They never told her that liver transplants are pretty much always temporary, at least with the immuno-suppressant drugs that were available most of the past 20ish years. Even with drugs, most people's bodies are constantly attacking the foreign liver and damaging it beyond its ability to repair itself. 20 years is a pretty good run; hers lasted 22.

This time around, she was in the hospital for two months (seemed much longer) while they tried to keep her alive. She went through all the symptoms you mentioned. Towards the end she suffered full-on dementia from the toxins in her brain. After two months of suffering, she lost her will to live, and told me and her family that she was giving up. I was sure she'd be gone by the end of the week, but that night the miracle happened; a compatible liver was available and she was at the top of the list. The next day, after a very long surgery (working around 22 years of scar tissue from the first transplant) she got a healthy new liver.

She remained in the hospital two more months, mostly in rehab, while her brain returned to normal (mostly) and she learned to walk again. It took months after going home for her to be strong enough to fully care for herself.

Unfortunately, the decades of drugs and months of liver failure pushed her kidneys past their limit. She's not on dialysis yet, but most likely she will need a transplant before the year is up. It's just a matter of time, and she's trying to find a living donor. If she can find one, she can get the transplant before she gets too sick again, which will make recovery much easier.

Organ transplants are absolute miracles of modern medicine, but we need artificial organs. Whether they're completely mechanical, natural organs grown artificially, or custom gene-spliced organs to prevent rejection, we need them. There aren't enough organs available now to meet the need, and the patients who get them have to go through hell first. And the ones who don't, don't survive at all.

Or a way to farm organs in the lab.

If self driving cars succeed in massively reducing accident deaths (yay!) an unintended consequence will be huge shortfalls in donatable organs.

https://www.technologyreview.com/s/603857/crispr-may-speed-p...

It was already ten years ago that some scientists figured out how to grow a 'mini liver' in a bioreactor. They've developed the technology a lot further since then, but it still looks to be 15-20 years out for full commercialization. The CRISPR solution may do wonders for people waiting desperately on organ lists in the meantime.

Let's stick to education and (why hasn't been tried?) financial incentives, please.

So it was mostly that suggestion that I was responding to. As to the negative tradeoffs in that option -- I think they're pretty obvious.

(Hint: we'd have to in effect force members of certain religious to at least formally disavow that aspect of their religion, for one).

As to opt-out, while of course different, it's still in the same (troublesome) territory as the 'mandatory' option -- definitely a major insult to people with strong personal or religious convictions about the issue. At the end of the day, it's inseparable from the idea that your body is, on a certain level, state property.

Which, aside from being repugnant to many people, is also in conflict with the emerging social consensus that, by and large, one's dominion over one's physical body is absolute and inviolable† -- which just so happens to form the legal and philosophical bedrock behind the idea that one should be free to choose to terminate a pregnancy; as well as (in the case of terminal illness, at least), the manner and timing one's own death; and of course, the manner in which one's body is disposed;

The same should naturally hold for the disposition of one's organs after death. We would never think of passing a law making, say, chemical dissolution the default disposal method for your body after death, unless you "opt-out" and choose some other method -- even though this is touted to have many environmental benefits. Nor would we think to propose that, by default, your body be served up for whatever experimental purposes the local university might have in mind (unless you "opt-out", that is). It'd just be way to repugnant to many people, and open up too many cans of worms ethically and legally.

So the organ donation issue is basically right in the same territory.

† Aside from proscriptions against controlled substances, of course. But that's just one of the many schizophrenic negative tradeoffs of that particular policy.

If that first glance was mistaken and the person was in a coma that could recover months from now, then basically a man was killed for his organs.

edit: I am a liver transplant recipient.

- Who owns your organs before death?

- Who owns your organs after death?

- I assume you are opting-out from a government mechanism for organ donation. What is the origin of the government's power to claim your dead organs unless you opt-out?

2. No one does

3. The origin for the claim is that you accept to give your organs, and it is that way by default in a lot of countries because most people either don't care or actively want to save lives. If you don't want to give them for whatever reason, you can always opt out

I would also like to point out that this whole point seems like debating for the pleasure of rhetoric : there is no specific downside to having organ donation opt out by default, as a lot of countries do, for example France since 76. And if you don't agree with organ donation, just opt out. There is, however, a huge upside : saving a lot of lives.

I don't have any liver related problems, or know/knew anyone with them, but I must thank you for having that sentiment.

Do you have a source that goes into the reasoning behind this? I could guess, but I'd prefer to give the subject the respect it deserves.

For me, a magical additional insurance policy appeared in my hospital account to which all transplant-related expenses were charged.

In addition, to get an organ in the US you must pass a series of exams regarding your physical and mental health, diet, your ability to get post-transplant support, and your willingness and ability to take care of your new organ. Alcohol and drug tests as appropriate. And for these evaluations, money can only indirectly help you.

I would also guess that there is a correlation between those people who have insurance and those that can pass the transplant evaluation, though that's a hidden variable that the powers that be probably want to stay hidden.

Organs are just too scarce to waste on a person who will squander one. It's a life and death competition between patients. It's horrible to see the people who get left behind, who wait too long, get sidetracked by some "miracle" cure, or even happen to live in the wrong region of the country where organs are scarce.

But the true miracle of a successful transplant is almost unfathomable (and that's said by a rationalist). From death's bed to walking a couple kilometers in a month and a half.

A simple "no" would have sufficed.

That 1M "cost" you mentioned isn't actually the cost is it? It's the amount the hospital wants to recover from an insurer. The true dollar cost is much lower.

I'm not saying it's easy to get an organ transplant without insurance, but to say it's impossible without anything but speculation isn't very useful.

Neither would proceed with any paperwork or testing without proof of insurance coverage specifically for transplant.

Honestly, I'm not especially concerned with edge cases like "is it possible to get a transplant without insurance if I offer to pay cash?" or questions about what a transplant really costs.

Those are irrelevant academic questions for the vast majority of transplant patients.

Where should you move if you want an organ?

The reasons are morbidly fascinating and too detailed to go into here.

Midwest and southern generosity typically drives higher donation rates. Neighboring states may draw organs from your state.

Transplant hospitals that do many cases get really good at it, and have enough experience that they will use organs other centers will reject. My liver was rejected by at least one other transplant center before it arrived in Indianapolis. (They let me see it before surgery. How cool is that?) So think twice before ruling out an organ just because someone else said no.

Blood type, physical size, and exact timing of things can cause lucky breaks.

Transplants are expensive, but the amount billed to your insurance is not a meaningful number in any way. Hospitals don't actually expect insurers to pay that; they set the number absurdly high as a starting point for the back-and-forth negotiations. This is particularly true for very expensive procedures which are almost always paid for by private insurance - both because of the expense, but in some cases by law.

(On that note, even looking at the amount paid by your insurance is misleading as well, because if you're on private insurance, you're paying not just for your own care, but to cover the care of people who are on Medicare and Medicaid, since private insurers are required to cover the costs of those patients' care as well. This is especially true for high-end, expensive, and/or chronic or terminal treatments like dialysis.)

The only major variable you should try to optimize is wait list time. Outcomes are roughly comparable across centers and are monitored by the government.