Health bias against alcoholics `unfair'

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The Independent Online
ALCOHOLICS DO just as well with a liver transplant as any other patients and denying them the option of a new organ amounts to unfair discrimination, new research suggests.

In a study that will fuel the controversy over whether patients who cause their own ill health - through smoking or drinking, for example - have the same rights to treatment as others, doctors in France compared the outcome of liver transplantation in drinkers and non-drinkers.

They found that the 53 patients with cirrhosis caused by heavy drinking did just as well as the 48 patients transplanted for other types of liver disease. They survived just as long and had similar rates of organ rejection, infection and cancer. The only difference between the two groups was in the number that went back to work after the operation. Half as many of the alcoholics returned to their jobs after surgery, even if they did not resume heavy drinking.

The issue of whether patients who bring misfortune on themselves "deserve" treatment - especially hi-tech, expensive treatment such as a liver transplant, which costs pounds 60,000 - is controversial. In 1997, the grandparents of a 15-year-old Scottish girl, Michelle Paul, who died of liver failure allegedly after taking half an Ecstasy tablet, claimed at a fatal accident inquiry in Edinburgh that she had been unfairly denied a transplant because she and her parents had a history of drug taking.

Although the inquiry rejected the claim, concluding that the decision not to transplant had been made on medical grounds - Michelle's chances of recovery had been extremely slim - the case provoked a wide debate about whether social issues should ever enter decisions about transplantations. Some surgeons argued that when organs were in short supply and resources tight, doctors had an ethical duty to give transplants to those patients with the greatest chance of recovery.

Since recovery depended on the patient being self disciplined enough to follow the strict regime of drugs and diet necessary after the surgery, they said social issues must be taken into account. The same argument has been raised in relation to smokers who need heart surgery, with some doctors accused of withholding treatment from patients who refuse to give up.

The French study, published in the journal Gut, challenges the view that some patients are less worthy of treatment than others. It found that 15 of the 53 alcoholics who received a transplant resumed drinking after the operation - a third of them heavily. Despite this, their overall survival rate was as good, if not better, than those who abstained.

Dr Georges Pageaux and colleagues from Saint Eloi hospital, Montpelier, say the arguments used against transplantation in alcoholics - poor adherence to immunosuppressive drugs and high rates of infection because of bad nutrition through renewed drinking - are "ill founded".

More than one-third of all children's deaths in Europe are caused by accidents, according to a study. Almost half of these 4,500 deaths a year are the result of road accidents. Drownings were the second most common cause of death.

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