I have an uncle in his sixties that has drank and smoked his whole life and he has been on heart and liver transplant list for about a year. Because he continued to live unhealthily his heart started failing this week with multiple heart attacks they moved him to level one priority and he will likely get his transplants this week. It feels weird that he is now ahead of others because they tried to be healthy and he did not.

Similarly a friend work for Alabamas football program and he couldn’t travel with the team to games in 2020 because he _hadn’t_ had Covid, while those who had gotten Covid could travel.

Basically… it’s hard to formulate rules for these sort of things and rarely are they “fair” to all involved.

Hey, regardless of the politics of the situation, I hope you and your family are doing okay. Sorry to hear about your uncle.

Thank you I appreciate the kind words.

I thought that hospitals specifically only put you on the list if you committed to a healthy lifestyle.

It likely varies hospital to hospital and region to region. I would hope it's more often the case than not though. I'm an organ donor and I wouldn't be happy to find out that my liver went to an alcoholic that wasn't making a strong effort at sobriety.

Do you know how arrogant that is? Alcoholics aren't people who deserve to die because of some kind of moral failing. Very often they're alcoholic because of other mental health problems or abuse. Would you want to deny a clininically depressed person your liver because they might commit suicide?

Im a recovering alcoholic myself, don't lecture me. I didn't say they deserve to die. But if they can't stay sober they don't deserve a liver over someone else who may need it more.

You don't represent alcoholics. Personal experience gives you a bias, not a justification for being condescending. Medical decisions are not and should not be based on moral judgements of the patient's behavior.

You're now changing your idea to add "over someone who may need it more", which is different, and I'm not disagreeing with that. It's the same as favoring young or healthy people because they're likely to gain more life extension from a transplant when the rest of their body is working OK.

I assumed that was implicit given the context of the conversation (a comment up the chain discussing their uncle who got higher priority because he continued to make poor lifestyle choices). Obviously I'd still rather my liver go to the aforementioned alcoholic than into the ground, but they wouldn't be my first choice.

There was and is no condescension present. I don't look down on them just like I wouldn't look down on a 90 year old man whose liver is failing from natural causes. Neither would be my first choice for recipients of my liver.

Sorry to imply he is still drinking. See my sibling reply to yours, but it is not sticking to the diet which is causing his issues.

Anecdotally, an ex-partner of mine here in Australia was denied a transplant for several years due to her heavy marijuana use, but was eventually allowed a transplant. Unfortunately her body rejected it and it had to be removed, and she passed away a year later.

He says he is committed to and I assume he has good intentions. He isn’t drinking or smoking, but water intake, salt intake, and red meat have been more challenging for his willpower/discipline.

Also, I have no idea if matters or not but he is wealthy (low eight digits) as well.

Honestly I can't find any fault here. Giving up the drinking and smoking has probably been monumentally difficult, and it's amazing that he's been able to do that. That alone tells me he is committed to getting healthier.

The diet stuff... honestly, nutrition "science" is full of contradictions. Sure, too much of anything is probably bad for you, but I don't think diet concerns should be a blocker for receiving a transplant.

At any rate, sorry you and your family has to go through this, and best wishes for your uncle's recovery.

The diet stuff is causing his body to fill with water. It isn’t just an eat healthier mandate. It is like becoming allergic to peanuts, but still eating them anyways when no one is looking.

Neither of those is a medical contradiction to receiving a transplant.

Smoking is the big no-no because it is fairly well proven to impair healing and increases chances of failure.

Evidence against red meat is very weak, and contradictory. Some studies show no harmful effects from non-processed red meat at all. In fact, there is just as much evidence against plant-based diets (they just aren't discussed widely due to the prevailing politics around CO2 etc), basically it's all just noise. Light alcohol use is absolutely fine in almost every case, and John Hopkins routinely does liver transplants for dependent alcoholics with an alcohol-related liver disease.

You should look up some centenarians cases, some lived on a diet of nothing but beer, waffles and blood sausages daily for several decades, and then had a nice healthy liver on autopsy at 100+ y.o., could've been from someone in their 20s.

Such is life.

Instead of contradiction, I believe you mean contraindication.

I'm also in agreement that cessation of alcohol and smoking are much more reasonable requirements for placement on the list than other dietary patterns that are highly individual regarding effects on overall health.

Chances are sugar intake is a bigger strain on his liver than the salt, but US doctors never tell people to eliminate sugar.

Sorry, I really don't mean to be a devil's advocate, but how do you know for sure that those others in the transplant line, also lived healthy lives w/ regular doctor visits.

Funny how having had COVID opens doors (eg. quarantine not required when traveling to some countries, and your example), but at the same time people are punished for not preventing it (vaccination, PPE). Talk about mixed incentives...

> (eg. quarantine not required when traveling to some countries, and your example)

For policies like quarantine following travel does it make any sense to distinguish anyone whether they have had covid, had a vaccine, had both a vaccine and covid, or had neither a vaccine or covid? Aren’t all of the above equally capable of carrying and transmitting the virus?

That's what I would think, but apparently Malaysia for example really wants people to have recovered from COVID specifically.

About everyone will get it sooner or later, vaccinated or not. (Pets are a reservoir, and nobody is vaccinating them.)

The best to hope for is not to die, be hospitalized, or suffer various long-term or permanent effects. Vaccination is all we have to prevent those.

Yes, but measures like the policies in question encourage people to get infected with symptomatic COVID so that they could go to doctor and get that very useful piece of paper.

That's the point. If you wanted to ensure people to not get COVID, do not give those who have had COVID pleasant exemptions. They failed, they should not be rewarded.

If everyone will get it, then no one who gets it and does not die or become seriously inconvenienced has failed. Dying, of course, is usually a fail, but literally everyone will do that, too.

I thought the last one on the list (neither vaccine nor covid) has a higher chance of carrying covid.

In general they are more susceptible to becoming infected and once infected they have higher risk of negative outcomes.

Yeah, that's my point. Because they are more susceptible to becoming infected, they're more likely to transmit the virus.

>Aren’t all of the above equally capable of carrying and transmitting the virus?

No. If I had Covid a month ago and recovered then baring a compromised immune system or new variant I am not going to get it again this month. So I am not "equally capable of carrying and transmitting the virus" compared to someone who "had neither a vaccine or covid".

> I am not going to get it again this month.

I understand that you would have antibodies and it be very unlikely if you carry the virus it would be unlikely to overwhelm your immune system in that time, but you can still carry/spread it right?

More directly related to the policy in question they can test you for antibodies, and maybe it is immaterial, but do they distinguish if you had covid 1 month ago vs 3 months vs 6 months? So does it work on the honor system or are they testing for antibodies, is it simply a matter of if you had covid at any point it doesn’t matter if you still carry antibodies you are not subject to quarantine?

Well it depends on your exposed viral load

Having anti-bodies reduces the viral load in your body, which also means that there are fewer viral fragments exiting your body

The policies are to reduce spread, not eliminate it

>but you can still carry/spread it right?

Once you have recovered? I don't think so, at least not if you have a healthy immune system.

From the article: “Doctors at the University of Maryland Medical Center were granted a special dispensation by the US medical regulator to carry out the procedure, on the basis that Mr Bennett—who was ineligible for a human transplant—would otherwise have died.”

He also basically murdered someone via stabbing so kudos for giving his body to science, but there's a case that he should have spent his life in prison.

He also lost a civil case, where the plaintiff was award 3.4 million in restitution, in which he paid $0 into.

https://www.washingtonpost.com/dc-md-va/2022/01/13/pig-heart...

> After Bennett got out of prison, she said, he “went on and lived a good life. Now he gets a second chance with a new heart — but I wish, in my opinion, it had gone to a deserving recipient.”

What makes him any less deserving? I don’t want to downplay the fact that he stabbed a guy, but the criminal justice system sentenced him and he, by all accounts, appears to have regretted his actions and reformed to be a good person. It seems like the system worked far better than it usually ever does. Once you’ve gone through the system and come out the other side rehabilitated, you’re done: continuing to deny random services, including in this case access to experimental surgery, is just cruel and seems really a desire for continued revenge against this person (which I definitely understand from a human perspective, but definitely does not belong in our social services scheduling).

> there's a case that he should have spent his life in prison.

Why? Normally you do this because you want people that cannot reform to stay away without resorting to murder. This person was gravely ill, which is it's own prison.

Why? If he had murdered Edward Shumaker (which seemed to have been what he intended to do), instead of merely stabbing him seven times, causing paralysis, and making him live the rest of his life in a wheelchair while in constant pain before ending his own life via a drug overdose of pain medication, a sentence of murder would be something the judge would have to consider. David Bennett Sr. got off pretty easy for ruining someone's life.