Woman who was denied a liver transplant, after review highlighted alcohol use, has died
Woman who was denied a liver transplant, after review highlighted alcohol use, has died
Jesus Christ that’s fucked up. Only 36 too and stopped drinking… and had a willing living donor. What do you do in this situation when they won’t help you? Go down to Mexico?
Well, stopped drinking when she got the diagnosis, not before, didn't comply with medical advice to stop drinking before hospitalization, and as they said in the article there are a lot of criteria for a living donation, and it's only an option if you otherwise qualify for a donation because of the possibility of rejection requiring an urgent transplant.
A different article said they were trying to raise funds to get the transplant done at an unspecified European hospital, so "yes". I think it's telling that they didn't go to the US, a north American country, or specify the country.
It's worth remembering that the only people who can talk freely are the people who were decided against and are talking about suing.
No one wanted her to die, but with organ transplants it's a case where you're more or less picking who will die. Phrasing it as being punished for bad behavior is unfair to the people who need to decide which people are likely enough to benefit, which isn't easy.
Jesus Christ that’s fucked up. Only 36 too and stopped drinking…
From the article:
Amanda Huska died Aug. 15 after spending six months in an Oakville, Ont. hospital.
and:
Huska, he said, stopped drinking as soon as she was diagnosed with Alcohol Liver Disease on March 3
So that sounds like she was immediately admitted (which implies she was already very sick) and only was sober in the hospital. In my opinion, that doesn't qualify for "stopped drinking" and unfortunately she didn't get a chance to prove whether or not she was actually able to stop.
I was reading through the article and I think the policy in question is this
Transplant guidelines in Ontario and much of Canada require patients with ALD to first qualify for a deceased donor liver. If they don't meet that criteria, they aren't considered for a living liver transplant, even if one is available.
Also this
"The sicker someone is, the more they benefit from getting an entire liver from a deceased donor, as opposed to part of the liver from a living donor," said Dr. Saumya Jayakumar, a liver specialist in Edmonton and an Associate Professor in the Faculty of Medicine & Dentistry at the University of Alberta.
"On the off chance their (living) liver doesn't work, they urgently get listed for a deceased donor," said Jayakumar. "We need to make sure that everyone who is a candidate for a living donor is also a candidate for a donor graft as well, " she added.
As for why that is, I'm not familiar. I've asked someone else and I'll edit in more if I learn more
And why the fuck is alcohol taxed so damn high then? I thought that was the compromise.
Partial transplant from a living donor was not viable for her. It would have immediately failed, leaving her with no liver at all, and then she would have died because she wasn't eligible for a full transplant. Doctors will not perform a procedure that guarantees death. The article explains this
There are more people who need transplants than there are organs, so the medical profession has to make decisions about who to deny. This was a reasonable decision, in my opinion.
In Canada, drinking more than 3 drinks per week is medically considered "high alcohol use" for a woman... (6 for a man). This limit keeps getting lower year after year
If this can prevent you from getting organ transplants, then it encourages lying to your medical doctor about your current habits... That lady was not considered alcoholic, she just used alcohol in greater amount than the limit considered acceptable by doctors.
Latest stats show that almost 4 out of 5 people has exceeds that limit at some point in their life. This woman died only because she was honest with her doctor about her alcohol use. (Note that the article says her partner was a compatible donor but the system refused to accept him because she used alcohol. It's not about lacking donors.)
That's total bullshit. As a IT professional I have a nightly drink after work for self medication. Never two. Just one.
The only genuine hint to the real reason of the refusal was "minimal abstinence outside of hospital".
Let me ask you bud, if you needed a liver transplant to continue living, would you have even one drink per week, or would you just quit completely?
Very biased article.
Plus, regardless of her husband being compatible, it still costs the state tens of thousands for the operation. In no way would it be ethical to put a new liver in someone who refuses to completely abstain from alcohol.
I'd be inclined to agree, except that her partner wanted to donate HIS liver and was prohibited from doing so as a living donation due to the alcohol use determination.
Hi, transplanted organ recipient here (heart in my case), please be an organ donor if possible, thanks.
Well I'm signed up, but you'll have to thank me after I actually do it.
I'm quite torn on this issue, my sister donated her kidneys and liver when she died. On one hand people who need an organ, need an organ but on the other hand deceased persons organs are so rare that they should go to those with liver diseases they have no medical control over before those who are sick from an avoidable disorder.
I don't like to think of my sister's liver going to someone who would abuse it over someone who just happen to have a genetic liver issue. She lived a life too short bringing joy and education to many children, her final act saving others would be soured by someone wasting it.
I guess you can also think of alcoholism as a disease too?
I completely agree that alcoholism is a disease, and as with any other disease, we have to look at the survivability if she got the transplant.
Let's be honest, while the article tries to be favourable to the patient, you can piece together the facts and see that her odds weren't good. While she's been sober since she got the diagnosis, it appears she was immediately hospitalised which tells us she was in very rough shape and has only been sober while in the hospital. Even if she was able to stay sober, it looks like the odds with a partial transplant aren't great.
Some could consider it a mental disorder.
Compared to an autoimmune disease that attacks organs and glands, I'd think the autoimmune patient should be top of the list. Probably good that I'm not on death panels though.
It is, or at the very least is a symptom of another one. I have all kinds of addiction issues which is why I must be super careful in my life. I am a former alcoholic who used to drink nearly every day from basically after work until I was too tired to keep going. I also have ADHD and possibly ASD (the latter not officially diagnosed as of now). There seems to be some evidence that those can play a role in addiction.
Maybe if donating organs was compulsory they wouldn't be so rare.
In my country, everyone is an organ donor unless they specifically opt out. Usually due to religion.
I've been seeing organ transportation ambulances near my city's hospital from time to time. It's weird to see, but a good thing.
Since no one has mentioned it, USA has the same policy basically.
And for good reason, really. The supply of livers is too small to save everyone who needs them, so they give them to the people most likely to have a successful outcome. Basically every lived given to one person is sentencing another person to death. That's just reality with supply being what it is.
She literally quit when she was told she had a failing liver that could not recover. Just to be clear, there is absolutely no way in hell that she didn't know she was on the way to killing her liver with her drinking because there are a plethora of signs long before you get to the point where alcohol has destroyed your liver beyond its own ability to repair itself. (Which is incredibly prodigious. The liver is the single most regenerative organ in the human body)
So forgive me if I'm skeptical that she really would have stopped being an alcoholic after she received a liver transplant.
IMO this was a tragedy of her own making and the money and effort in transplanting a liver would have been a complete waste. (Even one offered by her SO.) Especially when there is such a deficit of available organs and the surgeons who do the transplanting are needed for patients who aren't likely to go back on the sauce 6 months later.
In most places, if they've been clean for 6 - 12 months, they are no longer considered alcoholic in terms of transplantation. Similar to Canada
Well this was informative. I will now start lying to my doctor about my occasional alcohol use.
Or maybe read the article?
Occasional alcohol use won't put you in this situation (hopefully you'll never be in this situation for any reason)
However, of the reason you need a liver is that you wrecked your own with booze; you are unlikely to get another one
Same for all the people who eat nuts and get hospitalized as well, pull the plug right? I mean come on, they are lesser humans as we stand on our pedestals and look down on them. /S
Genetics play a huge role in liver diseases. 85% of liver replacements don't come from alcohol. Alcohol in sure is bad for you, but it really is a high horse scenario.
I didn't see in the article if she self-reported alcohol use, or was tested. I'm responding to the comments here about self-reporting.
According to the Summary Statistics provided by Canada at THIS LINK, Notably Tables 2A and 2D.
473 were simultaneously on a wait list in December 2023 and either 7 or 8 of them died awaiting transplant (or maybe gave up voluntarily).
So I'm not saying it's murder or anything, just that in order to prolong your selfish existence you're directly responsible for the death of another. You're an adjacent-murderer.
But it's impossible to know how many livers are or are not available at any given time, so absolutely a little morally ambiguous.
As grim as it might be, transplants are handled by apathetic, risk averse math and little else. Loose organs and surgeons are far from common.
My cousin was a raging alcoholic. He got clean, but not before he fucked his liver right up. I don't know if they even allowed him on the liver transplant list or not, but if he was, he was very low on it. He died in early 2015 at the age of 43.
He'd been drinking since he was a teenager, and he'd sometimes get blackout drunk, getting arrested for public intoxication, etc.
I donated a kidney to a friend earlier this year. The reason his kidneys failed wasn't anything he was at fault for, but even if it had been because of poor decisions he'd made in the past, I still would have given him one of mine. Because people deserve second chances. I can understand not wanting to give a recovering alcoholic a deceased donor's liver, when someone else could receive that liver, instead. But this woman's partner was a match and was willing to donate to her. What's the harm in that? That isn't a liver that could have gone to someone else who needed it. It's a donation that would have either gone to her or no one else. No one could have lost out of the donation had been carried out. This was just cruelty, and now someone is dead. And for what? Because there's a 15% chance (according to studies the article mentioned) that she might have started drinking again???
It's not super clear, but the article makes it sound like if a partial graft from a live donor fails, then the recipient is automatically fast tracked for a new transplant from a deceased donor.
If that's the case then maybe policy should be changed in the case of alcohol abuse.
The policy isn't there just to be extra nice, it's because otherwise the patient dies without a liver.
Since she was too sick for a partial liver transplant, and not eligible for a dead donor full liver transplant, she would have just died.
It might seem cruel but the same is done for a lot of other procedures; if the chance of you dying in surgery is way too high, doctors won't take the risk, they're not executioners.
It's not a moral judgement about her alcoholism, the same would have been true if she had a cancer no surgeon would take on.
If you are going to make alcohol consumption a bar to a liver transplant without making alcohol illegal you should all go fuck yourselves. You had a drink and you should die should not be a thing.
This isn't what happened though. She was addicted to alcohol, per her partner, got diagnosed with needing a new liver, she immediately quit alcohol, and they denied her anyway even though quite a bit of time had passed while she was sober. I am unaware if her liver disease was because of the previous regular alcohol use. It wasn't just 1 drink though.
Yes, organ donation is messed up. I met a girl dying in hospice once. She needed a new kidney. Genetic stuff, and then when she was 15 she tried to kill herself with Tylenol. She got her first transplant before the suicide attempt. She was denied a second one due to the suicide attempt itself. There are only so many organs in the world. She died in agony in hospice, young and covered in calcium deposits.
We punish substance use and mental health so harshly in this country. No one deserves the death penalty for previous substance use, especially for alcohol which is ancient af. It's horrible she was denied when there was a liver already available.
It's horrible she was denied when there was a liver already available.
Any full cadaver liver that could have gone to this woman didn’t get thrown into the garbage — it went to someone else who would have died without it.
As for the living donor liver her boyfriend offered, even though he was a match her level of liver failure likely meant that the partial liver her boyfriend could have donated wouldn’t have been successful. Living donors still need a liver for themselves, and we each only have one full liver — so the best they could have done is given her half a liver. Her condition was too poor for this to have a likely positive outcome, which was why this was also denied.
It sucks, but there aren’t enough donor livers for everyone who needs one. The cadaver liver she was denied however would have gone on to save the life of someone else you’re not hearing about in the press — someone else who may have died without it.
If the unfairness of it all upsets you that much, then make sure you’ve signed your organ donor card, and make sure your family members know and understand your desire to be an organ donor. And encourage the people you know to do the same. This is only a problem because there aren’t enough donor livers for everyone — when you have n livers, at best you can save n lives — and thus having a larger number of donor livers allows for more lives to be saved, with fewer qualifications.
From my limited knowledge organ donation criteria are horribly restrictive on a personal scale but unfortunately make sense on the macro scale. Organs are such a scarce resource that as I understand there's no other option.
This girl's death was undoubtedly a tragedy, but as fucked up it's to say if she lived someone else would probably die in a similar agony. Was she treated fairly - I don't know, can we make this system better - I unfortunately also don't know.
We punish substance use and mental health so harshly in this country
It's not punishment, any chronic illness will make someone ineligible for an organ transplant. It's not saying it's that person's fault, it's a situation of "2 people need this organ, which ever you choose the other will die in agony, one is more likely to live twice as long as the other."
It's incredibly sad to hear someone die of a preventable cause this young, but I can also somewhat relate with the people who reviewed her application.
If a living donor wouldn't have been sufficient, they've now created two patients where they previously had one, and without improving the primary patient's condition. It makes sense that a donor organ from a deceased donor would be preferable.
That said, the current requirement for the patient to meet deceased donor standards for transplantation to be eligible to use a willing living donor make no sense. Both situations should have their own unique criteria, given that a living donor situation involves different risks for both the patient and the donor than a deceased donor situation would incur.
Ultimately this whole situation boils down to a scarcity situation though. If we want to solve this, it will require more people to register themselves as a donor and a review of the eligibility criteria as soon as more donors are available.
And how prevalent and socially acceptable Alcoholism has become.
It's not just acceptable, it's encouraged by the province to keep people from rage quitting their lives here.
Using the most recent data from the Canadian Institute for Health Information on hospital bed costs (2016), Huska’s time at the Oakville hospital likely cost over $450,000 - ($3,592 per day for ICU care) with an additional 61 days in a ward bed which likely cost about $1,200 a day A liver transplant in Ontario is pegged at about $71,000 to $100,000 in Ontario based on data from 2019.
I've come to the realization the only ones getting us off the dark timeline is us. I'm in USA, ready and willing. Thinking through what beginning steps I can take.
I didn't like the cost section, because it felt simplistic. The actual procedure might be "cheaper", but it doesn't take into account the long term costs if something goes wrong with the "cheaper" option. Living liver donation is different from say a kidney, you're taking a part of someone else's liver.
"The sicker someone is, the more they benefit from getting an entire liver from a deceased donor, as opposed to part of the liver from a living donor," said Dr. Saumya Jayakumar, a liver specialist in Edmonton and an Associate Professor in the Faculty of Medicine & Dentistry at the University of Alberta.
"On the off chance their (living) liver doesn't work, they urgently get listed for a deceased donor," said Jayakumar. "We need to make sure that everyone who is a candidate for a living donor is also a candidate for a donor graft as well, " she added.
I worry people are going to see those numbers and run with them, even though there's more to consider than that. Financial calculations in medicine are always difficult, and it feels dirty no matter what
So some rough numbers I found from places online for rough estimates. Also, the link the article has for bed costs is actually to a study on liver transplant costs.
On average, 25 days in hospital between pre/post transplant. Of that, seems like a few days (varies by person) is in ICU. So thats 50 days of beds for the two of them, with say a week of combined ICU time.
Plus two surgeries - the article only takes an average cost of liver transplants, which is not indicative of a second surgery needed for a living donor transplant.
That puts the cost up to ~240,000-300,000. That cost is close enough that I can see it not being a factor for the decision.
The article is not clear. Is the $71k price listed the cost of the surgery itself or surgery + hospital stay?
If it is just surgery then it is a very unfair comparison since the ICU stay would have been needed in either case, and at least some of the days in the ward for recovery.
The provincial governments in charge of our single payor health care system made the conscious decision to keep the liquor marts open while banning in-person sales of tea kettles (and we call ourselves a commonwealth nation!) during a pandemic.
I think our single payor at least partially did this to themselves.
I'm pretty sure people would've stormed parliament if you banned alcohol sales.
Using the most recent data from the Canadian Institute for Health Information on hospital bed costs (2016), Huska’s time at the Oakville hospital likely cost over $450,000 - ($3,592 per day for ICU care) with an additional 61 days in a ward bed which likely cost about $1,200 a day
A liver transplant in Ontario is pegged at about $71,000 to $100,000 in Ontario based on data from 2019. "It's a shame that so much money was spent keeping her alive under such horrendous circumstances and putting her family and her partner under such stress when the remedy was a lot cheaper and could have happened much, much sooner," said Selkirk.
The survival rate of patients with alcohol-related liver disease who receive a deceased donor liver transplant has steadily improved to reach 80–85 per cent at one year after a transplant.
Can anyone make this add up?
Somehow I read the article thinkingshe had a kidney problem which we have two of.
How can her boyfriend even donate his liver? Wouldn't he die?
Something interesting about the liver is that we can regrow it. So it might be possible to take a portion of a liver, put it in another person, and then both those pieces grow into a full or well-enough-functioning liver. I'm not a physician and I don't know if such a procedure has ever been attempted.
I believe that's an established procedure. Both the donor and the recipient regrow full livers from the portion they have. You can only donate once though because of how the new liver tissue is structured. I believe the arteries in the new one aren't in the same place.
Edit: if you read the article it actually tells you her boyfriend was willing to be a live donor.
maybe this is a joke going over my head but you just described a liver transplant. what blew my mind was learning that they don't take the old liver out, they just squish the new one(the healthy liver sliver if you will) in and let it do it's thing
I thought this was about kidneys instead of livers and was very confused.
it's* their fault
@NightOwl brutal
How come we've managed to make artificial heart but not artificial kidney or liver?
Pump make blood go weee
Liver and kidneys have to filter and sort various chemicals to keep them from poisoning your body.
Also, dialysis is a thing, it's just generally external cause of the complexity.
The liver is one of the most complex organs in the human body. It is responsible for a wide spectrum of toxin breakdown and chemical synthesis. The heart only needs to pump blood, though it's uptime is very impressive. If your liver stops working you won't die immediately but if your heart stops working your body will be starved of oxygen in mere minutes. Ultimately though what the heart does is mechanical and simple.
As an alcoholic, I initially agreed. Don't waste a liver on me. Then this:
What the actual fuck.
A partial liver transplant wasn't viable for someone this sick, so when the partial transplant failed, they would have to resort to a full transplant from a dead donor, or she would die in operation.
Since she wasn't eligible, a partial transplant was just a death sentence.
They said it was viable in the early stages, and with a decent success rate. Just not the success rate they wanted, and for some daft reasons you need to be eligible for a full transplant from a dead patient to get a partial transplant from a living donor. Makes no sense.
Liver failure is terminal. She was invariably going to die without the transplant. She wanted to receive the donation, her donor wanted to donate. If the success rate for a living transplant is zero that's one thing, but that's not being claimed here since she wasn't eligible for procedural reasons.
Takes up valuable hospital times
No. A partial liver transplant wasn't viable for someone this sick, so when the partial transplant failed, they would have to resort to a full transplant from a dead donor. But she wasn't eligible, so a partial transplant was just a death sentence.
It’s not like giving away part of your liver is a zero sum game, now that person is at risk of infection, has lesser liver performance, and for what? Someone who has showed they will just continue to harm themselves, and others (the person they’re getting the liver from,) if you allow it?
I don’t know any other surgeons who would do that.
If a surgeon refused to let me save the life of the one person in the world i love then they wouldn't be able to save any more lives after that so add that to your heartless calculations...
Has lesser liver performance? What? Do you understand how a living transplant works? You both regrow a full liver after the procedure, because livers are so regenerative you can make a full one from less than half. This makes no sense to me.
Also she quit for 5 months after she found out she had liver failure.
I'd have supported her paying out of pocket to use the live donor that was willing, but not to use my tax money when it's pretty fucking clear she has no intention of changing.
It's the same reason I'm largely against the Liberal's diabetes funding - ~90% of diabetics are Type 2 (I'm willing to help Type 1's out because it's not their fault) and the vast, vast majority of those are from unhealthy lifestyle even if they are genetically predisposed.
If were going to have a public health system, people should be required to take care of themselves. And no, I'm not talking about the one-off accidents from riskier activities (although I do think people should bear the cost of their own healthcare if it's the result of criminal activities), I'm taking the problems that occur as a result of abusing your body for years or decades.
You've gotten a lot of downvotes but rather than doing that I want to explain to you why your position here is flawed.
First think of every lifestyle activity whether it be food, motorcycle riding, music, etc. Now consider that there are some activities that are statistically safer than others.
If we took your position to the point of being law why would we stop at food lifestyle choices? Why not just any risky lifestyle choices? Eventually you end up with a society where individuals have less choice and freedom and are constantly obligated to live the safest possible lives.
You and I both know that isn't a desirable outcome. We should be empowering people to live the lives they choose and encouraging them to be healthy, not punishing them for make the "wrong" choice.
What a shitty attitude.
On the face of it, this sounds sensible. But, thinking more deeply, who should decide the required amount of care a person ought to take? Ideas about what it means to 'take care of yourself' are varied. And consider that some citizens of this country are simply unable to take the same personal health decisions that others have the privilege to take without a second thought.
What you're talking about here isn't a public system. A healthcare system that only serves certain chosen people is not public in any meaningful sense.
A public healthcare system is imperfect on the whole, but on average, when funded and administered properly, is structured to apportion care based on need, instead of the profit motive. I think that's worthwhile, and the right thing for a society to do from a moral standpoint.
So I drink more pop than I should. Why should I have to pay more for my healthcare than my buddy who had a habit of timing running green lights as soon as they turned green. That isn't illegal, either, yet it's very risky behavior. It didn't work out for him just one time, and he nearly died. Why should taxpayers have to pay for him?
The answer is because the vast majority of us engage in risky behavior, or just have the bad taste of passing on our poor genetics to the next generation, and the social cost for penalizing people for not agreeing with societal norms are too high. This includes drug use, even legal ones like alcohol. Sure, don't spend limited resources such as donated livers on people who aren't willing to make the lifestyle changes required to make it worthwhile, because someone else will probably have to die for that to happen. But if we could make new livers and the price was reasonable, I wouldn't even be against that.
Thats a dark road to tread.
An example,
no alchol consumption is safe, so using your line of thinking you'd need to argue that anyone who partakes of alcohol at any anytime would fall under that line of thinking
https://www.who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health
Processed red meats simailary, especially those treated with nitrites, so those eating bacon, ham etc shouldn't be entitled to public heath care under your reasoning
https://www.cancercouncil.com.au/1in3cancers/lifestyle-choices-and-cancer/red-meat-processed-meat-and-cancer/
Or are those things ok becase you do them ?
On the upside, now you've excluded 95% of the population, public healthcare will be cheap :)
Contra to most peoples thinking, if you're concerned about public healthcare costs, you should "encourage" obesiety and smoking, they all die early, most health care coats are associated with healthy people in their old age. See here
https://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.html
Adults are stupid and greedy, we all are.
Until there is a diet that has long term success for a majority of its users I don't think this mindset is healthy or realistic.
"According to the latest weight-loss research, 95% of dieters end up regaining the weight they lost within two years. Calorie-restricting diets are often successful at helping people lose weight, but they’re very unsuccessful at helping people maintain that weight loss." source
https://diabetes.org/about-diabetes/genetics-diabetes#:~:text=Type%202%20diabetes%20has%20a,also%20depends%20on%20environmental%20factors.
Now that you know you were cruel and wrong about diabetes, what do you have to say? What about the type 2 diabetics that have a perfect lifestyle and still have type 2 diabetes?