You walk into a room in the intensive care unit and find a man in his 30s, skin yellow and abdomen swollen with the fluid that accumulates in liver failure. He smiles, even though he is almost always uncomfortable, even though he has not left the hospital in more than a month. Family members sit anxiously at the bedside. The nurses stop by just to say hello.
Without a liver transplant, he will die. Imagine that you are on the committee charged with deciding who gets a transplant. Would you add him to the list of patients waiting to receive organs?
Now open the chart. This is what you’ll see: an unemployed man with a history of untreated anxiety and depression and a recent descent into alcohol abuse. Months of binge drinking have destroyed his liver.
Your job on the transplant committee is to determine whether the patient will realistically comply with the rigorous post-transplant regimen and remain healthy enough for a transplant to be worthwhile.
Would you list him now?
My hospital declined to add this patient — my patient — to the waiting list for a transplant, but another hospital said it would consider doing so. Transplant committees regularly face complicated cases like these, and they also regularly come to different conclusions. These decisions can be especially thorny when the patient has a mental illness. Whom we choose to list for a limited resource, and whom we choose not to, reveals our biases about who is worthy of lifesaving care.
My first experience grappling with such questions occurred many years ago, during my residency. I was on my I.C.U. rotation when we admitted an older teenager who was in liver failure because of a Tylenol overdose. I had never seen anyone that sick. Her blood would not clot. As the toxins that her liver could no longer filter accumulated, she became more and more confused. Her kidneys failed. It was clear that without a new liver, she would die.
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The post When Doctors Don’t Agree on Who Should Get a Transplant appeared first on New York Times.
