Ethics of Liver Transplant Flashcards
1
Q
ARESLD
A
Alcohol related end stage liver disease: alcoholic cirrhosis
- caused by alcohol use/abuse
2
Q
ESLD
A
End stage liver disease: biliary cirrhosis, sclerosing cholangitis
- caused by various things, but not alcohol
3
Q
HCFA recommendation
A
- Medicare should cover transplant surgery for those with alcoholic cirrhosis who are abstinent
- decision: treatment approved by HHS secretary Sullivan, with NO required period of abstinence - no distinction between those who have alcohol liver disease and other types of liver disease
4
Q
Initial considerations - liver facts
A
- livers are non-renewable resource
- more than 1/2 of ESLD patients have ARESLD
- over 120,000 on current waitlist
- over 6000 will die this year
- transplantation requires money and support from the public. without this support, organ might not be donated, or funding might be taken away
- the root cause of ARESLD is clear, the same reason that disqualifies a patient for heart transplant
5
Q
Moss and Siegler’s proposal
A
- those with ARESLD should not complete equally with other candidates for a liver transplant
6
Q
Moss and Siegler’s response to objection
A
- 10-20 years of hard use to develop ARESLD
- alcoholism is a chronic illness, but effectively treatable by programs
- so, it is reasonable to attribute responsibility of ARESLD to the patient
7
Q
Discrimination against those with ARESLD
A
Q: why do we treat ARESLD patients differently than all the other patients whose behaviors put them at risk?
A: because of the extreme scarcity of the resource to treat it
- the resource needed to treat other conditions caused by health-risk behaviors are only moderately or relatively scarce
8
Q
Reason to doubt Moss and Siegler
A
- Alcoholism is the result of a free choice
- but the disease results in a chemical dependency, a biological need
- so, after that point, is the decision to drink a free choice?
- usually, we are only responsible for free choices, not unfree ones
