GROUP TO SET POLICY ON ALLOCATING LIVERS : SETTING A POLICY.Byline: Jessie Milligan Scripps McClatchy Western Service Remember Mickey Mantle Noun 1. Mickey Mantle - United States baseball player (1931-1997) Mickey Charles Mantle, Mantle ? The self-professed slugger of baseballs and alcohol drew public criticism when, after a short wait for a donor, he received a liver transplant liver transplant Hepatic transplant Transplant surgery A procedure that replaces a cancer conquered, metabolically defeated, or substance subjugated liver with one no longer required by its owner, many of whom donate same after an MVA Diseases requiring transplant in June 1995 and died two months later of cancer. Even before Mantle's death, the question of who should receive a scarce supply of livers sparked debate over issues of medical ethics medical ethics The moral construct focused on the medical issues of individual Pts and medical practitioners. See Baby Doe, Brouphy, Conran, Jefferson, Kevorkian, Quinlan, Roe v Wade, Webster decision. and politics. Lately, it's been heating up. A decision on how to allocate livers may be made as early as this week's meeting of the United Network for Organ Sharing United Network for Organ Sharing See UNOS. , the private, nonprofit group that sets policies on the routing of donated organs. Here's the question it will be considering: Should donated livers stay in-state, or should they go to the most acute patient in the region? The answer may make a big difference to smaller transplant centers. ``If they want us to export more livers, we wouldn't have enough in our own state,'' said Laurie Garretson, executive director of New Mexico New Mexico, state in the SW United States. At its northwestern corner are the so-called Four Corners, where Colorado, New Mexico, Arizona, and Utah meet at right angles; New Mexico is also bordered by Oklahoma (NE), Texas (E, S), and Mexico (S). Donor Services. Nationally, the demand for livers outpaces the supply by 10-to-1 - 40,000 recipients wait for what is normally 4,000 livers donated each year. The United Network for Organ Sharing earlier this year had proposed sending donated livers anywhere in the nation, wherever there were the most acute patients. But doctors at smaller transplant centers feared that would deprive their programs. Dr. Bijan Eghtesad, director of the transplant program at the University of New Mexico's University Hospital, joined 83 other small transplant centers in writing a letter opposing sending livers to the most acute patients in the nation. The most acute patients are often those who have had a failed transplant and are awaiting a second transplant at one of the nation's larger centers, such as the Mount Sinai Medical Center in New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of or the University of Pittsburgh Medical Center The University of Pittsburgh Medical Center (UPMC) is a leading American healthcare provider and institution for medical research. It consistently ranks in US News and World Report's "Honor Roll" of the approximately 15 best hospitals in America. . ``It is not fair to supply just the bigger programs,'' said Eghtesad, director of the liver transplant program that started at University Hospital in April 1995. ``We would expect they would come up with a way to reciprocate re·cip·ro·cate v. re·cip·ro·cat·ed, re·cip·ro·cat·ing, re·cip·ro·cates v.tr. 1. To give or take mutually; interchange. 2. To show, feel, or give in response or return. v. .'' The United Network for Organ Sharing decided against sending out the livers anywhere in the nation and now is considering whether they should be sent within the region or stay within the state. New Mexico is part of what the United Network calls the five-state Southwestern region. That region includes California and its much larger transplant centers. One change already has been made in liver allocations. In January, a new policy went into effect that says people with chronic liver disease Chronic liver disease is a liver disease of slow process and persisting over a long period of time, resulting in a progressive destruction of the liver. It includes amongst others:
Priorities for transplants Heading the list to receive livers are acute patients. Acute patients are those who have just received a transplant that is failing or those who have ingested in·gest tr.v. in·gest·ed, in·gest·ing, in·gests 1. To take into the body by the mouth for digestion or absorption. See Synonyms at eat. 2. poison, for instance, Eghtesad said. The policy that places chronic patients second on the list of recipients isn't meant to shun alcoholics or drug abusers, said James Wolf, medical director of the United Network for Organ Sharing. ``We're trying to select out the smallest group of patients who could benefit the most,'' Wolf told the Associated Press Associated Press: see news agency. Associated Press (AP) Cooperative news agency, the oldest and largest in the U.S. and long the largest in the world. when the policy change was announced late last year. Eghtesad at University Hospital said ethical debates shouldn't cast a shadow over liver transplants. ``I don't want to enter into the social background of patients,'' he said. ``I can't put the blame on someone who killed their liver by drinking alcohol. I can't blame someone who 20 years ago tried intravenous drugs. What about the guy with the big steak who killed his coronary arteries Coronary arteries The two main arteries that provide blood to the heart. The coronary arteries surround the heart like a crown, coming out of the aorta, arching down over the top of the heart, and dividing into two branches. and now wants a heart transplant, or the guy who smoked for 30 years? ``The issue is: Are they going to go into failure?'' Lifestyle matters Nonetheless`, the lifestyle of patients does enter into medical decisions. The liver serves as a filter, and thus can be damaged by illness and disease, including blood-borne sexually transmitted diseases Sexually transmitted diseases Infections that are acquired and transmitted by sexual contact. Although virtually any infection may be transmitted during intimate contact, the term sexually transmitted disease is restricted to conditions that are largely , such as hepatitis C Hepatitis C Definition Hepatitis C is a form of liver inflammation that causes primarily a long-lasting (chronic) disease. Acute (newly developed) hepatitis C is rarely observed as the early disease is generally quite mild. , and by lifestyle choices, including the use of alcohol and intravenous drugs. ``An active drinker should not be a candidate for transplant,'' Eghtesad said. ``I would hesitate to give a liver to patients who said they just had a half-bottle of whiskey. If they are not compliant with the order not to drink, they would also be noncompliant with medication. ``With a shortage of organs, we cannot use it for someone who wouldn't take care of it,'' Eghtesad said. A few hospitals will not perform liver transplants on any alcoholic, even one who has been sober for three years, said Dr. John J. Fung, chief of transplants at the University of Pittsburgh Medical Center. The United Network for Organ Sharing and Eghtesad say donations of organs are of critical concern. The national waiting list for livers has increased from 15,000 patients in 1987 to more than 40,000 in 1997, according to the United Network for Organ Sharing. At the same time, the number of livers harvested each year has grown only from 3,500 to 4,000. |
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