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liver transplant (cirrohis)
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csamsel posted:
I am doing a research paper about Liver Transplant and cirrohis caused by alcohol. I need to explain why a patient should NOT be able to recieve a transplant because of their drinking. Any sources would do along with opinions. The most help would be cases that have gone into court that have gone against the person who wanted a transplant. thanks for all of the help.
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John-SKPT responded:
You generally are taking a position that is contrary to the UNOS guidelines: UNOS take a medical position, not a moralistic one. If a patient has been sober for a significant period of time, then the previous alcohol use is not an issue any longer as far as UNOS is concerned. If a patient seems unable or unwilling to forgo alcohol in the present time, then the physicians are not going to risk an organ on that patient.

It is a case by case judgment, your statement sounds like you want to legislate a rule that says after the fact: "You caused your own trouble, now just live with it", The medical profession doesn't work that way. It's about helping, not about making moral judgments and punishing offenders. It's that sort of thinking that has always held back the advance of science and it continues to do so today.
 
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Byroney_WebMD_Staff responded:
Dear csamsel, John makes several excellent points. Transplant 'rules' have had to deal with medical ethics from the very first moment they started. Medicine is about helping whenever possible and to ease suffering where help is not possible, while the law is about deciding 'right' and 'wrong' or who has the superior legal position. I understand you many need to take a 'stance' for your paper, you should also be aware of what the opposing view is likely to be. Google is a good search engine to start with. If your school has access to legal journals (many do) through your student website/library, that's a good place to look, too. Good luck, Byroney
 
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jacky53 responded:
The first post pretty much said it all. I have or had pbc and this was something that was through no fault of my own. Why should an alcoholic or drug user knock a person like this out of a liver just because they might be a little sicker than a person who didn't bring it on themselves? There have to be guidelines in situations like this, unfortunately, some somewhat outdated. (Ex. meld scores) For some reason some people with pbc can be extremely sick & not have high meld scores. Thank goodness for living donors & my daughter because if it were up to unos I would probably be dead right now. As far as court cases, with the guidelines put forth & available pt. info I don't think a case of an active alcoholic or drug user would have a chance in court. If a person has recovered for a time period then by all means hop on the boat. It is also a wonderful thing that living donors are possible. This opens doors for many others who have not found a match. If you don't know what pbc is......add that to your research! Jacky 53
 
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macneel responded:
I have been diagnosed with (nash) and I have advanced Cirrohis , we are testing once a year looking for cancer. am I a candidate for a transplant? I am 59years old
 
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John-SKPT responded:
It would be up to the team of physicians who perform the surgery, and who have cared for you over the years.

(This is slightly different than the original post, but let's just ignore the original since it is based on someone's personal idea of right and wrong, not on medical circumstances.)

One principal factor would be any previous occurrences of cancer, anywhere in the body, not just in the liver. The immunosuppressants required for a lifetime after transplant do somewhat increase the odds of developing cancers or causing recurrences. Generally if a patient has been clear of cancers for 3 to 5 years, then transplants can go forward.

One other factor might be that non-alcoholic steatohepatitis occurs with a greater frequency in transplanted livers than in the general healthy population. So while this is not a contraindication, it might be a factor in the medical judgements.

The only way to be sure would be to ask your hepatologist or a transplant team and then get the rather lengthy evaluation process started and see where it goes and what your options are.
 
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becomehealthy responded:
My father just received a liver transplant on Saturday after waiting for nearly 2 years

Here in America, we have freedom to live as we choose. People should be free to live as they want, eat the foods they want, smoke all the cigarettes they want, drink all they want, etc but they should also have to pay the consequences for their actions. My father's cirrhosis was not from self-imposed behavior (ie alcohol use, hepatitis). He worked hard his whole life and was forced into retirement because of the cirrhosis. He almost died two weeks ago. I would hate to see his new liver go to some drunk/drug addict who damaged himself rather than someone like my dad who did not cause the harm himself.

I don't care if a drunk/drug addict getting the transplant is reformed or not. The harm to the liver was caused by selfish, harmful behavior THAT THE PERSON KNEW WAS HARMFUL! My dad should not have to move down the list just because some drunk was selfish. It was that person's choice. Also, my dad's new liver came from a cadaver of an idiot who was driving recklessly. It was his choice to drive recklessly and now he's dead. I feel bad for the family but I have difficulty showing sympathy for the guy directly. But they say, oh no, nothing will happen to me! Well, it did - face the consequences.

My dad did not choose behavior that led to cirrhosis and deserves a liver much more than someone with DUIs etc. Cirrhosis is a horrible way to die - you basically go into a coma and bleed out your pores. You are confused most of the time and can't function. A hardworking man who chose to be home every night with his family deserves better.
 
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btayful responded:
I would try and help you out here csamsel, but it seems almost pointless because that is, as said earlier, an ethics issue based off of personal opinion, which isn't usually something that makes decisions in the medical or scientific world. It could be why you are having trouble finding your information. Anyways, a person who was in need of a transplant from cirrhosis probably wouldn't ever even make it through a court process because of the critical condition is in. He/she would likely die before a verdict was made, though there may be some cases out there.

However, in response to the person above me, I must say that Alcoholism is a disease not a choice. When a person drinks, they do not hope to become an alcoholic. Yet when they drink even a little bit like a normal person does, it effects them differently and they become dependent. This is not something someone chooses. Of course a person can get help, but sometimes the disease itself is so overpowering or medical problems have risen that make there thought process not all there. It is very much so easier said than done for a non-alcoholic. My brother was only 26 when he was officially diagnosed with cirrhosis. He did not drink as much as many alcoholics and was on the road to recovery, yet alcohol can affect different people in different ways. You are telling me that if this happened to your own family, you would say, "So be it, you deserve to die?" At 26 years old, we deny you because you made a bad decision and you had a disease you did not know about that would show that particular decision to be fatal? If you don't know you are allergic to crabs, and you eat some shellfish, do you deserve to die? Alcoholics don't begin drinking alcohol thinking that they would sure love a few beers here and there to end up becoming something they need and that eventually kills them.
 
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bertiebon22 responded:
I have to disagree with you. As a health care provider, I have had a patient who recently had a liver transplant due to ethanol use. I was quite disturbed to learn that he had convinced his wife to bring him liquer.

Also, I am perplexed with the suicide attempt cases. Recently, a young woman had overdosed on painkillers. Shortly after, she had received a new liver, She also told me that she wishes that her plan had succeeded.

With a short supply of donors and and too many recipients, this is unfortunate to those who do want a second chance at life.

Many of my co-workers share my opinion.
 
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bertiebon22 responded:
Yes. I do agree. In fact, I strongly agree.

As a healthcare worker, I am not supposed to be judgemental, and for the most part, I am not.

But when I have patients that have had a second chance in life, and one asks his wife to bring him liquer with a new liver, and a suicide gone wrong, she later tells me that she wished that she have suceeded with suicide as oppossed to getting a second chance. This makes me very angry. Many of my co-workers share my opinion.

Best of luck to your Father.
 
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bertiebon22 responded:
Also, I read an article a few months ago, about a man on death row who got a new heart.

Yes, death row with a new heart. How can it be?
 
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Maggie12340 responded:
Wow! alot of ignorance out there about Alcoholism and mental illness. Why I am not surprised it comes from a health care worker!...A lot of anger out there too. addiction is addiction regardless of your drug of choice.... am willing to bet the bertiebon22's addiction is food and idle gossip.

Your remarks about two of your so called patient is unbelievable... as a matter of fact I don't believe it! I am on a wait list for a liver and i had to go through so much screening for mental illness as well as alcohol and drugs... in addition to every imaginable test there is to rule out any other illness such as cancer, HIV etc. It is people like you who have no clue what goes on physically, mentally, and spiritually when your handed a death sentence. You should be ashamed!!!!
 
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Maggie12340 responded:
Are you kidding bertiebon22 (btw is 22 your age) where did you read this article the inquirer? I came to this site by pure accident...looking for liver transplant support group....this is what came up on google! Sad state we still live in...ignorance a live and well....we start saying that Alcoholics drug addicts should not live....maybe we should also denies treatment based on race and sexuality as well....there's not enough to worry about....if you don't have the money or the insurance you will die anyway....

and while we are ad it diebetics who are over weight or still killing themselves with there diet should not be allowed insulin so that those who are doing the right thing should not have to pay higher health cost or prescriptions.....we could go on and on...how bout those who smoke...and dieing of lung cancer....are you going to shake your rightoues finger in there face and say "this is what you get or deserve" Where is empathy, human kindness, peace amoung men....maybe in my next life!!!
 
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rachelxo23xo responded:
helllo, This is jackie and Rachel. We are high school students in 10th grade. We have a final anatomy project and our topic is cirrhosis. We are wondering if anyone would supply us with information on the topic and answer some of our questions. A part of our grade is to interview someone with the disease. We would be very thankful if someone or some people would answer us by sunday the lastest. Thanks so much for your time, we hope to hear from you.
 
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luckyliver1 replied to becomehealthy's response:
your compassion is remarkable. In medical profession, those that are trying to help your father it is believed that addiction is a disease. This is not a selective process, it is a program that is managed with guidelines that were agreed and accepted by those who have the experience and knowledge to make those decisions/guidelines. Your opinion is well taken but it also comes with a great amount of judgement. I accept your argument regarding how the program is set up but your lack of gratitude you show for your father receiving the liver is truly appalling. It takes very selfish person to has no compassion for the deceased person and their family who gave your father life. Your whole comment is disgusting and reeks of I I I/ me me me. You must be a republican.


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