Wednesday, July 22, 2009

British man, 22, dies after being denied liver transplant

'Please help me Mum, I don't want to die': Last words of Binge drinker Gary Reinbach in hospital with his mother Madeline Hanshaw shortly before he died

Doctor's refused to give Gary Reinbach a liver transplant because of strict rules about who can or cannot be a candidate for the life-saving procedure. Gary had been drinking since a teenager and it ruined his liver. Readers can decide for themselves whether or not the hospital made the correct decision.

The sad case of a young sick British man has raised new questions about the fairness of the rules for organ transplants.

ABC News, Australia

Gary Reinbach, 22, an alcoholic, died yesterday after authorities in the UK refused to give him an emergency liver transplant.

Doctors there said he could not jump the queue and had not served the mandatory six-month period of being sober before having the operation.

Gary Reinbach was 11 when his parents split up. As a youth he turned to alcohol, by 13 he was binge drinking and at 22 he ended up in hospital with severe liver failure and in desperate need of an organ transplant.

Professor Ian Gilmore is a liver specialist at the Royal Liverpool Hospital. He told the BBC Gary Reinbach was unlucky to be in his position at such a young age, and that the odds were stacked against him.

"The saddest aspect of this case is it's because of the severe shortage of donors livers that these decisions are faced every day," he said.

"And we know, for example, that those who do get onto a liver transplant list will wait on average more than three months before finding an organ.

"One in six of those who are accepted with a wide range of liver disease, will die. One in six dying before they get their transplant."

Professor Gilmore says it was a hard decision to say no to Gary Reinbach and his family.

"It's never one single person's decision, it's a multi-disciplinary team that review it, it's made on practical grounds," he said.

"We know that these patients, who present very acutely like this with no past history, actually don't survive transplantation as well as some other groups."

'Tough calls'
Jeremy Chapman is a Professor at Sydney University and currently the President of the International Transplantation Society.

In general terms, he says scarce resources have forced tough calls to be made on the suitability of the patient for an organ transplant.

"Two things that matter in this situation, the first is waiting list acceptance - how does a patient get onto a transplant waiting list?," he said

"And secondly, once they're on a waiting list, how does the allocation of what is still a very rare and precious resource get made?"

And does the behaviour of the patient become a factor for example in the case where it is liver damage caused by alcohol, is it absolutely imperative that they give up alcohol?

"The criteria for acceptance onto the transplant waiting list are to do with, first of all, whether a transplant is actually needed, and secondly what the outcome would be after transplantation," Professor Chapman said.

"It is pointless trying to put somebody onto a transplant waiting list when you know that their success after transplantation would be very poor."

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