There was a time when a person who required a liver transplant through alcohol abuse would have to show a commitment to a life of sobriety, and prove that they had not consumed any alcohol, or alcohol-free substitute drinks for at least 6-months.
If a person was unable to meet these criteria, their request to go onto the liver transplant waiting list would be rejected and possibly reviewed again in a further six months (if at all). Patients would be referred back to the care of their respective GP’s or local hospitals.
Sadly for the patient, this could be seen as a sign of rejection. They could therefore just want to give up and be allowed to slip through the cracks.
I was therefore pleased to read the recent review by the UK Liver Advisory Group recommendations for alcohol-related liver disease referral: basl.org.uk/uploads/LAG%20A...
I post this purely for information for those who may be interested. While there will still be strict rules in place, I believe every case will be dealt with on an individual basis and on its own merits.
Some of you will no doubt know some of the names on this panel. And it’s good to see the British Liver Trust on this advisory panel too.
Written by
Richard-Allen
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Hi Richard, thanks for posting this. Forgive my ignorance but I was wondering what is the legal status of this document. Is this just a recommendation of how the rules should change... or have the new rules come into effect?
While I don’t think there is anything written into law about who gets to have a liver transplant and who doesn’t. There is however in common law the preservation of life. In which everyone's right to life shall be protected by law. No one shall be deprived of his life intentionally.
When it comes to organ transplants there exists a common code of practice amongst all organ transplant centres. They have to weigh up a person’s quality of life, and survival chances. In the case of liver transplants, all of the eight liver transplant centres have agreed to follow the same code of practice. This is why the people named on this panel are representatives of all the transplant centres and include the British Liver Trust.
The idea behind the UK Liver Advisory Group is to provide a code of practise that is agreed upon by all the liver transplant centres, and prevents certain hospitals from doing their own thing.
Not all NHS Hospital trusts are operated in the same way, and in some cases, they have become fragmented. If you take my own local Healthcare setup in North Staffordshire. You have all the GP’s coming under the North Staffordshire Healthcare Trust. You then have the local hospital which is a separate University NHS Trust. Mental Health is yet another NHS Trust, called North Staffordshire Combined Healthcare NHS Trust.
All these trusts operate independently from each other and have their own set of rules and procedures. If a person was to have end-stage liver disease and have an alcohol addiction, they could end up coming under all of these trusts at the same time. The main hospital would only be interested in the liver aspect, the mental health trust is only interested in the person's mental health state. The poor GP is the one who is left trying to coordinate the overall healthcare of the patient.
There was in the past, a chance that if a person was still drinking, the liver transplant assessment panel would deem them to be unsuitable for transplant and would just send them back under the care of their own GP or local hospital. The local hospital might not do anything as addiction is seen as being a mental health problem, and that is dealt with by a different NHS trust. It would fall to the GP to recommend additional support, and this may involve the use of outside agencies like Drug and Alcohol support which is run by the local council and not the NHS. So everything becomes complicated, and people can often fall through the cracks and be forgotten about.
These recommendations by the UK Liver Advisory Group, recommend a greater involvement by the Liver Transplant centres, in that if a person is considered to have mental health issues and possible addiction problems the Liver Transplant centre oversees the support and mental wellbeing and does not just send them back to their GP’s.
Hopefully, a person doesn’t get to feel they are being turned down and rejected.
Hi Richard, I found the reading most interesting of which I then shared with my sister yesterday, I wanted her to know the complex details that go on behind the scenes so to speak on how someone is assessed from all aspects to be allowed to go on a TX list .
Myself, I totally understand the reasoning behind it , my only surprise was that in the social aspect side of it they deemed it more favourable if someone were married /maybe long time partner for support
I'm single, well divorced from a vile nasty man yet I have had more support since I left him etc .. so that's my only gripe really, surely they can't discriminate if your not married ? Or have a long term stable relationship?
Thank you anyway Richard, noticed Andrew holts name mentioned on there
Yes, I know a few names on there including Andy's of course.
Post-transplant, after care is an important factor. After all, a person has just undergone a major surgical operation. A patient is going to be both battered and bruised, and for some, the emotional aspect can be very hard even if they do have someone they can share this journey with.
The after care aspect is important and this should be dealt with prior to any operation, your right that there wouldn't be any discrimination, but provision to post-transplant care would need to be addressed.
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