Some ethicists argue that patients with alcohol-related end-stage liver disease (ARESLD) should not be considered for a liver transplant due to the poor results and limited long-term survival. Others argue that since alcoholism is a disease, these patients should be considered for a transplant. What is your opinion, and why?
Mickey Mantle, Baseball Hall of Fame center fielder for the New York Yankees, received a liver transplant in 1995 after a six-hour operation. It took only two days for the Baylor Medical Center’s transplant team to find an organ donor for the 63-year-old baseball hero when his own liver was failing due to cirrhosis and hepatitis. Mantle was a recovering alcoholic who also had a small cancerous growth that was not believed to be spreading or life-threatening.
There is usually a waiting period of about 130 days for a liver transplant in the United States. A spokesperson for the United Network for Organ Sharing (UNOS) located in Richmond, Virginia, stated that there had been no favoritism in this case. She based her statement on the results of an audit conducted after the transplant took place. However, veteran transplant professionals were surprised at how quickly the transplant liver became available. Doctors estimated that due to Mantle’s medical problems, he had only a 60 percent chance for a three-year survival. Ordinarily, liver transplant patients have about a 78 percent three-year survival rate. There are only about 4,000 livers available each year, with 40,000 people waiting for a transplant of this organ. According to the director of the Southwest Organ Bank, Mantle was moved ahead of the others on the list due to a deteriorating medical condition. The surgery was uneventful, and Mantle’s liver and kidneys began functioning almost immediately. His recovery from the surgery was fast.
There were mixed feelings about speeding up the process for an organ transplant for a famous person. However, Kenneth Mimetic, an ethicist at Loyola University in Chicago, stated, “People should not be punished just because they are celebrities.” The ethics of giving a scarce liver to a recovering alcoholic was debated in many circles. University of Chicago ethicist Mark Siegler said, “First, he had three potential causes for his liver failure. But he also represents one of the true American heroes. Many people remember how he overcame medical and physical obstacles to achieve what he did. The system should make allowances for real heroes.”
Mickey Mantle died two months later from cancer.
a. As in the case of the liver transplant for Mickey Mantle, should the system make allowances for “real heroes”? Why or why not?
Student responses will vary. However, if the term hero is used to determine who will receive a scarce organ for transplantation, then who will determine the definition of hero? Should all war heroes or athletes be placed ahead of everyone else for a scarce organ? Many ethicists believe it is better to use more objective criteria, such as ability to recover and the age of the patient. Another approach might be the justice-based approach to rationing, which means that everyone should have an equal chance to the available organs. The seniority method and a lottery approach have been suggested and used in the United States. These are difficult ethical questions to answer, and students should know that there is no one right answer.
b. Some ethicists argue that patients with alcohol-related end-stage liver disease (ARESLD) should not be considered for a liver transplant due to the poor results and limited long-term survival. Others argue that since alcoholism is a disease, these patients should be considered for a transplant. What is your opinion, and why?
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