Thursday, July 4, 2013


   Recently there was a Supreme court case , where there was a  question, if children should get a adult organs. The decision was made that a child could get the adult lung . The patient got the adult lung and as it appears everything is OK . The question is how much limitation we in medicine we have , when it comes to transplant . I just was told by my office that one of my patients , about 50 years of age died .
     Ed was my patient for last 5 or 6 years . He had scleroderma and had some shortness of breath . He was doing OK for last several years , but recently , may be last year and a half , he was getting worse . As in many cases of scleroderma , he had some scar tissue in the lungs . We did the work up and his overall status was getting worse .We did the heart catheterization  and rest of the work up . In the span of 6 months he really got worse . I decided to refer him for transplant .He had to go out of town for the evaluation . AND they rejected him . He had mildly abnormal kidney function. This was contraindication for the transplant . So we had not much to offer . He continued to get worse and so  put him on hospice and he died . The medication that they use could worsen the kidney function in patients with scleroderma and then patient would need dialysis or renal transplant . So with our given technology , we could not help him .
     But there more to this than what this case illustrates . I often tell my patients that to get a new lung , someone has to loose one and which means someone must die .So we have quite a bit of limitations as to who gets the transplant and who is rejected . I have got patients that have been rejected due to previous cardiac history , or age or other issues . One of my other patient who needs lot of oxygen , 6 to8 l per minutes and he is short of breath on doing anything and he is less than 45 years old .But he was rejected for the transplants .
     There are many more cases that I have as patients that have been rejected for one or another cause . These causes range from the over weight to under weight , heart problems, kidney problem , psychiatric issues , family problems . This reflects more on our limitations and  the bad luck than true rationing , but in any case we in medicine do rationing all the time . This also applies to many other diseases and many other medicines use .

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