Q:

Dear To Whom,
I am one of a team of doctors who made the decision to deny a 22-year-old man a liver transplant. The man, who was an alcoholic, died this week after the panel and I refused to give him an emergency liver transplant. Donor organs are in very short supply and it is because of this that we are forced into making very difficult decisions like this every day. The young man was 11 when his parents split up and he turned to alcohol, by 13 he was binge drinking and at 22 he ended up in hospital with severe liver failure.

Donor livers are in such short supply that one in six of those who are accepted with a wide range of liver disease, will die before they get their transplant. But that doesn’t make our decision about this young man any easier. His mother and doctors are bitter that the patient never “got a second chance” because it was the first time he’d presented to hospital with an alcohol related problem. The patient and his mother said he did not realise that he was developing cirrhosis of the liver until he was admitted to hospital for the first time 10 weeks ago.

The mother insisted that he didn’t know what he was doing when he was 13. She said her boy was “desperate to recover” and had recently tried to give up. He’d even signed up for support group Alcoholics Anonymous just weeks before he was taken into hospital. Did we do the wrong thing by denying this person a second chance?

Dr I.G, London, UK.

A:

It’s so hard to make the decision to give up on anyone. There is never enough hard evidence. We never really know who will make changes and who will not. Despite research on treatment outcomes, there are always exceptions, and each exception is a life.

I gave up on a boyfriend once, Dr I, a ‘hopeless’ alcoholic and heroin addict, and someone I still can’t let go of in my heart. He died three years after I gave up even speaking to him. I regret every one of those conversations we didn’t have in those years. I still talk to him, but as the years go by it’s getting harder for me to imagine his side of the conversation.

Measuring worthiness can only ever be an inexact science, and perhaps it is these very measures and their inadequacy that have led to your questions here. How do you decide who gets a chance at survival? I understand there is a process, and colleagues with whom you confer. We all need to pretend there is some kind of order in the chaos of existence. But this does not sound as if it is shielding you from the enormous responsibility of your role. I cannot imagine the burden you bear, I can only hope you carry it with respect.

Any decision that we make that can hold up, that we can stand by in the case of life and death, must surely be made with those who will have to bear its consequences. Somehow we have lost the decision making process here in our focus on an illusory right and wrong.

To even imagine that one person is more deserving than another, that one week is worth less than one year, to hold up the possibility of fairness to those who are dying, is a sham. There is no fairness here. I can’t imagine there is a right decision either. Only the possibility of a decision that has right ownership.