Who should get a transplant?

emilee1978 · Mar 1, 2009

I worked for three years in an ICU which had mostly liver, kidney and pancreas transplants, about 4-5 patients PER week. I say honestly that I don't think anyone who is an alchoholic or drug addict should get an organ transplant EVER. These organs are veryhard to come by, especially good organs. And I also disagree with the notion that you don't have any control over your drinking or drug use. In Europe, they don't have AA meetings. Alchoholism/drug abuse is considered behavioral, ie: fix the reasons why you drink/use drugs, and you stop the drinking. The whole recovery community is based on the prevailing notion in our society, that nothing is ever YOUR fault. I'm sure I'll be lambasted for this, but it's my opinion. You drink too much, smoke, are fat, use drugs, have sex without a condom,etc., you get what you pay for.

leslie :-D · Mar 1, 2009

its a different paradigm.
definitely.
i was only contrasting the 2 r/t dealing with death on a daily basis.
in some ways its a lot like surgical oncology. even if you do everything right a percentage of your patients will be dead by the end of the year. on the other hand the rewards are immense. seeing somebody that was at deaths door a month ago come walking through your clinic door is the ultimate rush.
i'm thinking there are sev'l scenarios that create that rush.
whether it is life, death and/or sacrifice...all are gut wrenching.
i also give thanks every day to those that can think of others when they are experiencing their own tragedy. those are the true heroes.
david carpenter, pa-c

this is the sacrifice i speak of.

just could not deal with such volume of intensity 24/7.

and many, many sung and unsung heroes here.

leslie

SuesquatchRN, BSN, RN · Mar 1, 2009

Contraindications to Liver Transplantation
Uncontrolled psychiatric disorder

So my schizophrenic sister would have less of a shot than this drunk? What is "uncontrolled"?

emilee1978 · Mar 1, 2009

I think they mean people with psych disorders who are non-compliant with meds, therapy, etc. Just my guess, SuesquatchRN

SuesquatchRN, BSN, RN · Mar 1, 2009

In Europe, they don't have AA meetings.

Sure they do. I've gone to them. Hell, I went to a meeting in Cairo, in Africa.

PICNICRN, BSN, RN · Mar 1, 2009

I would have a hard time denying an organ because of past history of substance abuse, sad as it is to say. If they meet the criteria of their program and are deemed a proper candidate then they are a candidate. Sadly, ANYONE can be noncompliant post transplant in many ways- meds/lifestyle/diet ect. It is a very sad reality.

I took care of 3 out of 4 children in a single family of who we transplanted hearts. Congenital cardiomyopathy. Genetically, they did not have a chance- the parents underwent genetic testing after the first kid was diagnosed and were told their chances of having a child without the defect were slim to none. Their culture did not believe in birth control so............. needless to say.

It is hard not to judge.

emilee1978 · Mar 1, 2009

Let me clarify, from what I understand, and this is according to my husband who's from the UK, is that substance abuse is treated dramatically different in Europe. It's considered more of a behavioral/psych issue. I still think that none of them should get organ transplants just going by what I've seen working with this particular patient population. I've seen several patients get a transplant, drink/drug their way thru that one, and get listed for ANOTHER. It's a very unethical and discouraging specialty, which is why I left that particular unit.

nickos · Mar 1, 2009

In Europe, they don't have AA meetings. Alchoholism/drug abuse is considered behavioral, ie: fix the reasons why you drink/use drugs, and you stop the drinking. The whole recovery community is based on the prevailing notion in our society, that nothing is ever YOUR fault. I'm sure I'll be lambasted for this, but it's my opinion. You drink too much, smoke, are fat, use drugs, have sex without a condom,etc., you get what you pay for.

I don't know about the rest of Europe, but they most certainly DO have AA in the UK (specifically England).....

emilee1978 · Mar 1, 2009

Read my above posted comment, Nickos. Pay attention.

core0 · Mar 1, 2009

I worked for three years in an ICU which had mostly liver, kidney and pancreas transplants, about 4-5 patients PER week. I say honestly that I don't think anyone who is an alchoholic or drug addict should get an organ transplant EVER. These organs are veryhard to come by, especially good organs. And I also disagree with the notion that you don't have any control over your drinking or drug use. In Europe, they don't have AA meetings. Alchoholism/drug abuse is considered behavioral, ie: fix the reasons why you drink/use drugs, and you stop the drinking. The whole recovery community is based on the prevailing notion in our society, that nothing is ever YOUR fault. I'm sure I'll be lambasted for this, but it's my opinion. You drink too much, smoke, are fat, use drugs, have sex without a condom,etc., you get what you pay for.

Substance abuse treatment in Europe is similar to what we have here. The issue is they are much less likely to put someone in jail for possession instead choosing treatment (at least from my conversations with practitioners over there). The advantage they have is that treatment is much easier to obtain and paid for (unlike most US patients who have to pay for it out of their pocket).

The issue with self control is somewhat understandable but fails to appreciate how most treatment programs work. Part of evaluation of someone with an addiction behavior is that the patient much admit they have a problem and show insight into the problem and want help. At least in our program this is a key part of the evaluation.

As far as not transplanting anyone with a behavioral problem where do you draw the line? Lets say you have some one who experimented with drugs in high school and now 25 years later has cirrhosis from HCV. They have a well paying job and a family. Do you deny them a transplant because of an error in judgment made in the past? Alcohol is a similar problem. Remember regardless of the amount of consumption less than 5% of alcoholics become cirrhotic. What do you do about someone who stopped drinking when they were told to but progressed over 15 years to cirrhosis. Is that person OK to transplant? What about someone who stopped 10 years ago? Where do you draw the line?

Remember that the top three reasons that we transplant are HCV, NASH, and Alcohol. If you take away the odd person who is thin and has NASH we would cut our transplant volume down to about 15% or so of what we are doing now.

For the most part in medicine we work to optomize patients for surgery. Optimization in the case of transplant means working to minimize the chance of complications post transplant either physically or socially. We tend to try to apply this is a non-judgemental manner.

David Carpenter, PA-C

nickos · Mar 1, 2009

Read my above posted comment, Nickos. Pay attention.

Wow. I obviously posted my reply before I saw the last comment; I was *going* to apologize because it was a mistake. No need to be rude.

NurseKatie08, MSN · Mar 1, 2009

Wrong.
I had an alcoholic Uncle who died a couple years ago. He was in and out of rehab, went to jail many times, had to live with my Grandparents, had no job, no car, and no life. He tried many, many times to get sober, but he eventually just gave up. (There were a lot of family problems going on, too, but that isn't anyone's business.)
If he were still alive and in need of a liver transplant, I would not want him to get it one. Knowing his history, and how he just gave up on himself, I feel the liver would be better off with someone else.
I'm all for giving people a second chance. Therefore, I think these kind of situations need to be taken on a case by case basis. To say that I would never want an alcoholic/drug user to get a transplant is unfair; every person is different and so is their situation.
I think ghillbert's hospital policy is excellent.

I didn't say you would never want an alcoholic/drug user to get a transplant. I said I was willing to bet that many posters who automatically condemned alcoholics probably had no personal connection to the disease.

If you read my post, you'd see I agree that each person is different and should be handled on a case by case basis. I'm simply saying that I wouldn't initially rule anyone out soley based on a substance abuse history.