Choosing Who Lives: The Tough Calls in Organ Transplants

In a hospital's intensive care unit, a man in his 30s lies with a swollen belly, his skin yellowed from liver failure. Despite his discomfort, he smiles. His family watches anxiously, and nurses visit just to chat. Without a liver transplant, he won't survive. But should he be on the transplant list?

This man has a history of untreated anxiety, depression, and recent alcohol abuse. His liver failed due to months of heavy drinking. The transplant committee must decide if he can follow the strict post-transplant care needed to make the transplant successful.

Different hospitals make different choices. One hospital refused to add him to the list, while another agreed to consider it. These decisions are tough, especially when mental illness is involved. Who gets a lifesaving organ and who doesn't shows our biases about who deserves care.

Years ago, during residency, a teenager was admitted with liver failure from a Tylenol overdose. She was extremely sick, her blood wouldn't clot, and she was confused. Without a new liver, she would die. This case also raised tough questions about who should receive a transplant.

The decision to give someone a new organ is not just about medical facts. It's also about values and biases. It's about who we think is worthy of a second chance at life. These choices are never easy, but they are always important.