a bit of time had passed while she was sober. I am unaware if her liver disease was because of the previous regular alcohol use. It wasn’t just 1 drink though.
Yes, organ donation is messed up. I met a girl dying in hospice once. She needed a new kidney. Genetic stuff, and then when she was 15 she tried to kill herself with Tylenol. She got her first transplant before the suicide attempt. She was denied a second one due to the suicide attempt itself. There are only so many organs in the world. She died in agony in hospice, young and covered in calcium deposits.
We punish substance use and mental health so harshly in this country. No one deserves the death penalty for previous substance use, especially for alcohol which is ancient af. It’s horrible she was denied when there was a liver already available.
Any full cadaver liver that could have gone to this woman didn’t get thrown into the garbage — it went to someone else who would have died without it.
As for the living donor liver her boyfriend offered, even though he was a match her level of liver failure likely meant that the partial liver her boyfriend could have donated wouldn’t have been successful. Living donors still need a liver for themselves, and we each only have one full liver — so the best they could have done is given her half a liver. Her condition was too poor for this to have a likely positive outcome, which was why this was also denied.
It sucks, but there aren’t enough donor livers for everyone who needs one. The cadaver liver she was denied however would have gone on to save the life of someone else you’re not hearing about in the press — someone else who may have died without it.
If the unfairness of it all upsets you that much, then make sure you’ve signed your organ donor card, and make sure your family members know and understand your desire to be an organ donor. And encourage the people you know to do the same. This is only a problem because there aren’t enough donor livers for everyone — when you have n livers, at best you can save n lives — and thus having a larger number of donor livers allows for more lives to be saved, with fewer qualifications.
It’s hard to say if she would have lived or not.
I think a bigger discussion about medical gatekeeping and bodily autonomy is warranted here
I have been an organ donor since my first driver’s license
From my limited knowledge organ donation criteria are horribly restrictive on a personal scale but unfortunately make sense on the macro scale. Organs are such a scarce resource that as I understand there’s no other option.
This girl’s death was undoubtedly a tragedy, but as fucked up it’s to say if she lived someone else would probably die in a similar agony. Was she treated fairly - I don’t know, can we make this system better - I unfortunately also don’t know.
One easy way would be to make organ donation opt out instead of opt in. As in, if you do nothing, you’re an organ donor if you end up brain-dead, and if you don’t want to, you have to explicitly opt out. Alternatively, we could just say any brain-dead person may have their organs harvested, regardless of what they declared while still alive. After all, you don’t need the organs anymore once you’re brain-dead. (I’m specifying brain-dead, because if you’re completely dead, then the organs are also useless)
That would help to some extent with scarcity in opt-in countries. But there are already opt-out countries which still face the same dilemma. Because if you’re even one organ short how do you fairly decide who’s gonna die… Can you even fairly decide about someone’s life and death…
Organ donation panels are a sick Trolley problem come to life. I don’t know either.
It’s not punishment, any chronic illness will make someone ineligible for an organ transplant. It’s not saying it’s that person’s fault, it’s a situation of “2 people need this organ, which ever you choose the other will die in agony, one is more likely to live twice as long as the other.”
He was only offering the organ to the one person though
What does your second paragraph have to do with that?
My cousin was a raging alcoholic. He got clean, but not before he fucked his liver right up. I don’t know if they even allowed him on the liver transplant list or not, but if he was, he was very low on it. He died in early 2015 at the age of 43.
How long was he drinking? And how much?
He’d been drinking since he was a teenager, and he’d sometimes get blackout drunk, getting arrested for public intoxication, etc.
How has Polievre not tried to capitalize on this tragedy to pitch his “your bank is a better death panel than the transplant math” plan yet? American healthcare is half his platform!
He has a platform? Every time I check is just angry “I’m better than Trudeau” statements
As a former American, you do not want the American Health Care System unless you are very wealthy. It is an expensive bureaucratic disaster. BC Health may be imperfect but at least I am not paying us$700/month for family insurance that might be accepted by the doctor/hospital that sees me in an emergency.
Hi, transplanted organ recipient here (heart in my case), please be an organ donor if possible, thanks.
Well I’m signed up, but you’ll have to thank me after I actually do it.
Even if her partner could donate his own liver, it should still go to a better recipient. If anything he should be donating anyways to honor her and save a life
You (or the committee of doctors) don’t decide who is a better recipient for my goddamn organs. You can make whatever the fuck ethical decision you want when I’m dead, but not until then. And I’ve gotta say, it’s shit like this - treating patients & donors like you know better - that make me not want to be a donor anymore. If I wanna donate my lungs to Hitler because he’s my grandpa and I love him, that’s not something you get to have a decision on.
The fact that people are down voting you for saying in essence “my body, my choice”, is ironic for lemmy.
It’s a bit more complicated than that with transplants. Should people for example be able to sell their kidney to the highest bidder? That’s also “my body, my choice”. And should doctors be forced to participate in such a scheme?
A transplant system should consider fairness, equality and possible abuse. Obviously I think it should be possible to donate to a loved one, but we should also be careful not to create a system where the rich get priority, because they can pay more, and where poor people could be financially pressured to give up their bodily integrity by having to sell an organ.
Not really. All political factions try to sound like they are about principles when in reality they are about tribes.
Doctors are cops. Pass it along
My apartment only bring me debts.
Maybe he should, but maybe he is thinking “Fuck them, we tried to participate in the system. We had a living donor to go. What? Oh you have a ‘better’ recipient? Well, guess who doesn’t want to donate to a system that failed my loved one.”
The system didn’t fail, it worked as intended. If but mid 30s you’ve destroyed your liver with your alcohol addiction, it’s almost guaranteed you’ll slide back.
Recipients can’t drink ever, and have to take meds for life. She was not a good candidate for a transplant.
I agree. I understand the rules and it makes sense to me. The people going through it don’t care. The husband going through this loss doesn’t care about other people needing his living donor liver, or there being better recipients. He would view it (I imagine) as “why should I donate when they didn’t help my wife?”
That’s nonsense, because the partner would not donate his liver if it went to someone else.
Right? Like I would donate my liver to my kid, or my spouse, without even questioning it.
But if the doctor told me they can’t have it (for some reason other than incompatibility), and they died? Fuck them. I’d de-register as an organ donor out of spite.
Donating an organ is a pretty invasive operation that can have a lot of complications, doctors aren’t only taking the recipient health, but the donor too, in the equation.
We’re explicitly talking about a situation where the donor is suitable. So I don’t know what kind of information you’re trying to add here.
Even if the donor is suitable, the operation to extract the donor organ is invasive and can have complications.
All true, yet it has nothing to do with what we are discussing, so why are you muddying the water with it?
Since no one has mentioned it, USA has the same policy basically.
Wait, so if someone was ever an alcoholic - they gonna be denied? Even if they stopped drinking for many years?
Doctor here who has referred patients for transplant. No. You must be six months sober to be eligible for the transplant list. There’s so few livers to go around, they need to be sure the recipient isn’t going to just break the next one.
It’s rare to suddenly need a liver; they usually take months to fail and this gives the patient and doctor months of notice to try treating the failure first (including lifestyle changes and meds) before getting sick enough to go apply for a transplant.
I used to trust HCPs, but I know many of them now and have heard them shit-talk and judge their patients for mental health issues and drug use (among other things). I would NEVER, EVER tell a doctor or nurse about any form of drug or alcohol use now, or any kind of anger issues that could possibly be interpreted as aggressive. Especially not in a hospital where everything gets recorded in an electronic chart and may be used against you in the future. Fuck that.
I’m sorry you have such a low opinion, maybe you heard someone venting about their job after work?
You really think lying about your drug use is safe? It’s dangerous to give many types of anesthesia if you’re on drugs or alcohol. We don’t particularly care if you use or not, we don’t tell police or family, you just need to be honest so we can do our job correctly.
If I was going under anesthesia for a planned procedure, I would not drink or use drugs beforehand. If it was an unplanned emergency, I guess it would depend on the circumstances, but you are citing an extreme circumstance. If someone is actively high at the time they end up in the emergency department, well, that’s bad luck and it might be wise to disclose since the staff will figure it out pretty darn quick anyway. Same if you are a severe alcoholic or opiate addict. That’s not what I’m talking about, though. I’m talking about when doctors or nurses ask you about it as a lifestyle question.
You know as well as I do that the health care system classifies people in terms of their risk factors and then use that profile to make decisions about you. Once classified as a “drug user” in your chart, many doctors and nurses will treat you differently. They may or may not “care” from a moral perspective, and we know that they won’t tell family or police, but that won’t necessarily stop them from denying you necessary pain relief or deprioritizing you in triage. That’s the actual concern.
There is absolutely no reason to tell a doctor if you use cannabis or engage in moderate alcohol use or occasionally use cocaine, LSD, or psylocibin. If you are prescribed a medication that has an interaction with a recreational drug, the doctor can simply tell you that. They don’t need to know if you use that drug from time to time. Only you, the patient, need to know that so you can avoid the interaction. More extreme forms of drug use are a different story, of course.
Edit: Let me add one other overarching point. I think people are sick and tired of having doctors make decisions for them. I don’t need a nanny. I need information about risks and benefits in order to make an informed choice. Doctors rarely do that. Instead, they decide what should be prescribed, or not prescribed, regardless of the patient’s wishes. I know the reason is fear of liability, but here we are nonetheless.
Ah, you think you know better than doctors. Many people think this. Many have bad outcomes with nobody to blame but themselves.
I don’t care if you use cannabis, heck I can legally prescribe you some if you need it. Doctors are not law enforcement. I don’t bat an eye if you tell em you use cocaine, I’ll still give you morphine after surgery but I need to know you used cocaine so I can avoid beta blockers. You’re paranoid we’re judging you but you’re wrong. You’re not as rare as you think. We know you’re in pain regardless of your drug use and treat you anyway.
Many idiots who died in hospital thought that too, which is why we make you sign consent forms so that your family can no longer sue us for your stupid mistake.
It’s like you have no idea how doctors work and have an outdated idea of them. Your loss.
You misunderstand me. I don’t think I know better than doctors. Far from it. What I want from a doctor is information and informed choice, not a gatekeeper who makes decisions for me. As a group, physicians have been slow to adopt the patient-centered informed choice mentality that, for example, nurse practitioners and midwives have more thoroughly adopted.
The fact that you’ve doubled down here on calling patients idiots for being somewhat distrustful of the typical arrogant physician attitude confirms what I’m saying.
Their boyfriend was willing to be a living donor for them. So you aren’t talking about a scarce resource here.
In most places, if they’ve been clean for 6 - 12 months, they are no longer considered alcoholic in terms of transplantation. Similar to Canada
Notice that they never state she was an alcoholic. They also never atate she was a “high level” alcohol user. Just that she was an alcohol user.
You can make your own assumptions about her alcohol use, but in general these rules would also excluse a “normal” alcohol user with a congenital liver failure…
She literally quit when she was told she had a failing liver that could not recover. Just to be clear, there is absolutely no way in hell that she didn’t know she was on the way to killing her liver with her drinking because there are a plethora of signs long before you get to the point where alcohol has destroyed your liver beyond its own ability to repair itself. (Which is incredibly prodigious. The liver is the single most regenerative organ in the human body)
So forgive me if I’m skeptical that she really would have stopped being an alcoholic after she received a liver transplant.
IMO this was a tragedy of her own making and the money and effort in transplanting a liver would have been a complete waste. (Even one offered by her SO.) Especially when there is such a deficit of available organs and the surgeons who do the transplanting are needed for patients who aren’t likely to go back on the sauce 6 months later.
the pain of a cramping liver is excrutiating. if you deal with that kind of unrelenting never stopping pain und don’t stop drinking, you are addicted for sure.
And for good reason, really. The supply of livers is too small to save everyone who needs them, so they give them to the people most likely to have a successful outcome. Basically every lived given to one person is sentencing another person to death. That’s just reality with supply being what it is.
Their boyfriend volunteered as a live donor. They weren’t asking to be put on the general register.
Which was determined to be unlikely to be successful given her condition, so she would have just died in the attempt.
Read the article again. It said early on her chances were actually quite good, something like 80%
That’s not true. Living donors can donate part of their liver.
I donated a kidney to a friend earlier this year. The reason his kidneys failed wasn’t anything he was at fault for, but even if it had been because of poor decisions he’d made in the past, I still would have given him one of mine. Because people deserve second chances. I can understand not wanting to give a recovering alcoholic a deceased donor’s liver, when someone else could receive that liver, instead. But this woman’s partner was a match and was willing to donate to her. What’s the harm in that? That isn’t a liver that could have gone to someone else who needed it. It’s a donation that would have either gone to her or no one else. No one could have lost out of the donation had been carried out. This was just cruelty, and now someone is dead. And for what? Because there’s a 15% chance (according to studies the article mentioned) that she might have started drinking again???
It’s not super clear, but the article makes it sound like if a partial graft from a live donor fails, then the recipient is automatically fast tracked for a new transplant from a deceased donor.
If that’s the case then maybe policy should be changed in the case of alcohol abuse.
The policy isn’t there just to be extra nice, it’s because otherwise the patient dies without a liver.
Since she was too sick for a partial liver transplant, and not eligible for a dead donor full liver transplant, she would have just died.
It might seem cruel but the same is done for a lot of other procedures; if the chance of you dying in surgery is way too high, doctors won’t take the risk, they’re not executioners.
It’s not a moral judgement about her alcoholism, the same would have been true if she had a cancer no surgeon would take on.
I totally understand the mortality aspect, I was just thinking if a patient is 100% going to die from liver failure without a transplant, any chance to live from a live donor seems worth it. Of course I don’t know any statistics so I have nothing to base it on.
Maybe euthanasia should be a legal option instead of a slow agonizing death that puts next of kin into medical debt.
Surgeon time is precious as well.
In the article, it shows that the hospital spent significantly more slowly letting her die than the average cost of the transplant.
The comparison is apples and oranges. They only include the cost of the surgery itself, not the cost of after-surgical care, the potential cost of complications to both the patient and the donor, etc. Then there’s the cost if the partial liver donation doesn’t take, or if the patient relapses.
Obviously, there’s also a lot of potential upside to having the patient survive, I just don’t think the odds of that were all that high.
So let the free market sort out the organ redistribution problem!
I’m a free market entrepreneur and I’d like to solve your organ shortage and homeless problem all at once.
D:
womp womp, its their fault that she denied the liver
didn’t need the editing master here
Maybe if donating organs was compulsory they wouldn’t be so rare.
In my country, everyone is an organ donor unless they specifically opt out. Usually due to religion.
I’ve been seeing organ transportation ambulances near my city’s hospital from time to time. It’s weird to see, but a good thing.
There should be no opt out, even for religion. No I do not respect your customs as much as I respect someone else’s life.
I agree. I think people who choose to opt out for selfish reasons should be placed lower on the list. It’s inmensely hypocritical.
They still need to be a match
Imagine how many matching organs are just left to rot in the ground.
Can’t just implant a 90 year old liver. And a lot of them are unsalvageable. Doesn’t mean it shouldn’t be mandatory, just that it will still be a limited resource.
I don’t want to be morbid, but with as many gun deaths as there are in the US there are lots of young livers to go around.
Once again. There is more than the USA out there…
I think the US can supply surplus to its neighbors.
In my country, people are automatically registered as a donor. If you don’t want to donate, you have to choose to opt out.
Ever since that law was passed, I see organ transport ambulances around my city’s hospital from time to time. Transporting a matching organ to a waiting patient. The bold letters spelling “organ transport” on a red band is a weird but good thing to see.
Sounds dutch
God, the custom tailored ideal American healthcare system, you’re right but I hate it lol
Yeah… no. Perhaps opt out by default, but not compulsory.
Do you mean opt in by default?
No, the current system is opt in. You have to choose to be a donor. Opt out means you have to choose not to be.
Why not? Why do you need the ability to deprive someone of a live saving procedure after you literally died?
I dont know. Probably because it risks being abused. The US already has private prisons filled to the brim with trivial felons forced to work in sweat shops… im sure theyll love to sell their organs too after dying from heat stroke.
I see, that’s a valid concern. I wonder whether we could try to prevent such abuse by automatically excluding more prone groups like prisoners. It really seems crazy to me how many organs, which could literally save someone’s life, are going to waste.
I think opt out would be sufficient. Right now, its a compilcated to opt in and not many people thinks about it. In my state, the only time you see it, is a small checkbox when you get a drivers license.
But being opt out everyone is included unless they choose not to, for whatever reason. Which is think is more than fair. Its their body, they should have the right to do whatever they wish, regardless if they arent using it anymore. The amount of people opting out would be a minority, so it shouldn’t really be a concern.