What Do You Think -

What follows is a letter a dear friend of mine recieved from Duke University after being interviewd for a liver transplant - you see, my friend will die if she doesn't get a transplant. I am outraged by this letter and wondered what others would think/feel as they read this! I find the reasons for denial to be both trivial and stupid as we are talking about a woman's very life - after denying her, they offer to facilitate referral to other sources - what would have changed to make her more eligible at another facility? While I realise that this little Blog may not attract experts in this field..one never knows! I would be interested in any comments, suggestions, and recommendations anyone cares to offer! I have offered this letter as it was written (omitting any identifying information) Can you see that they can't even spell, yet making life/death decisions? (petty I know!)
August 21, 2006
(name omitted)
Duke History Number:
Dear Ms.
Liver transplant colleagues and ! have enjoyed the opportunity of meeting with you during recent weeks as you have under gone liver transplant evaluation. Thai process was completed recently, and there was an opportunity for all available information concerning you to be considered at our recent liver transplant selection committee meeting.Although there is no doubt that you have liver disease and portal hypertension, complications have been quite limited in recent months, and your current MELD score remains at 1415. Furthermore, I have to tell you that having a large spleen in and of itself does not allow us to apply for additional liver transplant priority (MELD listing points) on your behalf.It is very clear that your partner () is strongly committed to you. However, aside from one appearance by your daughter recently colleagues were concerned that he is the sum total of your visible social support system.Colleagues were also very concerned at the severe anxiety, in some cases unreasonable behavior that you demonstrated (for example insisting on wearing the face mask in clinic) and the PTSD arising from earlier bad life experiences.In conclusion, it was our view that the latter problems are so severe and so limited in terms of the possibility of getting better, that listing for liver transplantation would not be reasonable. As you become sicker from liver disease, so stresses become greater and anxiety levels increase. It is our view that you would not be able to cope sufficiently with these in such a way as to be able to maintain adequate healthcare towards liver transplantation.I have little doubt that this decision and the comments in this note will come as a great disappointment to you. However. I have to say on behalf of the group that they were reached after considerable evaluation and serious discussion.This decision does not prevent you from seeking liver transplant evaluation at another center within North Carolina, either at UNC Hospitals, Chapel Hill or in Charlotte. If yen would like to proceed with this, then we would be more than happy to facilitate such referral.Lastly, this decision does not prevent you from coming back to Duke University for continuing liver disease care if you would like to do so.Sincerely,Alastair D. Smith, MB,ChB,FRCP(Glasg) ADS:sr

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