Outline
1. Pros and Cons of Liver Transplant
A. Ethical Issues
B. Solutions
2. Pros
A. Argument
B. Questions
3. Cons
A. Argument
B. Questions
4. Conclusive Argument
Pros and Cons of Liver Transplant
Liver transplantation involves surgical procedures to substitute a failed liver in a recipient, with a healthy one from a donor. Organ transplant has been one of the medical advances in the recent past. However, it raises several ethical issues regarding the donor and recipient. Vital organ failure and decreasing organ pool has been related to the long waiting periods and mortalities. Methods of allocation of these organs have also raised a concern since they are cited as being unjust. Besides, minors have been involved in organ donations, which question their eligibility. Organ trafficking for financial gains has been on the rise and is achieved by exploiting poor individuals. This however, could be minimized by use of living donors and Split Liver Transplantation (SLT). Besides, animal organs and xenotransplantation could help to solve organ shortages. Organ donations are also associated with several risks both for the donor and recipient. Consent from donors is also crucial to allow for organ procurement (Cupples & Ohler, 2003). To be precise, ethical issues regarding liver transplants revolves around their procurement as well as distribution.
The benefits of liver transplants are enormous since they allow patients with liver disease to live happily. However, if the disease results from Alcohol-induced Liver Disease (ALD), their eligibility is often controversial. Additionally, for this type of transplants, it is often cited that since the disease is self-inflicted, the ALD patients should not be eligible to the already scarce organs. These patients are also said to undergo recidivism and therefore, the disease could recur and therefore no need for liver transplant. Organ complications also arise since there is no agreement with medical therapy. On the other hand, ALD patients should be treated equally with other patients who need organ transplants. Liver dysfunction that cannot be reversed is managed by having a transplant. However, the condition could be contraindicated due to cancerous cells surrounding the organ, alcoholism, septic infections, advanced age and heart disease, since they do not allow for transplantation. The economic expenses, which come with the procedure, may overburden a patient. These are incurred during liver dialysis, immunosuppressive management, blood transfusion, medical evaluation of donors, and procedures to manage graft rejection. This paper aims at evaluating the pros and cons of liver transplants, to give detailed information on ethical and medical issues related to liver transplants (Everson &Trotter, 2009).
Pros of Liver Transplant
The main advantage of liver transplant is its potential to safeguard life. Individuals donate organs to safe other helpless persons especially for living donors. Liver transplant is the greatest alternative for a patient with a terminal liver disease. Living donors have aided in managing liver organs shortages and comes with more benefits as compared to diseased donors hence, increased liver organ pool. This is particularly possible since living donors decline the waiting mortalities particularly for hepatocellular carcinoma (HCC) patients. Living donors allows room for preoperative interventions, which includes dietary treatment (Kaido & Uemoto, 2010). They allow timely transplantation procedures and this decline progression of the disease and reduce mortality. The damage caused to the liver is less in living donors since the surgical procedures are elective and happen simultaneously. The donors of the liver have to be in good health, which guarantee good organs unlike cadaveric organs, which undergo pathophysiologic effect as a result of brain death (Carr, 2009). Since preoperative interventions are possible for living donors, treatment and medical stabilization of patients is possible prior to the surgery. Besides, living organs are not subject to excessive cold-ischemia, which often takes one hour unlike for deceased organs, which take six to ten hours in more than fifty percent of patients. This may increase complications as well as graft dysfunction (Killenberg et al., 2006). The patient must also be in a better health state, in order to undergo successful surgery and recover with no postoperative complications. The prognosis of liver transplants is promising and survival rates are high (Carr, 2009).
Some of the important questions to ask the opponents include; what are the reasons for liver transplantation? Life threatening health problems such as hepatitis and cirrhosis identified a doctor could require a patient to undergo liver transplantation. What are the sources of liver transplants? Cadaver donors and living donors supply the liver organ pool. What are the survival rates of patients following liver transplants? The survival rate is high and ranges close to eighty percent. Why are liver transplants a good target for organ traffickers? Illegal organs fetch good money due to their shortage. It is part of illegal organ trade where doctors are involved. Is it possible to prevent organ trafficking? Indeed. This can be curbed by implementing policies to prevent illegal organ trafficking. Heavy penalties should be imposed on the individuals involved. Healthcare systems should be monitored to avoid corruption and trading of organs. What are the procedures of allocating liver transplants? In the developing world, procedures to allocate organs have been corrupted to comprise distributive injustice. The poor are exploited and are denied equal rights to the organs. Would you choose to secure a liver transplant or face death as a result of liver dysfunction? I would rather secure the liver transplant since my health would be promoted. Besides, the patients’ survival rates are high and it is only a matter of choice on whether to live or die by either opting for the organs transplant or not. Does clinical transplantation always arouse ethical issues? Yes. However, when it comes to matters of life or death, ethical issues are often sidelined. What are ways to manage ethical issues surrounding liver transplants? It is essential for donors to give consent to procure the organs. Besides, the procurement from deceased donors should be done following the brain death or legal death. Strict measures should also be drafted by involved bodies in order to curb organ trafficking. Liver transplantation is a matter of life and death and ruling it out on ethical basis is vague. To what extent do you agree with the statement? I agree. This is because life is much more worth than the ethical issues involved. Safeguarding that life should therefore, be a priority whatsoever. Does genetic engineering offer any solution to liver transplants? Yes. Gene therapy is essential to increase the organ pool by having safe transplants which have been under extended cold ischemia. Is liver always procured during total brain death from a deceased donor? This should always be the case but it has been controversial since there lacks an agreement to when the legal death occur. Some physicians could also procure organs contrary to the set standard. Do liver transplants promote health and societal wellbeing? Yes. Patients with terminal liver diseases can be restored back to life through substituting the diseased organ with a healthy one. What are some of human rights related to liver transplant? Right to good health should be safeguarded irrespective of the socioeconomic status of the patients. Merit should be used in the healthcare system to distribute equally the organs. What do you consider as legal death? This is brain death which cannot be reversed since the cerebral neurons become dysfunctional due to lack of oxygen. It is the legal indicator where transplant organs could be procured. Do you think organs should be harvested from living of deceased donors? Living donors are better since they could have preoperative preparations to ensure the organ is in good condition unlike deceased donors.
Cons of liver Transplant
The crucial issue on liver transplant is their dysfunction or complications which may arise. Living donors increases donor risks thus the mortality rate is close to 0.1-0.3% (Kaido & Uemoto, 2010). Donor mortality and morbidity results are controversial due to inadequate comprehensive database. Therefore, the donors lack the actual information of the risks involved in the procedure in order to give an informed consent. The survival rates of grafts in living donors is less than that of diseased donors and may result to more biliary complications in patients. Hence, successive preoperative interventions are necessary to manage biliary complications. Living donors allow elective procedures to minimize complications when waiting unlike cadaveric organs. Shortage of organs cannot meet the needs of many patients who need them, many of whom die waiting for cadaveric organs. In addition, the right hepatic lobe graft could not offer appropriate hepatic function in patents with “severely decompensated liver disease” (Killenberg et al., 2006 p. 198). Several requirements such as donor-recipient blood type compatibility are a perquisite before the liver transplant is conducted to minimize the probability of organ rejection. However, consent from the donor is always crucial for the organs to be procured.
Some of the questions to ask the supporters of liver transplants include; what are the reasons for liver transplantation? Life threatening health problems such as hepatitis and cirrhosis identified a doctor could require a patient to undergo liver transplantation. What is the period taken to get a new functional liver? It depends on the availability of donor organs, waiting period and the condition of the liver. The tests might take a few days or even weeks. What is the procedure for replacing a diseased liver with a healthy one? After live therapy, an orthotopic transplantation is conducted which involves hepatectomy to remove the liver, anhepatic phase where liver is absent and post-implantation phase following the transplant. An incision is put over upper abdomen by separating ligaments that attach to the liver and the liver is removed and replaced with a healthy one. How does organ rejection occur and how can it be prevented? It occurs due to incompatibility of blood types which cause agglutination. Histocompatibility is also another cause due to mismatched HLA. HLA typing and Immunosuppressive treatment is awarded to manage rejection. Are there alternatives to liver transplants? Gene therapy, hepatocyte transplantation, xenotransplantation and bioartificial liver are some of the alternatives. In case of ALD, what is the recidivism rate for patients who have had prior liver transplant? It is usually high and patients have been noted to return to alcoholism barely a year after surgery which cause histological liver problems like fibrosis When can a patient resume to normal activities such as work? Can work facilitate postoperative complications? Yes. Heavy manual job could lead to complications. Patients are advised to stick to clean, simple and better working environments. Is vocational rehabilitation necessary for transplant recipients? Yes. It is essential to access, train and help the postoperative patients to go back to work. What are the risks of undergoing a liver transplant and should they be paid for? Risks involve graft rejection, anesthesia, and surgical risks such as bleeding, infection and recurrent liver disease. What are their success rates? Prognosis on Liver transplants is very promising and success rate is high. Is a patient eligible for a second transplant? Yes. Every patient has a right to good health no matter the number of organs he or he has acquired. Are liver transplants worth the financial costs incurred? Yes. In order to promote health liver transplants are worth in clinical practice to safeguard life. How can procurement of liver transplants be efficient? The organ is harvested from deceased donors after brain death or from living donors following their consent. Is there an assurance that the new liver will work and how do I prevent it from being damaged? If there are no postoperative complications, the new organ is highly functional. It should be safeguarded by taking a lot of pure water and supplements such as milk thistle which is an essential antioxidant.
Conclusive Argument
Organ transplant has been one of the medical advances in the recent past. However, it raises several ethical issues regarding the donor and recipient since the process is both challenging and complicated. The past decades have been marked by advancement in surgical procedures, which have facilitated the results of patients who have undergone liver transplantation. The liver ranks second of all transplant organs following the kidney. This is as a result of increasing liver diseases such as hepatitis and liver cirrhosis, which calls for liver transplantation. The process is often challenging and triggers several ethical issues. All the same, radiological procedures such as magnetic resonance as well as computed tomography (CT) have enabled patient in need of liver transplantation to be evaluated precisely, prior and after the procedure. This has gone a long way in the reduction of complications. Therefore, the prognosis of liver transplants has been successful. This depicts the success nature of the procedures, which makes it safe for human in order to safeguard their lives. The transplants have however, been invaded by traffickers who seek their personal wealth through exploiting others. This is part of the global transplantation tourism, which has to be prevented by establishing the necessary measures.
To become medically eligible for a liver transplant the patient has to be surgically suitable for the process and give consent for the same. Consent from a donor is also important and if he or she is not in a position to do so, the family members could give their consent to allow for the procurement of the organ following their legal death. Patients with many health issues could cause jeopardy of the procedure. The increased organ shortages have called for living donors and procedures such as Split Liver Transplantation (SLT) (a surgical procedure, which forms two allografts from a single cadaver or donor organ). The procedure is however, technical and requires specialized physicians. These methods are aimed to increase donor pool and have caused a high morbidity and unsuccessful procedures (Chakravarty & Jan, 2010). Liver transplants helps to promote health and the overall welfare of the society. As a result, liver transplantations have more benefits as compared to the disadvantages and therefore, should be conducted under strict medical practice
References
Carr, B. I. (2009). Hepatocellular Carcinoma: Diagnosis and Treatment. New York: Springer.
Chakravarty, D., & Jan, W. C. (2011). Liver Transplantation. New Delhi: JP Medical Ltd.
Cupples, S. A., & Ohler, L. (2003). Transplantation Nursing Secrets. Philadelphia, Pennsylvania: Elsevier Health Sciences.
Everson, G. T., &Trotter, J. F. (2009). Liver Transplantation: Challenging Controversies and Topics. Totowa, NJ: Springer.
Kaido, T., & Uemoto, S. (2010). Does living donation have advantages over deceased donation in liver transplantation? Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd, 25(10):1598-603. doi: 10.1111/j.1440-1746.2010.06418.x. Retrieved on July, 6, 2011 from http://www.ncbi.nlm.nih.gov/pubmed/20880167
Killenberg, P. G., Clavien, P., & Smith, A. (2006). Medical Care of the Liver Transplant Patient: Total Pre-, Intra- And Post-Operative Management. Malden, Massachusetts: Wiley-Blackwell.
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