Heroin, Hooch and Harry Reds..sorry, no organs for you!

[Drunken Monk]

Well this idea hit me yesterday while I was watching Scrubs and I thought, hey why not start off a post about it and throw it out there for a little discussion. The topic has to do with doctors and their right to make a choice when doing surgery involving organ transplants. Basically what that means is, suppose person A has a bad liver and needs a new one..it is up to the medical chief of the hospital, along with his legal consultant, other experienced doctors as well as the assigned surgeon to decide wether person A qualifies for such an operation or not. They call themselves the "ethics committee".


Now, person A can be refused a new liver if :

1) He's an alcoholic or drinks excessive amount of alcohol (a definition which changes constantly and is at best, highly ambiguos.)

2) If he has done drugs in the past and/or uses them recreationally even today.

3) If he smokes and shows no signs of stopping (again a subjective definition.)

4) Even if he doesn't exercise enough and shows signs of obesity, unhealthiness or being physically inactive.


So my question is basically this - what gives this "ethics committee" the right to deny person A an organ and give it to person B instead who has a clean sheet presumably and is free of any of the restrictions that person A has. This committee is basically making a presumption that person A won't appreciate or take good care of his organ and are hence giving it to the other candidate. But what's to say that the other guy won't smoke/drink/do drugs or become a fat lazy bastard sometime in the future?


I agree, there is a shortage of organs and the demands exceeds the supply by far, but instead of picking and choosing like this, wouldn't a "first come, first serve" system be better? Afterall, these doctors are trained to study medicine and medical histories, not the characters and personalities of patients and sometimes I just have a problem with the way these things happen. Was wondering what everyone else thinks...

[Doobz]

well i can see this decision being made with the thought in mind that if an "addict" gets a new organ whats to say he isnt going to fuck the new organ up, and thats a waste of time, money, resources, and the organ itself... i do know that if you are an "addict" in need of an organ, you can be placed on the organ donor list after completing an intensive outpatient rehabilitation program as i had a friend who had to do so... so there i guess you are killing two birds with one stone... so yes i do think thats ethical, and the doctors are the ones who "know best"

and i also know there a certain factors that go into who gets an organ first, because it isnt really a "first come, first serve basis" there are factors that can get you jumped up the list and they go by a point system of compatability between donors and recipitents... it very much depends on the blood type as an O type can recieve any blood type organ, an A type can recieve A or O, B type B or O, AB type A/B/O... and they dont go by RH factors so the negative and positive doesnt matter. They also go by if you want a living or deceased donor, a living donor will get you in quicker as well and has a better chance of working by about 10%. And i know that in the states there are organ banks that put you in a network for comparison with deceased donors organs and if you are a perfect match they will jump you to the top of the list. Other factors are obviously age and "quality of life."

just my 2 cents

dont ask how i know all this :w00t:

[Jacx]

Now, person A can be refused a new liver if :

1) He's an alcoholic or drinks excessive amount of alcohol (a definition which changes constantly and is at best, highly ambiguos.)

2) If he has done drugs in the past and/or uses them recreationally even today.

3) If he smokes and shows no signs of stopping (again a subjective definition.)

4) Even if he doesn't exercise enough and shows signs of obesity, unhealthiness or being physically inactive.


So my question is basically this - what gives this "ethics committee" the right to deny person A an organ and give it to person B instead who has a clean sheet presumably and is free of any of the restrictions that person A has. ...

First..where on earth does it say that about being refused?

Secondly the reason its a bad idea to allow that is becuase u get this:

http://en.wikipedia.org/wiki/Gurgaon_kidney_scandal

excuse me for using wiki but it was the first one when i was looking for examples!

Restrictions cause black markets, black markets cause more death!

Everyone should be auto registered as a donator but have the right to opt out!

[Drunken Monk]

First..where on earth does it say that about being refused?

Secondly the reason its a bad idea to allow that is becuase u get this:

http://en.wikipedia.org/wiki/Gurgaon_kidney_scandal

excuse me for using wiki but it was the first one when i was looking for examples!

Restrictions cause black markets, black markets cause more death!

Everyone should be auto registered as a donator but have the right to opt out!



Well as far as the Gurgaon kidney scandal goes, it is very easy to relate it to a a proposition of black market abuse. However you have to ask the question that perhaps the black market only exists in the first place because of these restrictions on people who need the organs. You're addressing donor issues whereas I'm addressing recepient issues. Ofcourse a donor should have the option of pulling out if he wishes, that's his decision. But what I'm saying is that if a person needs a vital organ, shouldn't he be given that one a first come, first serve basis instead of "ethics committees" making judgements and decisions about it.

I personally find the ethics committees completely redundant and superfluous because the way I see it, they're effectively choosing wether a person lives or dies based on their understanding of human nature, which unlike medicine is an open science and depends on subjective interpretations. My original point was that there's no guarantee a person with a clean record is not going to abuse the organs given to him/her and likewise the person with a dodgy past may have turned over a new leaf. There's just no guarantees whatsoever and that's why I think the first come first serve basis would remove all these technicalities and these unsure methods of distribution.

Here's one of my sources btw - http://atheism.about.com/library/weekly/aa052302a.htm


........


I'm not addressing blood type and Rhesus factor compatibilities, I'm assuming all those have been dealt with in the first come first serve system. That applies to the point system as well. What I'm saying is that why should people be refused if they have alcoholic/drug addicted/smoking/unhealthy pasts. Again, just because a person goes into rehab doesn't mean he's going to quit his addictions and so that doesn't seem very effective in determining organ transplants. Similarly, person who's been clean all his life, may just start doing drugs, excessive drinking or smoking at some point later in his life as well. So again to restate the original point, doctors and ethics committees are making assumptions into human nature which is an unpredictable and highly volatile science (if in fact it can be considered a science at all) and so to eliminate the bias and possible mis-judgements, a first come first serve system would mean indiscriminate availability where the only mitigating factor is time of application and urgency of need.

[Doobz]

well i was just stating my rare knowledge, but it may make these points more easy to understand... and its definitely a possibility that someone that has already recieved a transplant could start using, but assuming that person wasnt a user at the time of the transplant one could assume the odds of the person becoming an addict are pretty slim, and if the person who needs a transplant is an addict we can assume that rehab could help him at some point in time, and by doing so he has the chance to help himself... all in all the process for transplantation is what it is and im sure they do it the best way they can.

and the majority of the decisions by the so called ethics committees are probably to keep the doctors safe from any frivolous or malpractice lawsuits... they look out for there own

[Dai]

I don't believe in this country (UK) any doctors are making moralistic judgments about whether someone gets an organ or not.

The choice will be made to use an organ in someone who may be deemed less deserving by society if their chances are better than someone who may seem more deserving but has lower chances.

For example - someone who through no fault of there own developed cancer which has spread to their liver versus a reformed alcoholic - it's a no brainer - transplanting someone with disseminated cancer is not going to do them much good (if any, maybe a poor example actually) so you'd give the organ to the alcoholic.

Use of drugs/alcohol/cigarettes/obesity/poor physical conditioning will all affect chances of a good outcome to some degree and are legitimate to include in allocating this resource.....to some degree.

Ultimately, when it comes down to it, for most medical problems a person gets you could look at some aspect of their lives and suggest they could have done better....but I think it's a dangerous slippery slope.

[Drunken Monk]

well i was just stating my rare knowledge, but it may make these points more easy to understand... and its definitely a possibility that someone that has already recieved a transplant could start using, but assuming that person wasnt a user at the time of the transplant one could assume the odds of the person becoming an addict are pretty slim, and if the person who needs a transplant is an addict we can assume that rehab could help him at some point in time, and by doing so he has the chance to help himself... all in all the process for transplantation is what it is and im sure they do it the best way they can.



You just proved my point there :)

[Drunken Monk]

I don't believe in this country (UK) any doctors are making moralistic judgments about whether someone gets an organ or not.

The choice will be made to use an organ in someone who may be deemed less deserving by society if their chances are better than someone who may seem more deserving but has lower chances.

For example - someone who through no fault of there own developed cancer which has spread to their liver versus a reformed alcoholic - it's a no brainer - transplanting someone with disseminated cancer is not going to do them much good (if any, maybe a poor example actually) so you'd give the organ to the alcoholic.

Use of drugs/alcohol/cigarettes/obesity/poor physical conditioning will all affect chances of a good outcome to some degree and are legitimate to include in allocating this resource.....to some degree.

Ultimately, when it comes down to it, for most medical problems a person gets you could look at some aspect of their lives and suggest they could have done better....but I think it's a dangerous slippery slope.


Yeah I agree partially with what you're saying and being a doctor yourself, I'd think you'd have the most insight on this issue. My step dad's a doctor too and he was relating one of his stories regarding this earlier and he tried to sway my mind with various examples. I suppose in the UK this topic is less relevant than in the US because this sort of decision making happens there a lot more than here, but there's much more important issues to talk about as far as they're concerned, like HMOs and Med Insurance so I'm not going to do that lol. All I'm saying is, I wish organ transplants were indiscriminate.

EDIT : Sorry about the double post. Was going to copy paste and merge it into the other one but I forgot :hidey:

[Doobz]

lol... fuck you monk... but there is truth to it... and as you posted in response to dai there are other more "important" agendas doctors have here in the states and we have the most fucked up health care system i think but that a whole other topic... i really just started this post to do this :fu2:

[Drunken Monk]

lol... fuck you monk... but there is truth to it... and as you posted in response to dai there are other more "important" agendas doctors have here in the states and we have the most fucked up health care system i think but that a whole other topic... i really just started this post to do this :fu2:


Well :fu2: isn't a proper argument now is it Doobz? Take that shit to AIW :flowers:

[Spork!!!]

Monk, I thain most of us wish transplant lists were "indiscriminate", but the sad truth is there are fewer donor organs than there are ppl. waiting. The doc's have to decide who has the best chance of a successful transplant. One day I guess we will be growing new organs artificially, and the companies doing it will promote drug and alcohol (ab)use so they can sell more livers, lungs etc. Until then, there just aren't enough for everyone.

[Drunken Monk]

Monk, I thain most of us wish transplant lists were "indiscriminate", but the sad truth is there are fewer donor organs than there are ppl. waiting. The doc's have to decide who has the best chance of a successful transplant. One day I guess we will be growing new organs artificially, and the companies doing it will promote drug and alcohol (ab)use so they can sell more livers, lungs etc. Until then, there just aren't enough for everyone.


I think that day grows ever closer Vinnie, I mean check out what they're doing with stem cell research as it is. If I save my kids' umbilical chord, there's a good chance that'll provide cells for the development of cures to various ailments. I just wish the technology was a little more mainstream when I was born so I'd have that luxury as well, but I don't. I'd really love to see a day when the number of organs available matches or even exceeds demands. Just on a side track, would it be too wrong to extract someone's organs after they've deceased? The ones that are functioning well I mean. I wonder what you guys think about that.

[The Wicked One]

This article might bring some weight to the discussion...................


A musician who was denied a liver transplant because he used marijuana with medical approval under Washington state law to ease the symptoms of advanced hepatitis C died Thursday.
The death of Timothy Garon, 56, at Bailey-Boushay House, an intensive care nursing center was confirmed to The Associated Press by his lawyer…. Dr. Brad Roter, the physician who authorized Garon to smoke pot to alleviate for nausea and abdominal pain and to stimulate his appetite, said he did not know it would be such a hurdle if Garon were to need a transplant.
Garon died a week after his doctor told him a University of Washington Medical Center committee had again denied him a spot on the liver transplant list because of his use of marijuana, although it was authorized under Washington state law.

.................................................. ...................

Here was a man who never drank booze,
didn't smoke cigarettes,
& only smoked pot at the recomendation of his doctor.

[Drunken Monk]

This article might bring some weight to the discussion...................


A musician who was denied a liver transplant because he used marijuana with medical approval under Washington state law to ease the symptoms of advanced hepatitis C died Thursday.
The death of Timothy Garon, 56, at Bailey-Boushay House, an intensive care nursing center was confirmed to The Associated Press by his lawyer…. Dr. Brad Roter, the physician who authorized Garon to smoke pot to alleviate for nausea and abdominal pain and to stimulate his appetite, said he did not know it would be such a hurdle if Garon were to need a transplant.
Garon died a week after his doctor told him a University of Washington Medical Center committee had again denied him a spot on the liver transplant list because of his use of marijuana, although it was authorized under Washington state law.

.................................................. ...................

Here was a man who never drank booze,
didn't smoke cigarettes,
& only smoked pot at the recomendation of his doctor.


Brilliant little find (Y) Exactly my point you see..who the hell is anyone to decide wether he does or does not get an organ, and thus effectively, wether he lives or dies.

[DnD]

I believe that untill organs are made more abundant, or the need for them is made less, than this kind of system is a neccesary evil, for reasons allready stated.
It certainly could be improved on though. For substance abuse/behavioural type scenarios, psycologists could be included to assess the individuals likelyhood of continuing such detrimental behaviours, and the possibility of reform. The program could include mandatory rehabilitation and detox. Just a couple of ideas..

One thing is for sure though, I certainly would not want to be in any situation to make these choices for other human beings.

[Dai]

Yeah, I would hate to be the one holding the key to the organs.

Even in the NHS we use psychiatrists to try to assess for example an alcoholic's likelihood of relapse - obviously that can go wrong *cough* George Best *cough*.

But a puff of marijuana, as recommended by your doc - I don't know what the criteria are here but that's extreme.

[HellRaiser]

I read everyones reply and examples etc...
I just don't think even rehabilitation should be included as point from self abusers.

I will just say, if you as an individual is "responsible" for ( input any organ here ) your organ failure
due to excessive non prescribed narcotics, excessive booze or excessive consupmtion of junk food etc,
then technically no one is to blame but that individual for their symtoms and doesn't "deserve" (in my opinion) any transplant.
So, with that said now... I would be strongly voting with offering organ transplants to those who didn't create their organ failure.

[Dai]

I empathise with those feelings at times Hellraiser.

I think it needs to be a choice from society, definitely not from medical professionals. But....if it becomes policy and common knowledge that lifestyle choices will be used to judge responsibility and therefore allocation of organ transplantation people will lie about their habits and it adds a new bureaucratic layer to navigate.

Desperate people will mount legal challenges to such judgments. There is already this problem in relation to lifestyle factors that affect the effectiveness of a treatment (e.g. ongoing alcohol usage for liver transplantation) so it's clearly not totally insurmountable.

[DnD]

Another thing to consider, is that the more intricate the organ donation process is made, the more expensive it becomes and the less likely anybody is to get an organ transplant.