this post was submitted on 08 Sep 2024
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[–] [email protected] 154 points 1 week ago* (last edited 1 week ago) (10 children)

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 ~~us~~ is 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.

[–] [email protected] 44 points 1 week ago* (last edited 1 week ago) (3 children)

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.

[–] [email protected] 69 points 1 week ago* (last edited 1 week ago) (4 children)

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.

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[–] [email protected] 12 points 1 week ago (1 children)

Question: are there any countries where this is allowed? Would they have been able to go abroad and do this operation?

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[–] [email protected] 10 points 1 week ago

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.

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[–] [email protected] 90 points 1 week ago (40 children)

As an alcoholic, I initially agreed. Don't waste a liver on me. Then this:

Even pleas for a living liver transplant, with Allan offering to be her donor, were not entertained.

What the actual fuck.

[–] [email protected] 99 points 1 week ago (2 children)

A partial liver transplant wasn't viable for someone this sick, so when the partial transplant failed, they would have to resort to a full transplant from a dead donor, or she would die in operation.

Since she wasn't eligible, a partial transplant was just a death sentence.

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[–] [email protected] 54 points 1 week ago (10 children)

Jesus Christ that’s fucked up. Only 36 too and stopped drinking… and had a willing living donor. What do you do in this situation when they won’t help you? Go down to Mexico?

[–] [email protected] 90 points 1 week ago (9 children)

Well, stopped drinking when she got the diagnosis, not before, relapsed into drinking while on the transplant list, and as they said in the article there are a lot of criteria for a living donation, and it's only an option if you otherwise qualify for a donation because of the possibility of rejection requiring an urgent transplant.

A different article said they were trying to raise funds to get the transplant done at an unspecified European hospital, so "yes". I think it's telling that they didn't go to the US, a north American country, or specify the country.
It's worth remembering that the only people who can talk freely are the people who were decided against and are talking about suing.

No one wanted her to die, but with organ transplants it's a case where you're more or less picking who will die. Phrasing it as being punished for bad behavior is unfair to the people who need to decide which people are likely enough to benefit, which isn't easy.

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[–] [email protected] 50 points 1 week ago (1 children)

Jesus Christ that’s fucked up. Only 36 too and stopped drinking…

From the article:

Amanda Huska died Aug. 15 after spending six months in an Oakville, Ont. hospital.

and:

Huska, he said, stopped drinking as soon as she was diagnosed with Alcohol Liver Disease on March 3

So that sounds like she was immediately admitted (which implies she was already very sick) and only was sober in the hospital. In my opinion, that doesn't qualify for "stopped drinking" and unfortunately she didn't get a chance to prove whether or not she was actually able to stop.

[–] [email protected] 10 points 1 week ago (3 children)

How much do you need to drink to get ALD at 36?

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[–] [email protected] 22 points 1 week ago* (last edited 1 week ago)

I was reading through the article and I think the policy in question is this

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.

Also this

"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.

As for why that is, I'm not familiar. I've asked someone else and I'll edit in more if I learn more

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[–] [email protected] 32 points 1 week ago (4 children)

I'm quite torn on this issue, my sister donated her kidneys and liver when she died. On one hand people who need an organ, need an organ but on the other hand deceased persons organs are so rare that they should go to those with liver diseases they have no medical control over before those who are sick from an avoidable disorder.

I don't like to think of my sister's liver going to someone who would abuse it over someone who just happen to have a genetic liver issue. She lived a life too short bringing joy and education to many children, her final act saving others would be soured by someone wasting it.

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[–] [email protected] 32 points 1 week ago (9 children)

Since no one has mentioned it, USA has the same policy basically.

[–] [email protected] 30 points 1 week ago (2 children)

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.

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[–] [email protected] 28 points 1 week ago (2 children)

As grim as it might be, transplants are handled by apathetic, risk averse math and little else. Loose organs and surgeons are far from common.

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[–] [email protected] 28 points 1 week ago (2 children)

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.

[–] [email protected] 15 points 1 week ago

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.

[–] [email protected] 13 points 1 week ago (11 children)

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.)

[–] [email protected] 30 points 1 week ago (1 children)

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

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[–] [email protected] 27 points 1 week ago (2 children)

Maybe if donating organs was compulsory they wouldn't be so rare.

[–] [email protected] 13 points 1 week ago (1 children)

They still need to be a match

[–] [email protected] 12 points 1 week ago (5 children)

Imagine how many matching organs are just left to rot in the ground.

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[–] [email protected] 13 points 1 week ago (1 children)

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.

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[–] [email protected] 25 points 1 week ago (2 children)

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.

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[–] [email protected] 21 points 1 week ago (1 children)

Hi, transplanted organ recipient here (heart in my case), please be an organ donor if possible, thanks.

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[–] [email protected] 20 points 1 week ago (7 children)

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???

[–] [email protected] 14 points 1 week ago (1 children)

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.

[–] [email protected] 11 points 1 week ago (1 children)

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.

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[–] [email protected] 13 points 1 week ago (2 children)

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.

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