Donors’ organs should be treated with more respect

Twenty-six-year-old Kirstie Booker was killed in a car crash in 2006 and her organs were then used to help no fewer than five people. However, her mother has spoken out this week, seemingly suggesting that the way the NHS allocates such organs should be subject to a different ethic.

"I find it offensive," says Eunice Booker, "that one in four of the livers donated go to alcoholics. If there are two people side by side wanting a liver, and both have the right tissue match, and one is an alcoholic and one isn't, there’s no contest - you take the one who’s not an alcoholic, they are more entitled."

Ms Booker’s remarks were occasioned by the release of statistics showing that last year one in four liver transplants were given to alcoholics, an eight per cent increase on the preceding year, and that the long-term increase - since, in fact, Labour came to power - has been 61 per cent.

During this period a total of 1,300 livers have been transplanted into people who have damaged their livers due to chronic alcohol abuse. Naturally, the NHS are quick to assure the public – who smart from one postcode lottery treatment scandal after another – that all these are 'good' boozers, who have sincerely promised to quit, but I’m sure that it’s not just me and Eunice Booker who find this difficult to credit.

One of the grossest recent exercises in tabloid Grand Guignol was the shot-by-pint destruction of George Best's liver, witnessed by a multitude, with his own doctor taking on the bizarre role of MC.

Alcoholics have to want to change themselves for transplants to work

Obviously an alcoholic will promise not to drink if he or she is facing death, and just as obviously they will continue with this regime through the gruelling process of the transplant and its aftermath. But alcoholism is a powerful mental illness, and without a programme of recovery that is consistently maintained, usually for a lifetime, relapses frequently occur. Alcoholics have to want to change themselves; and even the most terrifying of external sanctions cannot enforce abstinence indefinitely.

It's tempting, given these facts, to follow Ms Booker into the good patient/bad patient dichotomy, although that way madness lies, with the morbidly obese refused treatment for heart disease, and smokers denied pain-relief for their 'self-induced' cancers. Why not regress still further, and disallow the promiscuous treatment for sexually transmitted diseases? After all, if only they'd control themselves, etcetera, etcetera.

No, we have to take a hard look at our underlying assumptions about disease, and understand that there are no such things as moral and immoral pathologies. The stigmatisation of IV drug users and gay men as having 'bad Aids', while those who had contracted HIV through blood transfusions were deemed to have the 'good' variety of the disease, was only the most glaring example of this ethical fallacy. An ethical fallacy and an epidemiological mistake as well, for branding people with 'bad AIDS' led to needle exchange and to contraception programmes - which would have contained the epidemic - being neglected.

Doctors have an unsettling penchant for so-called ‘heroic’ medicine

The analogy with liver transplants and alcoholism is closer than you might think: there is an epidemic of alcoholism in this country, and there are treatments available - however, they are costly 'talking' therapies rather than chemical cure-alls, hence the medical establishment tends to take little interest in them. Rather than insist that their transplant patients are in such ongoing programmes, liver specialists would rather go ahead on the basis of a promise.

Doctors have an unsettling penchant for so-called 'heroic' medicine - and a liver transplant fits the bill: a patient is going to die, but lo! like Lazarus they are raised from the dead. The slow grind of maintaining a recovery from alcoholic illness is something such miracle-workers neither understand nor endorse.

So, while I decry Ms Booker's desire to deny alcoholics liver transplants, I do agree with her that there's something rotten in the medical body, when such transplants are unaccompanied by a real commitment to treat the underlying disease.