NEWS : 25.2.10 - Dying drug addict refused second liver transplant

[kingpin007]

Dying drug addict refused second liver transplant

CATHY O'LEARY MEDICAL EDITOR, The West Australian February 25, 2010,2:35am

Claire Murray is a 24-year-old mother of two who has only months to live if she does not have a liver transplant, but she is being refused a place on the waiting list for a donor organ.

Her family knows her case will polarise views because she has abused heroin in the past.

She even took drugs after her first transplant last year to treat acute liver failure caused by 12 years of addiction to amphetamines and heroin.

That donor liver has now failed, and doctors at Sir Charles Gairdner Hospital have told her parents, Michael Murray and Val Milne, they cannot consider her for a second transplant.

Ms Murray's family accepts she continued to abuse drugs after the surgery but argue that the success of the transplant may have been limited because of issues with the surgery and inadequate rehabilitation.

Nationals MP Vince Catania and Labor MP Martin Whitely are campaigning for the mother of Chloe, 5, and Taj, 4, to be given another chance.

Mr Murray said yesterday his daughter had been a happy and healthy A-grade student at a Perth private school before being diagnosed with attention deficit hyperactivity disorder at age 12. She was prescribed dexamphetamines and began abusing the drugs, later moving on to speed.

"We feel one thing led to another, and ultimately her addiction, and that's when our problems began," he said.

Mr Murray said his daughter had been on the methadone program before her transplant and was deemed fit for the surgery but he did not believe she was properly followed up to ensure she did not continue to abuse drugs.

Ms Murray's mother had given up work to support her and she had been clean of drugs for eight weeks.

"She now has three to six months to live," he said. "We're very aware that if Claire goes back on the list it doesn't mean she's going to get one and it's not necessarily going to save her life. But everyone deserves another chance."

Ms Murray said she felt far more prepared and determined to make the most of any chance she was given.

A SCGH spokeswoman said the hospital operated a world-class liver transplantation unit that met Transplantation Society of Australia and New Zealand protocols for eligibility and had exceptionally high survival rates.

It denied that surgical care or post-operative treatment were lacking or contributed to Ms Murray's outcome.

Late yesterday, Health Minister Kim Hames said Ms Murray did not meet national guidelines for a transplant and it was not reasonable to provide an organ to her when there were seven West Australians waiting for their first transplant.

He said 19 liver transplants were carried out in WA last year, and three people died waiting for a new liver.
But he said the State Government was prepared to pay for his Mr Murray and his daughter to go to New Zealand for the case to be reviewed by a specialist experienced in "live" liver transplants, which used a piece of a liver from a living family member.

http://au.news.yahoo.com/thewest/a/...-drug-addict-refused-second-liver-transplant/

 

[kingpin007]

Wtf she got a transplant but still took drugs ....

give this liver she wants to a sick child I say !!!!!

 

[Dankness6669]

whatever.

 

[Romie1092]

Oh shit this is a very tricky topic, was going to say she deserves a second chance but she already had a transplant and continued with the drug abuse. I dont know what to say, one part reckons she still deserves another transplant but another part reckonsd she should be left to die as she already got given a second chance. Not many people get second chances. You'd think after a near death experience from the first transplant she might of learned to respect herself. She'd probably do the same thing if given another transplant.

 

[Dragynfyr]

How good could the transplant liver have been if she blew it out that quickly?

 

[chemi]

Dankness6669, thanks for the contribution 8)

What a joke that girl is, how disrespectful to the family who donated the first liver. If I ever got so bad I had to have organs transplanted before I was 25, I'd be reshaping my life so fast...

 

[phase_dancer]

Mr Murray said yesterday his daughter had been a happy and healthy A-grade student at a Perth private school before being diagnosed with attention deficit hyperactivity disorder at age 12. She was prescribed dexamphetamines and began abusing the drugs, later moving on to speed.

She's not the first one I know of to go onto speed from dex and later have problems with addiction. FWIW I think you're all being far too judgmental here. Perhaps, if there were enough organ donors, it wouldn't be such an issue.

 

[chemi]

^ of course, however the fact remains that there ARE limited donors, very limited; that's what makes this all the more shocking (and to be honest, disgusting) IMO

 

[TripppAR]

I always say to my girlfriend whenever the anti smoking adds come on, that i don't really feel sorry for the croaky old man who died later after the filmimg.

He KNEW what was coming, and i think that if you want to continue to pump nicotine (or in this case heroin, amphets) then you kind of have it coming. Fair enough for her to get a 2nd chance..but a 3RD CHANCE!? Is she fucking for real?

There are (as stated) alot of other people waiting for a liver that to be honest, i think deserve it more then her. Even if the others are chronic alcoholics etc...its their 1st transplant. I would have the same thing to say if it was an alco that just kept drinking after teh transplant...if you can take the gift of life and just spit it back in someones face, you deserve to die..

Could sound harsh..but i mean come on. Yeh we are all drug users and feel for one another and whatever. But this is outrageous.. I mean even putting in a request to be thrown to the top of the donor list is incredibly selfish. She wants to live longer so she can bang more drugs, simple.

And of course she will use her children as the argument. Its bullshit..

 

[Crankinit]

Honestly, I can't support the idea of another liver being given to her. She had her chance and she blew it, organs are a valuable resource and why the hell should somebody already proven too irresponsible to handle that gift be given it over somebody who will take the precautions and utilize it properly.

When there's a very finite supply, it should go towards saving the life of a person who has the responsibility to preserve it, not to someone who will most likely just destroy it yet again, leaving another sick person in need of a transplant to die.

 

[phase_dancer]

The thing about liver transplants is that you don't need a whole organ. Indeed, 3/5th can be cut from the liver and it will grow back. Living donor transplants are commonplace these days, so why should it be such a problem.

Living donor transplantation

Living donor liver transplantation (LDLT) has emerged in recent decades as a critical surgical option for patients with end stage liver disease, such as cirrhosis and/or hepatocellular carcinoma often attributable to one or more of the following: long-term alcohol abuse, long-term untreated Hepatitis C infection, long-term untreated Hepatitis B infection. The concept of LDLT is based on (1) the remarkable regenerative capacities of the human liver and (2) the widespread shortage of cadaveric livers for patients awaiting transplant. In LDLT, a piece of healthy liver is surgically removed from a living person and transplanted into a recipient, immediately after the recipient’s diseased liver has been entirely removed.

Historically, LDLT began as a means for parents of children with severe liver disease to donate a portion of their healthy liver to replace their child's entire damaged liver. The first report of successful LDLT was by Dr. Christoph Broelsch at the University of Chicago Medical Center in November 1989, when two-year-old Alyssa Smith received a portion of her mother's liver.[5] Surgeons eventually realized that adult-to-adult LDLT was also possible, and now the practice is common in a few reputable medical institutes. It is considered more technically demanding than even standard, cadaveric donor liver transplantation, and also poses the ethical problems underlying the indication of a major surgical operation (hepatectomy) on a healthy human being. In various case series the risk of complications in the donor is around 10%, and very occasionally a second operation is needed. Common problems are biliary fistula, gastric stasis and infections; they are more common after removal of the right lobe of the liver. Death after LDLT has been reported at 0% (Japan), 0.3% (USA) and <1% (Europe), with risks likely to decrease further as surgeons gain more experience in this procedure.[6]

In a typical adult recipient LDLT, 55 to 70% of the liver (the right lobe) is removed from a healthy living donor. The donor's liver will regenerate approaching 100% function within 4–6 weeks and will almost reach full volumetric size with recapitulation of the normal structure soon thereafter. It may be possible to remove up to 70% of the liver from a healthy living donor without harm in most cases. The transplanted portion will reach full function and the appropriate size in the recipient as well, although it will take longer than for the donor. [1]

Living donors are faced with risks and/or complications after the surgery. Blood clots and biliary problems have the possibility of arising in the donor post-op, but these issues are remedied fairly easily. Although death is a risk that a living donor must be willing to accept prior to the surgery, the mortality rate of living donors in the United States is low. The LDLT donor's immune system does diminish as a result of the liver regenerating, so certain foods which would normally cause an upset stomach could cause serious illness.
[edit] Liver Donor Requirements

Any member of the family, parent, sibling, child, spouse or a volunteer can donate their liver. The criteria for a liver donation include:

* Being in good health
* Having a blood type that matches or is compatible with the recipient's
* Having a charitable desire of donation without financial motivation
* Being between 18 and 60 years old
* Being of similar or bigger size than the recipient
* Before one becomes a living donor, the donor has to undergo testing to ensure that the individual is physically fit. Sometimes CT scans or MRI are done to image the liver. In most cases, the work up is done in 2-3 weeks [7]

[edit] Complications

Living donor surgery is done at a major center. Very few individuals require any blood transfusions during or after surgery. Even though the procedure is very safe, all potential donors should know there is a 0-5 to 1 percent chance of death. Other risk of donating a liver include bleeding, infection, painful incision, possibility of blood clots and a prolonged recovery.[8] The vast majority of donors enjoy complete and full recovery within 2-3 months and obtain tremendous satisfaction in having given someone a new lease on life.

So, everyone wins

 

[fatstep]

How would using heroin/amps fuck your liver anyway, unless she shot a batch with hepatitis in it? It couldve just been a nearly fucked liver from the get go.

 

[ayjay]

This is very sad. The article doesn't say, but I assume the original liver failure occurred from hep C. Pretty unlucky for hep C to lead to liver failure in a decade - but not impossible I guess. Hep C is the leading cause of liver failure in Australia but unusual to see this happen in someone so young.

As to why the transplanted liver didn't last that long - apparently them's the breaks with liver transplants. You're looking at about 5 years on average for a transplanted liver - if you get 10 then you are lucky. To get only a year is unlucky but not extremely so. It's a bit judgemental of the hospital to refuse her another liver.

And on that note, I must slip into Nanna mode - you people who posted above with your judgemental rubbish should be ashamed of yourselves!! This isn't the Herald Sun comment board!! Of course she kept using drugs after her transplant - wouldn't you? You all need to take o good long look at yourselves!! Now I'm going to have 3 xannies and a lie down - I'm getting overheated...

 

[Crankinit]

And on that note, I must slip into Nanna mode - you people who posted above with your judgemental rubbish should be ashamed of yourselves!! This isn't the Herald Sun comment board!! Of course she kept using drugs after her transplant - wouldn't you? You all need to take o good long look at yourselves!! Now I'm going to have 3 xannies and a lie down - I'm getting overheated...

It's a choice between the liver going to save someone who'll take good care of it, or it going to someone who'll most likely just trash it again. That isn't judgemental, it's a a no-brainer.

Of course some people did raise some good points, how exactly did heroin/speed use ruin her liver to the point of needing a transplant? If it was Hep C, you'd think they would mention it.

 

[phase_dancer]

Thanks ayjay for that info.

I'd like to see what some of the above posters are like later in life and what habits they take on that they find hard to impossible to shake. From some of the comments posted on use/abuse patterns, some of you fit the bill all too well. Don't think that because you're 20 something and only use once a week/ month that things can't possibly change in the future. I've seen plenty of addicts not become addicts until their 30s and even 40s, and one or two in their fifties - people that never, or seldom used drugs in their younger lives. But I suppose you're all so content with life and have rock solid willpower. Good on you then, you're better than most people I've met. When I knock on your door in 10-15 years time, of course you'll be happy, secure, and addiction free 8)

So keep your judgmental comments to yourselves or go somewhere they're welcome. How do you know the complete story? Most of you are all too eager to criticize a newspaper article spouting shit or incorrect facts about your favourite drug - to a point it's often pathetic - yet you're ready to back a story like this, and effectively state you'd be willing to condemn a person to death if it was your choice

And you're not in Nanna mode ayjay, just that it must look like that to the immature among us. To those he was referring to, I say grow the fuck up, do some community work and lose that disgusting attitude, or at least one thing will go from Aus DD for good.

Notice the incredible degree of self control I'm exercising here...it's not worth the hypertension ayjay, but things are certainly hanging by a thread....

 

[hyroller]

How would using heroin/amps fuck your liver anyway, unless she shot a batch with hepatitis in it? It couldve just been a nearly fucked liver from the get go.

toxic substances need to be excreted from the body somehow.
booze (for example) doesnt go straight from your throat to your peehole - it has to be broken down by the body first, and when it is constantly forced to kick into overdrive to filter out mass amounts of toxins.... of course it's going to fail! 8)
(added to the possibility of contracting a hepatitis infection.... the odds were against this girl from a young age...)

I'm divided over this one. The fact that she has two young kids really shouldn't make her a target for everyone's superior judgement

 

[Crankinit]

Thanks ayjay for that info.

I'd like to see what some of the above posters are like later in life and what habits they take on that they find hard to impossible to shake. From some of the comments posted on use/abuse patterns, some of you fit the bill all too well. Don't think that because you're 20 something and only use once a week/ month that things can't possibly change in the future. I've seen plenty of addicts not become addicts until their 30s and even 40s, and one or two in their fifties - people that never, or seldom used drugs in their younger lives. But I suppose you're all so content with life and have rock solid willpower. Good on you then, you're better than most people I've met. When I knock on your door in 10-15 years time, of course you'll be happy, secure, and addiction free 8)

So keep your judgmental comments to yourselves or go somewhere they're welcome. How do you know the complete story? Most of you are all too eager to criticize a newspaper article spouting shit or incorrect facts about your favourite drug - to a point it's often pathetic - yet you're ready to back a story like this, and effectively state you'd be willing to condemn a person to death if it was your choice

And you're not in Nanna mode ayjay, just that it must look like that to the immature among us. To those he was referring to, I say grow the fuck up, do some community work and lose that disgusting attitude, or at least one thing will go from Aus DD for good.

Notice the incredible degree of self control I'm exercising here...it's not worth the hypertension ayjay, but things are certainly hanging by a thread....

Well maybe the way I worded it was a little extreme, but it's quite simple when you break it down. If she failed to take care of the first one, there's absolutely no reason to believe she won't fail to take care of the second one. Therefore, the liver should go to someone who can fully utilize it, as opposed to someone who will, in all likelyhood, trash it and be back in 12 months for a third. It's wasted on her unless there's some way to guarantee that she'll stay sober this time around, which there isn't.

It's not a question of condeming someone to death or not, but a question of who you condemn to death. If there's one liver, and more than one person who needs it, it either goes to someone who'll have their life extended by years, or someone who'll be in the same situation in 12 months time. There's absolutely no way to justify forcing someone else to go without the liver just so you can give it to someone who it probably won't help significantly anyway.

For it to go to the addict, someone else has to miss out. Why would you deny someone an organ so it can go to someone who'll just trash it anyway?

 

[footscrazy]

It's easy to sit here and say she should have stopped using drugs after her first transplant. But a wake up call is not a cure. She'd still face all the same struggles anyone else battling with addiction does. Relapse is part of addiction and recovery.

That being said, I don't think she is the most worthy of the too few donor livers available.

 

[Akhenaten]

Addiction is an extremely difficult place to be, and Heroin addiction is serious especially if you have taken it over a sufficient period of time to develop physical and psychological dependence. People die as a result of complications from withdrawal (including the usual psychological disturbances, but haemmorrhaging can also occurr).

Without appropriate support (including withdrawal management) addiction can be extremely difficult to break. Ask anyone who delivers services to addicts. If this young woman did not receive appropriate support to manage withdrawal and emotional support after the procedure then it is very likely that she would continue with abusing drugs.

I think this is not so much an issue of allowing or dis-allowing a transplant, but whether appropriate support and services were delivered to her in the first place to help her overcome the addiction during the run up to, or after the first transplant. Would the outcome have been different? Without knowing much more about the background it is difficult to say.

On a personal note, my mother is addicted to cigarette's. She smokes 40 a day, and spends her mornings coughing a choking cough that is sometimes laced with blood and it won't be long before she requires oxygen tanks at home to help her breathe. She has tried to give up but can't, and time is getting shorter. She knows that she will not get a transplant, she knows this and despite that fact she will not stop. Addiction is not trivial and is not something that can be quantified easily by anyone else other than the addict.

Tomorrow the addict will wake and find themselves in the same situation, with the same options, with the same circumstances, and the same capabilities as the day before. Nothing changes until something changes.

 

[ayjay]

If she failed to take care of the first one,

Ahh - there's the rub. You are confusing correlation and causation. She used drugs after her transplant, and her transplanted liver is still failing. That doesn't mean that the drug use caused that failure - you are just assuming that. Liver transplants just don't last that long, as I said above. Even if she becomes a complete abstainer such as yourself, she will still need another 5-10 transplants over the course of her life.

And of course - even if her drug use is affecting her liver adversely - really how very human of her. We all do things that are less than ideal for our health. It's very easy to say how we would do things differently if we were in someone else's shoes - but really that's bollocks.

Finally - be very careful entering into calculations of "worthiness" to receive health care. That is a very slippery slope my friends!!!