Liver Transplants for Alcoholic Patients: Should they be placed on the Waiting List for an Organ - Thesis Example

? Liver Transplants for Alcoholic Patients: Should they be placed on the Waiting List for an Organ? of the Nursing of the ConcernedProfessor May 30, 2013 Liver Transplants for Alcoholic Patients: Should they be placed on the Waiting List for an Organ? Simply speaking, a liver transplant tends to be a surgical procedure that is carried on the patients suffering from liver ailments, so as to save their life. Liver transplant involves the replacement of a diseased or malfunctioning liver with a healthy liver or a segment of the donated healthy liver. A liver transplant is a standard procedure that is mostly performed on the patients suffering from a liver failure. A large number of liver transplant procedures are carried out every year (Lucey, Merion & Beresford, 1994). The livers that are transplanted in the liver transplant operations are mostly received from the patients who are dead and have consented to their livers being transplanted in the patients who are alive and have a dysfunctional or non-functioning liver. The second group of liver donors happens to be individuals who are alive and donate a portion of their healthy liver to a patient who has a sick or non-functioning liver. As liver transplant is a procedure that is replete with ethical ramifications, the objective of this paper is to discuss the two opposing ethical arguments pertaining to the issue under consideration, for there is present an intense controversy regarding whether the alcoholic patients ought to be placed on the recipient list for the donated organs, irrespective of the fact that every patient has a right to have access to any available treatment, regardless of one’s disease (Brudney, 2007). A healthy liver may get damaged owing to a plethora of reasons are they accidents, substance abuse and drug abuse, reckless smoking, alcoholism, inhalation of harmful or poisonous gases from the surrounding environment for prolonged periods of time, and wasting diseases that eventually lead to liver damage. All the patients that suffer from a liver damage owing to either of the reasons mentioned above are usually, urgently in the need of a liver transplant, in case there is available a health donated liver, and the patient being on top of the waiting list contrived for selecting a liver recipient is the one that is considered for a transplant (Lucey, Merion & Beresford, 1994). However, there is a range of ethical issues that govern the practice of liver transplant and the selection of a specific patient who is to receive a donated liver. These ethical issues may include whether the individual whose liver got damaged owing to substance abuse like reckless smoking, drug addiction and consumption of alcohol be considered for a liver transplant, in the presence of patients who are young and did not develop liver issues owing to substance abuse (Bramstedt & Jabbour, 2006).? Should the concerned authorities stick to the waiting list procedure to allocate the donated livers, even when the probable recipient may be an alcoholic, or should the patients who got sick owing to other reasons and do have a higher chance of survival ought to be considered first? Should people who are young and have families and children be given precedence over people who are alcoholics, while allocating the donated livers? No wonder, the number of ethical questions that are imminent on the issue as to whether the alcoholics be placed on the waiting list for donated livers in the face of the fact that there are many other sober patients who developed liver ailments owing to no reason of their own making is limitless (American Association for the Study of Liver Diseases, & International Liver Transplantation Society, 2000). These questions could be answered from a range of perspectives like the personal perspective of a particular individual, from the ethical perspectives upheld by the society in particular, and from the perspective of medics and nurses that owe allegiance to the Hippocratic Oath that stresses on saving the life of any individual irrespective of the cause of one’s illness. In the light of these individual and ethical perspectives, the pivotal question is that should the patients who have damaged their livers owing to an excessive consumption of alcohol and drug abuse be considered for liver transplant (Petechuk, 2006)? A viable answer to this disturbing and confusing question could only be facilitated in the light of the ethical beliefs and morals of the individuals who are required to deal with such issues on a daily basis. People who hold an adverse opinion pertaining to substance abuse and alcoholism and consider unrestrained alcohol consumption to be immoral and unethical may prefer not to place the alcoholics on the waiting list for organs. In contrast, the medical professionals like doctors and nurses have the ethical guidelines imminent to their profession which may strictly restrain them from evolving a subjective opinion pertaining to the placement of alcoholics on the recipient list for the donated organs (American Association for the Study of Liver Diseases, & International Liver Transplantation Society, 2000). No doubt, the topic under consideration is of immense importance and relevance for the nursing profession. During the normal course of their line of duty, the doctors and nurses are continually required to decide whether they need to save the life of a particular patient, or should they place the medical needs of certain patients above certain other types of patients. The pressure of according preferential treatment to certain patients is a dilemma that the nurses face on a regular basis. Hence, a viable ethical catechism regarding this topic will be of unprecedented importance for the nursing profession as this will allow them to have a more meditated insight while making the decisions, which are of life and death significance. This will facilitate general ethical guidelines as to whether to allocate livers to individuals who have pursued a reckless lifestyle that involved substance abuse, drinking and smoking that consequently damaged their healthy livers or should the precedence in the matters of receiving donated livers be given to the sober patients who got their livers damaged owing to some accident or disease (Blumstein & Sloan, 1989). View 1/Thesis: Alcoholics should be placed on the organ list. There are valid ethical lines of argument that hold that the alcoholics should not be discriminated against and they have every right to be placed on the list of individuals who are in the need of a liver transplant. It sounds fair and true to believe that each and every person on the earth has one’s distinct life style and the life style of an individual should not prove to be a primary impediment when it comes to taking important and crucial decisions regarding one’s health and well being. Hence, it is unethical to place the alcoholics at a lower level on the list of people in the need of a liver transplant. The life of each and every human on this planet is worth the same and it will be absurd to say that a particular person has less of a right to live as compared to any other person. Thereby, non-alcoholics patients need not be given a preferential treatment as compared to the alcoholics on the list for organ transplant. The alcoholics need to be placed on the organ transplant list in the order of criticalness of their condition or as per the other statutory criteria that are used to determine the place of a person on the list for organs (Blumstein & Sloan, 1989). The second premise that needs to be considered is that no individual’s life could be deemed to be perfect and every person has his or her peculiar weaknesses or fragilities. Hence, if one goes by the argument that alcoholics ought to be placed lower on the organ list, there is no dearth of experts who may extend this argument to propagate that people with certain sexual preferences should not be placed on the organ list, or people with criminal background should not be placed on the organ list, or immigrants should not be placed on the organ list, or, perhaps non-vegetarians should not be placed on the organ list. If one curtails the rights of the alcoholics in the sphere of organ transplant, nobody knows where this line of argument will end up. Many patients who have their names on the organ list may agree to certain risky behaviors they engaged in, in their past. This will be totally prejudicial on the part of health professionals to penalize alcoholics owing to their risky behavior and not the other patients (Cherkassky, 2011). The other valid point is that no expert or health practitioner could be extended the ultimate power to decide about the right to live or die for a person. No expert or ethical school could be granted a God like power to decide on the life of any person. It is some higher and unknown power that extends life to people and takes it away and human beings, however ethical or well informed are too imperfect to decide upon such matters (Everson & Trotter, 2009). The thing is that alcoholism like any other disease is a disease and it would be absurd to penalize an alcoholic for being the victim of a disease that is perhaps beyond one’s control. Many people who are alcoholics got glued to this addiction owing to a variety of factors that happen to be genetic, social, academic, economic and ethnic in their origins and one simply cannot blame an alcoholic for being totally responsible for falling victim to an addiction. Even more unethical and unjust would be to remove alcoholics from the organ list. The other thing is that many alcoholics do try hard to divest themselves of this addiction, but fail to do so owing to a lack of proper treatment, scarcity of resources or lack of care. Hence, it is appropriate to extend to the alcoholics a fair chance to live by placing them on the list for organs. Perhaps, a liver ailment may turn out to be a wakeup call for many sick alcoholics and may motivate them to abstain from drinking for ever (Everson & Trotter, 2009). View 2/Antithesis: Alcoholics need to be given a lower precedence on the waiting list for donated organs. A more conservative ethical line of action suggests that the patients who are alcoholics and are in the need of a liver transplant should be placed lower on the liver transplant waiting list. This ethical standpoint may accrue support based on a number of premises. First and foremost, this will drastically reduce the demand for donated livers and will assure that people who are in dire need for a liver transplant get the donated liver. This is because the current supply of the donated organs is really low as compared to the overall demand for the donated organs. Owing to this scarcity of the donated livers, many patients have to die in the absence of a timely liver transplant. Hence, if one takes into consideration the existent scarcity of the donated livers, it will be unjust if not unethical to divert these livers to the people who have damaged their healthy livers from the reasons of their own making like smoking, drugs and alcoholism (Trzepacz & DeMartini, 2000). The ethics of placing the alcoholics low on the list of donated organs could also be justified in the light of the benefits accrued by the sober patients who receive a timely liver transplant. The patients who could be expected to make ample use of their new life they gained by a timely transplant and could be expected to live their lives to the fullest should be considered higher on the recipient list as compared to the alcoholics who damaged their livers by their reckless lifestyle and hence are more likely to damage the received liver in the future (Trzepacz & DeMartini 2000). This is because there is a high precedence that the individuals who are given to alcoholism are more likely to revert back to their erratic lifestyle, once they are relieved after a successful liver transplant (Cohen, 1991). Hence, transferring livers to alcoholic patients amounts to abject wastage and imprudence and thereby the alcoholics must not be given a priority when it comes to allocating the donated livers (Blumstein & Sloan, 1989). The other reason that discourages the placing of alcoholics high on the organ list is the effort and resources being invested in the contemporary times to educate the masses as to how to lead a healthy life and the relative benefits of pursing a healthy lifestyle. There is no denying the fact that a majority of the masses in the developed nations do have access to the information regarding the harmful effects of smoking, drug abuse and alcoholism and how these addictions play havoc with their health and organs like lungs, liver, heart and kidneys. Even, in the ready existence of such a knowledge and information, if a person chooses to be an alcoholic or engages in the inordinate consumption of alcohol, and ends up being on the list for organs like liver, than, but naturally, it is a tragedy of one’s own making and hence must invite little medical sympathy and dedication of resources as compared to people who pursued a healthy lifestyle, but still got sick. Thus, it will be totally rational to not to place the alcoholics on the organ list (Blumstein & Sloan, 1989). Conclusion: Personal View In conclusion, it will be too simplistic and reactionary on my part to assume that alcoholics should not be considered for a liver transplant or they should not be placed on the list for organs. In an ethical perspective, I believe that alcoholics do deserve a right for availing the available treatment. However, considering the fact that the supply of donated livers is scarce and the number of patients requiring livers at any time is too high, the placing of an alcoholic on the list for organs should be subject to certain preconditions and stipulations. Any alcoholic while being placed on the organ list must be required to register for getting treated for one’s alcoholism and only when a body of concerned experts verifies in writing that there is a minimal chance of the concerned alcoholic suffering a relapse that one should be gifted a liver transplant. This may sound too unfair to some people, but what is the use of donating a much vaunted organ to an individual who is not likely to reform and respect the life one is being gifted, while many other deserving candidates are waiting in line. References American Association for the Study of Liver Diseases, & International Liver Transplantation Society (2000).Liver transplantation. Hoboken, NJ: Wiley & Sons. Blumstein, J. F., & Sloan, F. A. (1989).Organ transplantation policy: Issues and prospects. Durham: Duke University Press. Bramstedt, K.A, & Jabbour, N. (2006). When Alcohol Abstinence Criteria Create Ethical Dilemmas for the Liver Transplant Team, Journal of Medical Ethics, 32(5), 263-265. Brudney, D. (2007). Are Alcoholics Less Deserving of Liver Transplants? When does Behavior Trigger a Lesser Claim to Medical Resources? When does Chronic Drinking for Example , Mean that one has a Lesser Claim to a Liver Transplant? Only when One’s Behavior becomes a Callous Indifference to Others’ Needs- When One Knows the Consequences of Heavy Drinking and Knows that by Drinking One may End Up Depriving Someone Else of a Liver. The Hastings Center Report, 37(1), 41-44. Cherkassky, L. (2011). The Secret World of Liver Transplant Candidate Assessment, Medical Law International, 11(1), 23-44. Cohen, C. (1991). Alcoholics and Liver Transplantation, The Journal of American Medical Association, 265(1), 1299-1301. Everson, G. T., & Trotter, J. F. (2009).Liver transplantation: Challenging controversies and topics. Totowa, N.J: Humana Press. Lo, B. (2009). Resolving ethical dilemmas: A guide for clinicians. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Lucey, M. R., Merion, R. M., & Beresford, T. P. (1994).Liver transplantation & the alcoholic patient: Medical, surgical, and psychosocial issues. Cambridge: Cambridge University Press. Petechuk, D. (2006). Organ transplantation. Westport, Conn: Greenwood Press. Trzepacz, P. T., &DiMartini, A. F. (2000).The transplant patient: Biological, psychiatric, and ethical issues in organ transplantation. Cambridge: Cambridge University Press. Read More