When I was learning about organ donation and being placed on the list there were many questions that I dealt with that were hard to answer. One of my readers posed a question about people receiving an organ transplant who seem to have done the damage to themselves. Some examples may be long time smokers or alcoholics who are on the list to receive an organ transplant. Should these people receive a new organ? Below I have posted the question and my response. I would love to hear your thoughts on the issue. I am not expecting everyone to agree with me, but I would like to know the views AND REASONS FOR THEM that are out there.
Czenfan wrote:
It kinda screws my head up about this guys [The crash recipient] lung transplant .. . because he did it to himself... he is taking someone elses lungs because he didnt care enough about his own life of health to just quit smoking.
To me that undermines the reason transplants exist - I feel they should give a renewed quality of life to someone, and not be a license for someone a renewed chance to abuse their new Lungs, or whatever...
Thoughts !?
My response:
This is a sticky situation as I deal with some of these thoughts about alcoholics receiving new livers. I will try to put my same insight on a lung transplant
My thoughts on this situation depend on whether he quit smoking when he found out he had the disease. If not, I really don't see it fair to give it to him when someone else who has tried to take care of themselves has to wait. In this case, him receiving a second chance just doesn't seem fair.
On the other hand, at 50 years old, he was born in ~1957. At that time, smoking was much more common than today without the known and documented risks. I have a hard time faulting him for something that was accepted socially. I would definitely feel different if he was my age and had been told his entire life that smoking will kill you.
Either way, I am happy that he received the transplant! Now it is up to him to show his donor family as well as his would be donor family (due to the crash) that he was worthy of his lungs. He must do this by taking care of himself and his lungs. He will be in the public eye for a while, so time will tell. This is a touchy situation and exactly why I am glad I am not in the position to make the choice about who gets what available organ.
Let me know what you think! I wouldn't mind getting a little discussion started here, just be tactful!
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About Me
- Josh Carpenter
- I am a 27 year old 5th grade teacher. I had a liver transplant on March 26, 2006. I love to be outdoors whether it is fishing, gardening, hiking, or any other thing that I can do in the sunshine. I live in the North Georgia Mountains, otherwise known as God's Country.
7 comments:
Hi Josh...
This is a somewhat frequent quandry... Whether substance (alcohol or otherwise) abusers deserve livers or kidneys, whether smokers deserve new lungs or hearts, whether obese, food abusers deserve new hearts -- maybe even whether diabetics who did not take appropriate care of themselves during their lifetimes deserve new kidneys...
There are a lot of moral and ethical judgments than can be made as to whether these people deserve another or a second chance at life -- or whether those organs should go to someone the public might feel more "worthy" -- someone whose problem did not come about because of abuse...
I can tell you this -- that gentleman who received the lungs very likely has not been smoking for at least a few years... Every lung program that I know will not accept a patient who continues to smoke, or who they suspect will likely resume smoking post transplant...
I've also been at a few lung transplant lectures given by promanent lung transplant physicians who have stated that they have had a few transplant patients resume smoking -- and within six months of resuming smoking they were dead. (Smoking seems to quickly bring about bronchiolitis obliterans, which is the same way rejection typically manifests itself...)
The media seemed to make a big stink that this recipient was a 50-year-old smoker. Again, doubtless he has not been smoking in a while -- but the media seemed to portray him as if he were smoking in the surgical waiting room before his surgery...
Similarly, with liver transplants for substance abusers -- programs take transplant very seriously and do not want to squander organs donated by incredibly generous individuals and families... They would not transplant a liver or kidney into a candidate who was still actively using or abusing -- or even had reason to believe they would continue after transplant...
We all have issues and moral failings... I have cystic fibrosis and received two beautiful, new lungs about seven years ago... Yes, I have a genetic disease and that was not my fault -- yet, it's entirely possible that I might have taken better care of myself and not needed, or avoided transplant for a long while -- was slacking off now and then a moral failing on my part, similar in some ways, but not quite as "bad" as continuing to smoke even though he should have known it would impact his health?!?! I knew slacking off would impact my health too -- but sometimes it was just exhausting to take complete and proper care of myself... Where do we draw lines as to what one "did to themselves"?
At some point, asbestos workers knew they were potentially damaging their lungs -- should they have left their well-paid field of work and become a WalMart greeter? And if they didn't, should they at least go to the back of the line behind people with "legitimate" illnesses?
A little of my story is here:
www.ClimbingForKari.org
I'll be interested to see where this discussion goes...
Take care...
Steve Ferkau
Chicago, IL
Congrats on your transplant and thanks for joining the discussion, Steve.
I don't know where we draw the line with people taking care of themselves or even if a line should be drawn.
I also had a possibly genetic, autoimmune disease that I had no control over.
I know that at Emory they were very serious about me being compliant with medication, clinic visits, as well as taking care of my new liver. I know that they are the same way with every potential recipient.
Just like you, there were times that I "got tired" of dealing with my condition and did things that were probably not beneficial to my liver. I am glad they didn't send me to the back of "the line" because of a few, in my hindsight opinion, dumb decisions. As for me, drinking alcohol post-transplant would probably destroy my liver in a short amount of time because of the strain on the liver, as well as the reactions with my immunosuppressant medication.
Just as the asbestos workers had to make a choice to stay in that line of work, we constantly have to make decisions as to what is most important in our lives.
For them, making money may have outweighed the risk of cancer. Is that a wrong decision? Making the decision to have a lemonade at dinner instead of a glass of wine is more important to me. Is that a right decision? To echo your question, who draws the line between right and wrong? I don't know that answer.
As I said in my last post, I am glad that I do not have to make the decisions that place people on "the list" or keep them from being placed. The selection committee have to take people at their word and hope they follow through.
It's a puzzlement, alright...
Along the asbestos lines -- cancer is not the only outcome -- lung transplant for asbestos workers due to asbestosis is not that uncommon; we have two recent transplants I'm aware of in our little support group in our center... But "making money may have outweighed the risk" makes it sound less than it may be...
Often when they took the job, they weren't fully aware of the risk -- however, even after they became aware, it then became about supporting their family -- living in a decent neighborhood... sending their kids to decent schools and college... Getting them appropriate medical care. They had a job that covered all of that -- many other available jobs today likely would not come near that...
Similarly, you brought up smoking back to the 50s when the risks weren't completely known (or at least more covered up...) and someone getting hooked... Today you've got high school kids and early college who are back to smoking -- they're making a mistake, possibly due to their lack of maturity -- how much and how long do they pay for that mistake?
And like you, our center is very serious about compliance -- before and after transplant -- and the before transplant performance can cause one to be put "on hold" or dropped from the list if it is felt it is a good indicator that the patient will not be compliant post transplant... As you know -- this is a serious little situation and blowing off various meds can throw us into rejection or worse very quickly... It would be unconscionable to give someone a gift like that if you KNEW they were going to waste it. Of course, the problem is truly knowing...
If the choice was mine to give two lungs to a 20-year-old who suffered their entire life with cystic fibrosis, or a 60-year-old whose emphysema was caused by smoking -- I'd probably go with the 20-year-old... I'm kinda glad I'm not in charge though...
UNOS guidelines, and sometimes more importantly, transplant center guidelines work to weed out situations like this. The various entities that determine who gets what are so very aware how precious this resource truly is. They would not knowingly transplant an active smoker -- they would not knowingly transplant an active/drinking alcoholic -- and as for "knowingly", it's not easy to get around that...
A reasonably big problem would be where to draw the line -- a HUGE percentage of the problems requiring organ donation involve some sort of self-abuse. Smoking and substance abuse are obvious -- but so many heart issues are due to over eating or poor diet... And even genetic and other diseases that are supposedly out of the realm of control of the patient -- are sometimes more controlable than we'd like to think...
Could a juvenile diabetes patient have rebelled during his/her teen years and let their disease worsen when they could have maintained better care? They're paying for it in their 40s-50s... Do they deserve an organ less?
With my cystic fibrosis -- surely there were some infections I could have jumped on more quickly, but I was too busy at work or with life and didn't want to spend two weeks in the hospital, so I put it off 2-3 months and it caused more damage... Did I deserve lungs less?
I think we all effup some times in some ways, just some are more obvious than others... The difficult question is when does it impact your opportunity for a second chance, and who decides.
You take care, Josh -- interesting argument...
Steve
I have lived a fairly healthy life, knock on wood. However I find this interesting. From reading Josh's blog and from my mother recently recovering from lung cancer I find myself on both sides of the fence. No, I do not ever believe that a current abuser, current being they key word, should be given an organ that could save someone who is not abusing their lungs, liver, heart. But at the same time I feel the line that is drawn is a tough one to define. My mother smoked from the time she was a teenager (mid 50's) and by the time smoking became an issue she had already been smoking for too many years to simply put them down - or at least she thought. She tried the patch a few times but ended up always going back to the cigarette. Then she was told she had lung cancer, nothing will cure you from smoking like being told you have lung cancer. Luckily they were able to remove the cancer by removing only 1/4 of a lung and it had not spread. However, if she had been diagnosed with emphysema instead would she have deserved the chance to live any less than the surgery removing a portion of her lung gave her? Personally I think not, especially if she made the same commitment to quit that she did when the cancer struck her. The key is being able to really tell the current abusers from those who have made and are living with the commitment to stop.
Thanks for the comment Lisa. I think that you are probably on the same page as Steve and I concerning this dilemma.
My grandpa smoked from the time he was 8 until he was diagnosed with lung cancer as well. He had half of his right lung removed and about a year after the surgery he started smoking again. The cancer returned and he had 1/4 of his left lung removed. Since then he has quit for good. The difference I see between your mom and my grandpa is that your mom was compliant after she found out about the cancer where my grandpa wasn't.
This may sound bad, but from an objective view, I would probably be against my grandpa getting a new set of lungs while I would be in favor your mom being transplanted. Of course, him being my grandpa I would fight tooth and nail for him to get one though I doubt he would take it if given the chance.
I think that everyone can put on a good show to get what they want. They can act compliant when in reality they are not. I know that is why in the transplant community having a support group in place is so important. At Emory, they make sure you have people in place who care about you and want you to be healthy. Part of the transplant process involves determining their commitment to you. This weeds out many of the people who may abuse themselves after transplant, though it keeps some deserving people from receiving a transplant as well.
I do not believe it is really up to us who gets what or if they really deserve it. I totally believe that God takes us when it is our time to go and he allows people to live because he is not finished with what he has planned for them during their lifetime here on earth. Some people might continue to smoke after recieivng a transplant but they might be doing something totally awesome in other areas of his / her life that touch people in some other way. Maybe that person has someone in his / her family that smokes and they see what this person is going through and how they recieved a second chance through a transplant and maybe that scared them enough to stop smoking before it go to the point where they need a transplant. I have never needed a transplant but there are things I have done in my life that there are times I ask myself why am I still here? We all do things that harm our bodies at one time or another, it may just not be as obvious as smoking or drinking.
Julie
anonymous, I don't fully believe that God takes us when it's our time. That removes free will, in which he has given us. Predestiny may also mean we have already been selected for hevan or hell based on if we have asked for forgiveness or not. Still, it's a different discussion for another blog.
As for the ethics, no one has touched on it, but I will. What about a lifelong criminal in perfect health? Should they get an organ transplant before a chain smoking pillar of the community?
No matter what, someone loses. There has to be a death in order to have an organ donor. A life is extended by receiving a transplant. So, right now, one of the rules is the overall health. WHile the MELD scores are based on health, perhaps they could put in another criteria based on what others think of you. Extend the process to 50 peers from family, work and community. How's that for an idea?
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