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120 If someone abuses their body, will they still be given a transplant?




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This article is from the Organ Transplant FAQ, by mike_holloway@hotmail.com (Michael Holloway) with numerous contributions by others.

120 If someone abuses their body, will they still be given a transplant?

Question:
I am doing a research paper on transplantation. Can you please answer
these questions?

1. Prior to a transplant, is life-long abuse of the individual organ
considered in the decision-making process?

2. If there is a choice between two patients, one who took care of an
organ, but it fails and the other who abused it, who gets the organ?

Answer:
The answer to both your questions is: NO, whether one's conditions is
self inflicted or not is not considered when allocating organs. Basing
allocation on a judgment of whether one's condition was self-inflicted is
simply not possible. Supposing that it is possible is far too simplistic
a view. Where would the line be drawn between someone that is "worthy" to
receive an organ and someone that had created their own problem and was
therefore not "worthy"?

Show me one adult human being alive that has never done something that
was known to be contrary to their health. Well, one little steak with
fries and lots of salt didn't cause anyone to get high blood pressure and
kidney failure and heart disease, did it? How about eating these foods
once a week; once a night? How about one glass of wine a night? An
occasional binge with the gang? Cigarettes that were smoked in an era
when everyone else smoked? What if someone was "stupid" enough not to
quit their job if it caused them to be exposed to a hazard, like
second-hand smoke? All of these behaviors cause diseases that may be
treatable by transplantation. What about the person that foolishly didn't
adhere to his doctor's advice to have a treatment that may have avoided
the need for a transplant? ("If that guy had only taken his blood
pressure medicines, he wouldn't have gotten kidney failure, therefore we
should withhold a kidney transplant because he is to blame for his
disease.") Is such a person less to blame for their disease than the
person who drank excessive amounts of alcohol when everyone in the room
was doing the same thing? Who is going to define just how much abuse was
permissible? What about the person that "abused" his heart by choosing to
have a job with a high amount of stress? Many occupations are known to be
associated with higher rates of heart failure. Do people in those
occupations deserve a heart transplant when someone who chose to be a
librarian needs the heart as well? What about the person who was abused
by their spouse and dealt with it by drinking alcohol to excess? Are they
not accountable for their disease? It is known that abused people tend to
drink too much. Do we want a medical system that defines exactly how we
have to live in order to be judged worthy of care? Organ transplant is
THE standard of care for chronic liver, kidney, heart and lung failure.

The amount of alcohol necessary to cause liver failure is extremely
variable. It is a misconception to suppose that everyone that has liver
failure from alcohol was a worthless boozing leach on society. Most
alcoholics are genuinely surprised to find out they have liver failure
from too much alcohol because they drink the same amount as their
buddies. Would we be judging them unworthy because of the fact that their
disease was self- inflicted, or because they were too naive to realize
they had a disease? There are people that probably could not drink enough
alcohol to damage their liver if they had to, and there are people that
can get liver disease from 4 drinks a day.

Organs are allocated based on need, fairness, and the likelihood that the
organ will succeed in restoring health. Patients that continue to abuse a
substance are not candidates for transplants. Patients that attend
alcohol rehabilitation, and are able to change their ways, are candidates
to receive a life-saving organ. If we were to hold them accountable for
past mistakes, we would be forced to hold every transplant patient
accountable for their mistakes out of fairness, and this would not be
possible. In general, if a patient does not follow medical advice when
caring for a transplanted organ, they are not a candidate for a
retransplant, whereas those who take care of their organs can rejoin the
list of those waiting if a retransplant is required.

Jeff Punch, MD (University of Michigan)
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