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7-2: Two Organ Recipient Candidates: Who Will Receive the Liver?

Mr. Mann’s Clinical Scenario

Mr. Mann, aged 50 years, has been a longtime heavy drinker and has liver disease related to alcoholic cirrhosis. He will soon die if he does not receive a liver. He has been unemployed for years and on financial assistance. Mr. Mann has stated that after he receives his new liver, he will try very hard to quit drinking on a long-term basis but he will make no firm promises. He is not drinking now because he is committed to remaining abstinent for the required period of time before the organ transplant and during the recovery process. Mr. Mann is divorced, lives alone, and has two married sons who are not on good terms with him.


Ms. Bay’s Clinical Scenario

Ms. Bay, aged 37 years, has active viral hepatitis C with end-stage liver disease (ESLD). Ms. Bay is a wife and mother of two children, aged 16 and 12 years. The family members are a close-knit family, very active, and well known in the community. Ms. Bay feels critically sick and is often confined to bed and frequently admitted to the hospital. Her medications are Olysio, interferon, and ribavirin, but because of her severely advanced disease, the medications are not as effective as they could be. She is ahead of Mr. Mann on the wait list for a liver. Questions Based on your knowledge of the two diseases, you know that patients diagnosed with alcoholic cirrhosis like Mr. Mann, with a new liver and medications, could have a slightly better success rate and a longer life than do some patients with advanced hepatitis C ESLD, despite the fact that recovering alcoholics may have a high recidivism rate (relapsing to old behavior). Mr. Mann is at the high end of the age range for receiving a liver transplant. On the other hand, Ms. Bay has only a marginal chance of recovery if she gets a liver transplant because her new liver drugs have not yet destroyed the hepatitis C virus; therefore, the virus will continue to circulate in the blood during and after the new liver transplant. As a result, hepatitis C will infect the new liver.

To increase your knowledge for this scenario do the following:

Compare the situations of the two organ recipient candidates.
Read the material about organ transplantation in the chapter.
Search the Organ Procurement and Transplantation Network site (http:// -transplantation/how-organ-allocation -works/ and http://optn.transplant.hrsa .gov/resources/ ethics/) for principles of fair organ allocation, ethics, and other guidelines used by the network to make decisions about organ allocation.

1. The information you have gathered about liver allocation and transplantation provides you with a picture, though somewhat limited, of Mr. Mann’s and Ms. Bay’s circumstances. Which patient would you choose? What is your rationale?



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