http://www.watoday.com.au/wa-news/premi ... -p8vr.html

Was this the right ethical decision?

Personally I don't think its the right decision, and I don't know how it was made, given that lots of people die on the waiting list or are too sick by the time their turn for a new liver comes up.

Possibly Colin Barnett made the decision based on all the admittedly moving media coverage that has been given to this case. If he did that, it shows a lack of statesmanship. Much as I disliked John Howard, I had to admire his ability to make tough decisions in cases such as these.

In New Zealand they do live liver transplants, it would be more fitting for the state government to make moves to develope that technology here. It starts a dangerous precedent when people can trash a precious donated liver and then expect another one.

There are actually two separate decisions here which have ethical implications.

1. She has been denied a place on the waiting list for a transplant of a whole organ from a deceased donor. This is because she previously had such a transplant, and relapsed into drugtaking which is seen to have contributed to the failure of that transplant. As a result of that she is not seen as a likely prospect for a successful second transplant – the assumption is that if she relapsed before, she is at increased risk of relapsing again. Places on the waiting list go to those for whom the procedure is judged most likely to be successful. This is – ostensibly - not a moral judgment about whether drugtaking is good or bad, but a pragmatic judgment about whether someone with a history of drug abuse is less likely to benefit from a liver transplant.

2. Given that she does not qualify for a whole organ from a deceased donor, she wants to explore the option of a “live transplant” – the transplant of liver tissue from a living donor which – it is hoped – will regenerate into an entire liver. The prospects of success for this operation are not great, but it’s now the only chance of survival she has. The donor would have to be a close relative, to ensure the best chance of tissue matching. In addition, the procedure is risky for the donor as well as the donee – having a large chunk of your liver removed is dangerous - so only someone very close to the patient is likely to volunteer/ But all of that does mean that, if the procedure does go ahead, it will not be at the expense of any other person needing a liver transplant, and therefore this is not a reason to deny her the possibility of the treatment.

What Hames has agreed to do is to pay for this patient to go to New Zealand to be assessed as a candidate for a live transplant. It is the practice of the WA Health Department, in relation to unusual procedures not available in WA but for which the patient is otherwise qualified, to pay for patients to get the treatment in another state. In this instance live transplants are not done anywhere in Australia, and Hames has agreed to fund at least the exploratory trip to New Zealand, where they are done.

It seems to me that the second decision is a no-brainer. This patient has been denied a chance of a whole liver because of the limited supply of whole livers, and the need to prioritise those most likely to benefit from a whole liver transplant. However that issue simply does not arise in relation to a live transplant; she is not competing with other patients for a chunk of (say) her father’s liver. And the cost of the assessment in New Zealand is unlikely to be very great; from the newspaper coverage, the airfare seems to be the largest element of the cost.

However, a third decision with ethical implications looms. Suppose she is assessed as suitable and (say, again) her father is a suitable donor and agrees to donate. Will WA pay for the procedure to be performed in New Zealand? Presumably this will cost a great deal of money, its prospects of success are uncertain, and it poses some danger to the donor, her father. Yes, it may save the life of a young mother and possibly alter forever the course of the lives of her two sons but, still, is it the best use of a health budget which is not unlimited? How do we prioritise health expenditure? Are our moral views about drugtaking relevant at all?

The cost of this assessment visit, obviously, is not great.

101,

I don't belive it was right or ethical.

Quoting from the article.

Health authorities ruled the 24-year-old mother-of-two, Claire Murray, ineligible for a second transplant because she continued to take drugs after her first transplant.

I have always been lead to believe that in order to get a transplant you have to be clean for some period of time prior. So it means this person made a concious decision to resume taking drugs even though she had been provided a second lease on life and she had two children that were dependent on her.

Why should the resources of society be used on her yet again?

I'm 101% with 101 on this, there are obviously many more deserving cases for the spending of public money; if someone wants to finance her trip, operation and care then that is another matter, providing always that the NZ system has the room for her and no one there will be disadvantaged.

Well, because she's ill.

That's generally why we treat people, and we don't generally ask how they became ill, or make treatment decisions based on whether we consider that they fell ill in a morally acceptable way.

The reason that she has been denied a second donor liver transplant is because the supply of donor livers is limited, and they are assigned to those for whom they offer the best chance of success. Her history of relapsing drug abuse is the reason she has denied a transplant, but that is a clinical, not a moral, judgment. If she had metastatic cancer in any organ she would also be denied a transplant, or a pulmonary condition, even though they normally raise no moral issues.

The issues are slightly different when it comes to tissue transplantation for a live donor. If this patient has such a transplant, it will not be at the expense of a transplant for someone else, since the donor who is willing to donate 70% of his kidney to this patient is unlikely to be willing to donate it to anyone else. Thus denying her a transplant does not enable us to give a transplant to someone else.

Assuming she is assessed as suitable, all the indications are favourable, etc, then the only reason to deny her a transplant would be to save the cost, not to give a liver to someone else. But I think we go down a very slippery slope if we deny somebody medical treatment because we disapprove morally of the circumstances in which they fell ill. This isn’t an enquiry we normally make in relation to medical treatment; why should we make it on this occasion?

Very Insightful, perengius