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Liver transplant for a cancer patient is a matter of discussion that requires a balance between therapeutic argument and ethical standards of practice. Selection for a prospective liver transplant patient is multifaceted procedures that depend on various factors. Selection of patient for liver transplant does not, therefore, require an evaluation of past health condition for approval and in essence the disease conditions management. Addressing the issue of patient selection a clear stance has to be drawn on the importance of procedure saving the patient from this life-threatening disease. The central point of the argument is based on whether an alcoholic patient should be allowed to undergo the treatment yet their alcoholism lead to the liver cancer itself. Ethical view, on the other hand, indicates that selection should be based on disease conditions such as chronicity, mortality, morbidity and equitable health provision policy. The following paper, therefore, explores the selection criteria based on chronicity, mortality, and morbidity as the best alternative criterion.
The ethical issue strain liver transplant is the selection criteria that bring two main viewpoint. The first viewpoint emphasize on selection based on stakeholder perspective that consider both patient and health professional. This has resulted in argument as health practitioner considers social factors used in selection as compared to patient that view liver transplant as medical obligation that require equities. Second perspective considers the disease conditions such as chronicity, morbidity and mortality among other as the criteria used to select patient. This implies that there is need to distinguish between the important perspective that balances between ethical perspective and therapeutic perspective (Donckier, Lucidi, Gustot & Moreno, 2014).
Addressing the liver cancer patient selection issue
The ethical view for the selection of liver transplant patient presents the main criteria as mortality and morbidity. The selection criteria set aside the opinion about behaviours of patient especially social aggregates. There are many different ethical support principles that have set the argument for the selection of prospective liver transplant patient. These principles take into considerations both therapeutic practice and the ethical standards expected to take course. Some of the guiding viewpoints for the ethical basis of selection of patient include disease chronicity, mortality, morbidity, elimination of discrimination and Risk-benefit analysis (Organ Procurement and Transplantation Network, 2015).
Disease chronicity of liver cancer is based on two main factors and these are disease mortality and morbidity chances. Liver cancer is an clinical significant condition that presents high challenge in healthcare system in Canada (Vanden, Morrison and Shuster, 2010). Disease chronicity is an important factor in it comes to selection liver transplant patient. Chronicity of the illness require critical assessment of patient to ascertain the complexity associated with the liver transplant procedure and any other factor that is most likely to result persistence of the illness. In addition, physicians need to assess the time factor that will play a critical role when performing the transplant. Chronicity offers time constraint that needs to be factored in managing the liver disease (Bobbert & Ganten, 2013). Some of the selection criteria under this basis include the morbidity, mortality and
Morbidity of the patient
Firstly, morbidity chance of liver transplant patient is one of the main basis for selection of liver transplant patients. Based on this viewpoint, health practitioners are required to assess the morbidity of the patient to establish any likelihood that patient can develop complications. In addition, the criteria allow patient to be assessed based on the disease conditions not on social factors. For instance, the morbidity due to alcoholism can be assessed to ascertain the condition of illness and used to determine the need for transplant management. This can also be done for other liver cancer patient regardless of the casual for that illness. This criterion allows patients to have equal chance of medication irrespective of their past lifestyle or social aggregates (Addolorato, Mirijello & Leggio, 2013).
The disease mortality another is the major factors that set the platform for selection of prospective liver transplant patients. Under this criterion, disease mortality considers above all the disease pathogenesis and the treatment options. Based on disease mortality basis of patient selection, the main focus is on the likelihood of disease persisting and becoming injurious or life-threatening to the patient than any other factor (Watt, Burak & Deschenes, 2006). One of the key considerations for patient is mortality of the disease because this gives the urgency of the treatment and benefit-risk-analysis. The ethical standard of practice requires fair treatment of patient regardless of their past lifestyle. The main guiding principle is professionalism and above all disease’s mortality conditions. Patient suffering from liver cancer requires serious organ transplant and this follows the likelihood that illness will have low recovery unless the liver transfer is effected within the required time (Triguero, García, Molina, Miguel, Notario et al., 2015).
The ethical perspectives also provide the need to eliminate any discrimination that may be based on social preferences. This implies that when considering a patient that is the best fit for liver transplant, the ethical codes indicates that discrimination should not be tolerated (Zarrinpar, 2012). In addition, patients either alcoholic or congenital biliary are selected based on the ethical principles and standards of practice. The guiding principle is based on the fair treatment of patient and equitable provision of healthcare service without any discrimination. In this sense, gender disparities are not considered in the selection of patient as this is just but social grouping and has minimal effect on the fairness provision of healthcare services. Moreover, social preference based on an addiction to illicit drugs or alcoholism reduces the equitable health provision policy while at the same time lowers the patient-centeredness approach to care. Therefore, discrimination based on past social and lifestyle events is against the ethical standard of practice (Rhodes, Aggarwal & Schiano, 2011).
Risk-benefit analysis is another criteria that are used to select patients considering the balance between risk and benefits of the transplant. The liver transplant requires analysis of inherent risks of surgery, recurrent disease, and long-term immune-suppression that are expected upon approval for transplant (Telles-Correia & Mega 2015). Risks associated with the surgery prove that ethical standards of practice need to consider the survival likelihood of patient other than other social preference. This means that before considering patient fit for liver transplant patient need to be evaluated on the risk. There are many different strategies that have been put in place to deal with risks associated with liver transplants. These strategies consider situations such as alcoholic sobriety period and the expected medication. Therefore, there is no excuse for avoiding alcoholic patient on the basis of post-transplant risks (Lucey, 2014).
Common therapeutic argument
There many arguments that have been presented on the therapeutic consideration in the selection of liver patient. Liver transplant is a multifaceted treatment that does not concentrate on the as single factors as the main determinant for selection. In this sense, therapeutic perspective is also an important factor to put into consideration since the transplant must meet the standard of practice. According to Ajay, Alexandra, Welch, Deepti and Elisa (2016), ethics from therapeutic perspective gives various conditions that must be met to foster successful liver transplant. Some of the argument points for consideration that have weak ethical principles include patient assessment, comorbidities, alcoholic liver diseases and sobriety period for the alcoholic patient (Stroh, Rosell, Dong & Forster, 2015).
Firstly, patient selection criteria give the required threshold that includes assessment of patients for their ability to undergoes surgery. The central point of argument under patient selection main entails the risk associated with alcoholic conditions and limited ability to survive. The ethical reasoning indicates that the before surgery risk-benefit analysis is conducted that will evaluate the patient based on the benefit of operation and the likelihood of survival and not on addiction conditions (Locke, Durand & Reed, 2016).
Secondly, comorbidity is another therapeutic argument standpoint that provides grounds for rejecting some patient based on their ability to develop other liver-related diseases. The comorbidity issue is tackle based on the multidisciplinary approach that takes center stage during a liver transplant. This implies that multidisciplinary approach ensures there is minimal risk associated with other liver infections. Moreover, an ethical requirement at the point of medication should be based on exploring all the available options used for treatment comorbidities during liver transplant (Watt, Lyden & McCashland, 2003).
Thirdly, sobriety period for the alcoholic patient is one important therapeutic perspective that has also been addressed by the presence of Alcohol Addiction Unit (AAU). From this argument, some therapist indicates that least 6 months and is widely adopted a criterion for the selection of patients with an alcoholic (Rice & Lucey, 2013). In contrast, Alcohol Addiction Unit (AAU) provides the guidelines that help reduce any risk associated with such alcoholic condition and should not be used to select a patient. In addition, patients require fair treatment that applies the uttermost professionalism as possible especially during this life-threatening illness (Gundle, 2004).
Another point of argument among many healthcare practitioners for selecting patient involves the shortage of organ for transplant. Based on this argument, organ shortage drives the need to evaluate the patient based on their lifestyle to tackle any future demand for the organ by the patient (Griffin, 2007). This means that alcoholic patient can end up in the same condition they have been in due to addiction. The argument, therefore, sees the approving alcoholic patient as a recipe for negligence. In contrast, organ shortage cannot be compared to the mortality of illness as may be established in liver transplant. In another word, disease mortality and morbidity is the central point of selection since a good medical practice aim at saving life and not discriminating one on the basis of the cause of illness (DiMartini, Dew & Day, 2010).
Despite the above therapeutic arguments, a clear position remains that there is need to observe many ethical standards that allow liver transplant especially due to the disease chronicity. Many studies have been conducted on the ethical standards required during the selection of patients and this is based on the above discussed ethical viewpoints (Campsen, Zimmerman & Trotter, 2008). In addition, many strategies have been put in place to help in dealing with various risk factors to ensure that liver patients undergo transplant despite the complexity of the treatment. One such strategy is the Alcohol Addiction Unit (AAU) that gives advice on alcoholic patients and the complexity of liver transplant in these patients. Secondly, disease chronicity and other disease-related factors such as mortality, morbidity and fair healthcare provision are given priority when selecting liver transplant prospective patients (Ahmad, Bryce, Cacciarelli & Roberts, 2007).
In conclusion, selection of prospective liver transplant patient has been a matter of debate. The central argument has been on the criteria of selection that majorly focus on social preference such as alcoholism versus congenital biliary patient. The ethical standard of argument indicates the acceptable standards that are based on disease chronicity, mortality, morbidity and limited discrimination. This viewpoint allows the assessment of disease severity and risk-benefit analysis to ascertain the likelihood of treatment against the past lifestyle. In addition, some of the therapeutic argument has been based on the complexity of the procedure, risk associated with the procedure and above all the likelihood of past social conditions coming into play at post-transplant. The best ethical practice gives all patients an equal chance based on the disease severity and morbidity of the disease.
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