Monday, August 31, 2009

We regard transplanted organs as a gift, not as a medical right

This father should think again before demanding a new liver for his alcoholic son

Anjana Ahuja TimesOnline

One can imagine the surprise of the barman who went to serve Gareth Anderson. The 19-year-old wandered in to a Belfast pub last week, and asked for a drink. Nothing wrong with that, except that Anderson was clad in hospital gown and slippers, accessorised with intravenous drip needles in his arm. Sensibly, the barman refused to serve him, and rang the Ulster Hospital opposite.

Had the barman known the reason for Mr Anderson’s hospitalization, he might have been less measured: the teenager is awaiting a liver transplant, precipitated by a blowout weekend fuelled by 30 cans of lager. The young alcoholic is now in a London hospital, which has refused a transplant unless he stays dry for six months (as is requested of all potential liver recipients whose condition is drink related). Mr Anderson’s father, meanwhile, is planning legal action to overturn the six-month ruling.

There is much to rue in this story, not least an alcohol-worshipping culture that is now corroding the health of ever-younger drinkers. It is regrettable that donated livers are in such short supply; if they were not, Mr Anderson could have received a new organ and resumed his normal life (minus the booze, we hope).

But it is his father’s determination to resort to law that strikes me: surely his protective paternal instincts could have been deployed much earlier, including handcuffing his son to the hospital bed (he would surely find any judge sympathetic).

Brian Anderson admits that his son is an alcoholic. Alcoholism doesn’t happen overnight. According to a petition set up in Gareth’s name, he has been drinking from an early age. So what was Mr Anderson Sr doing when his son took the first steps on the lager-lined road to the emergency ward?

It may seem harsh that doctors will not make an exception, given that Gareth is critically ill. Their stance would also seem perverse in the face of research published in the British Medical Journal in 2004 that looked at liver transplantation for people who had drunk themselves into ill health. The authors wrote: “The length of abstinence before transplantation does not reliably predict abstinence afterwards, so no justification exists for a fixed arbitrary period ... death may be the price of proving abstinence.”

So it may be in Mr Anderson’s case. And there has been wide discussion of whether it is wise or justified to make moral judgments when deciding whom to treat. Doctors advise against rationing on moral grounds.

This is why we give chemotherapy to the woman who smokes 40 a day, and stomach-stapling to the man addicted to doughnuts. It would be an unkind and unjust society that did otherwise.

But organ donation is trickier. A liver that goes to Mr Anderson is a liver that is denied to somebody else. If he is seeking lager (beer) from the comfort of his hospital bed, can we be confident that he will spurn it when discharged? Here is the nub: we regard organs as a gift, not a medical right. These precious, limited resources flow not from drug companies or government coffers, but from the untimely misfortune of others (including, in China, from executed prisoners, it seems). That is why we resist the idea that they should be traded for money, like so many bags of sugar or barrels of oil.

So we ask that those who want them demonstrate that they are worthy of such largesse. In Mr Anderson’s case, it is six months on the wagon. The six-month rule is as much about making liver transplants for alcoholics socially palatable as it is about the chances of relapse.

Youth is not a compelling reason why Mr Anderson should jump the queue: he might be more deserving than a 60-year-old unreformed soak, but, hand on heart, I do not see why he should usurp, say, a 30-year-old father who has shunned the bottle for six months because it is his only chance to watch his children grow up.

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