I can't believe this: To get on Heart Transplant list, one needs to be nicotine free 6 months.

[FarPoint]

This was told to me today by a 21 year old girl who has a grave cardiac condition. She is now on 24/7 Primacor IV infusion at home. She needs to be on the transplant list now! She has been nicotine free for 40 days....I doubt she will live 6 months without a new heart let alone live long enough just to be placed on the list.

He father died at the same age with the same condition. No diabetes, no substance abuse beyond cigarettes.

I have a very hard time accepting this criteria. Apparently, the rationale is that if they smokes, they will waste a good heart.

Anyone out here with knowledge regarding this frightening standard?

I don't have a reference tool or documentation as of yet. What I do know is she is not on the list. Her mother actually told me this as the girl is very weak and talking is difficult.

[Bonx]

1. You know what I can't believe ?

One of my co-workers underwent open heart surgery a few years ago and was smoking regularly again within a couple months. Still smoking today. He doesn't look healthy either.

[XemaSab]

61. This is why they don't waste hearts on smokers:

It's a waste.

[NYC_SKP]

136. Why can't alcoholics get a liver transplant?

Same thing, no?

[Drunken Irishman]

178. Pretty much.

My dad's brother could never get a transplant because he couldn't stop drinking. He died earlier this year.

[NYC_SKP]

179. Sorry to hear about that, DI.

Peace to your family...



David Crosby came to mind in this instance.

[Drunken Irishman]

182. Thanks...

But I'll be honest, I was not close to my dad's family. He was not close to his family. They were toxic black holes he didn't want any part of.

I know it's awful to say, but I felt no emotion when my mom told me he had died.

[AuntFester]

63. Yours is the answer to the question above.

[BlueToTheBone]

181. Welcome to DU!

[SharonAnn]

113. SMoking makes the blood "stick" increasing chances of clot formation.

That could be deadly serious for anyone but especially a heart transplant victim.

If the patient won't do what is needed for their physical care, then the odds of success are greatly lowered.

My brother couldn't get a liver transplant because he wasn't "compliant" with his health care requirements. None of us were angry about that. He insisted on using drugs and alcohol and those are "no-nos" for transplant patients. We all understood the issues and accepted that he wasn't going to be able to get a transplant. Unfortunately, he died several years ago but honestly, it was his choice.

[Brigid]

127. And his cardiologist is doing this:

[elehhhhna]

2. If she changes her name to CHeney she can smoke during surgery

I think nic is bad for the heart and vascular system -- although smokeless nic might be different.

I get why they do this and I am a too heavy smoker myself. 6 months is long but plastic surgeons won't do a facelift if you're a current smoker (good ones, anyway).

I hate this but there are likely some actual stats and science behind this rule.

[Ms. Toad]

158. Are you aware that Cheney waited far longer on the list than average?

Sorry - but there are very strict rules about being listed, and about who gets the organ when it is available because the supply is so limited.

People with means (or fame) do have some advantages - like being able to afford to be listed at all (you have to prove you have the resources - or adequate health coverage - to both pay for the transplant and for the lifelong meds you need after), or to travel enough to be listed at more than one transplant center (you have to be willing/able to live near the transplant center for an extended period of time, which people with fewer resources can't do).

So - in that sense, Cheney had a break. But he did not jump to the head of the line or get to break the rules.

(Inaccurate allegations about people we love to hate possibly getting organs unfairly has been cited by people on DU and elsewhere as reasons for not donating their organs - and there are too few organs available for the folks who desperately need them (including my daughter at some point) - so I get cranky about statements that might discourage people from donating.)

[JI7]

3. i think there are many restrictions liked this because there are limited number of hearts available

and many who need one. so they work out these things based on those who are most likely to benefit from it getting it instead of them being "wasted".

[FarPoint]

5. I understand....

yet...I sense she will not survive the 6 months while waiting to be eligible to be placed on the list.

This presents an ethical dilemma in my opinion...

just 21 years old...also has a 1 year old child.....


I'm filled with sorrow for this young lady.

[JI7]

8. this may sound harsh and it probably is but i am very curious

did she tell you why she took up smoking in the first place if she has a heart condition ?

[FarPoint]

17. I think it is related to her poor social group.

Limited education....not that information was not provided..she has been treated as a child for cardiac issues...Appears the standard of heath prevention and management may not of been enforced by the mother I'm guessing...and passed onto the daughter.

[JI7]

33. either way it's sad for her daughter, i hope things still end up being ok

for them.

does her daughter also have heart problems ?

[FarPoint]

35. I do not know if the 1 year old has the condition....

Child is not on any meds and looked dandy.

[OwnedByCats]

140. I still don't think it's fair

She's only 21, she doesn't have this heart condition because of her smoking, it was hereditary. She's not been an alcoholic for the last 30 years and needs a liver. She's been nicotine free for 40 days, that should show them she's serious. What's wrong with putting her on the list, testing her regularly while she waits? One might say "why give her a heart if she smokes?". That's ridiculous. Anyone can lead an unhealthy lifestyle after a transplant, there is nothing you can do about that. Are we to suspend transplants in case it's "wasted"? Sometimes transplants are wasted because the body rejects that organ, sometimes leading to the death of the person getting the transplant. It's just how it goes. There are no guarantees with transplants.

If more people donated their organs, this would be less and less of an issue.

[Ms. Toad]

159. When they are desperate for an organ, people can muster up all sorts of good behavior.

And living with a transplanted organ is trading one chronic condition for another which requires a lifetime of very rigorous care.

I doubt this heart disease just popped out of nowhere - and if she was unable to quit smoking until she was in the end stage of her disease, that is a pretty good indication that when the immediate crisis of needing a heart is past she may be unable to continue her good intentions to care for the heart.

That's why they have rules which may seem ridiculous and unfair. Living with someone else's organ is no picnic -and while many people lose weight, the forever task of keeping it off means that most people put the weight back on when there is not an immediate goal in front of them. Strict rules (like 6 months without smoking, or 6 months without a drink, no drugs - even medical marijuana) are part of proving that you are capable of following rules, and not just in the heat of the crisis. Because giving a heart to someone who is likely - because of inability to control behavior - to waste it means someone who is more likely to be able to control their behavior (or who never smoked in the first place) maybe someone even younger than this woman may die for lack of a heart.

You are right, though, that if more people donated organs it would be far less of an issue.

[OwnedByCats]

160. Yeah I understand that there are risks associated

with doing transplants on smokers. Given 6 months smoke free they are in a better position. It also demonstrates a will to live within your realistic means. It all seems draconian but makes sense. I just didn't like some of the replies people made that really didn't address the practical issues in this situation. Explain why it would be better to wait from a risk standpoint, not sound as though she doesn't deserve a heart because she smoked or that she could go back to smoking once the transplant is done so she should be denied, even though we don't know that is her plan. She made a mistake, she's young and we've all done stupid crap as teenagers. Unfortunately some of us will pay for it dearly with our lives.

[Ms. Toad]

162. That is the unfortunate reality with organ transplantation.

A friend died about 2 months ago - he was listed at two different sites and was at the top of the list on both. But by the third (or perhaps 4th) time he was called (the first 2 or three were not viable), his body was too weak to recover. He takes excellent care of his body, and was a resource for many others with the disease - and leaves behind a wife and three small children. He was still well enough that they though it was worth risking the liver - but he ultimately didn't make it.

A second friend died about a month ago. Again, impeccable care for her body and a resource for others with the disease - and she died waiting to get well enough (after a horrendous medical mistake) to go back on the list (after at least 2 false starts - again with non-viable organs). She was taken off the transplant list because medical malpractice made her too weak to be expected to recover.

It really isn't a matter of blame - it is a matter of the hard reality of very scarce resources and making the best predictions about who will be most able to fully utilize the precious gift. And, the reality is - because smoking makes your body less able to recover in the short run - and because a short time off of cigarettes (when your life is immediately at risk to motivate you) is not a good indicator that you will be able to stay off the cigarettes (no matter how good or strong your intentions). And it is not a forever ban - just as alcohol is not a forever ban for liver recipients. Six months is a reasonable time to prove you may be able to remain abstinent (and to let your body recover).

Unfortunately, if you wake up too late to the need to abstain, that may mean you die before you are eligible to be listed.

[FarPoint]

57. No...and I never asked.

Seemed futile to mention given her current status. I'm guessing teenage peer pressure.

[pnwmom]

54. It is very sad. But there are other young people waiting for hearts

who are more likely to benefit than she is, unfortunately. Forty days off cigarettes isn't long enough to know she's free of that addiction.

[Walk away]

60. It's not just the addiction. Smokers don't heal as well.

Even 40 days later her body is more likely to reject the heart. A non smoker is statistically more able to heal and thrive.

[hlthe2b]

82. It is sad, but not policy meant to be punitive, but to ensure such a rare & invaluable resource

is not wasted.

--this is also why public service advertisements have become increasingly graphic, grim and very very candid (and tobacco company ads/activities that target teens were the largest part of the national settlement)

Very sad situation for your friend, though...

[handmade34]

4. seems reasonable...

sad for the young woman

[avebury]

6. What is sad is that the girl did not

learn anything from her Dad's experience. She ignored her family's medical history and followed in her Dad's footsteps. Had she showed more wisdom and stayed away from cigarettes in the first place she would most likely would be on the transplant list today. It is sad for her mother but the girl must accept the role she played in putting herself in the position she is in today. I know this sounds harsh but that is the reality.

[FarPoint]

9. Youth has it's unfortunate characteristic of denials....we all have had our share...

I won't judge her on that issue....Education was not really well absorbed in this family.....yet they are a loving family.

[TheDebbieDee]

15. You sound as though you are a disciple of "The Secret".

The Secret is a book that espouses a theory that people somehow deserve the bad things that happen to them....I only had the read the book jacket to know that I didn't want that piece-of-shit bringing bad karma into my home.

[KittyWampus]

29. if you throw a ball in the air it isn't a matter of "deserving" to have it fall on your head.

Karma is actions following each other in logical sequence.

If you don't want a ball to fall on your head either don't throw it up in the air or if you do throw a ball up in the air pay attention to it.

[avebury]

36. What I believe in is the saying that those who do not

learn from the past are doomed to repeat it. In this case, if someone is aware of his/her family medical history then it behooves them to be mindful of their own health. For example, there are numerous incidents of cancer on my Dad's side of the family so I have been aware all of my life that I have a greater chance then normal of developing cancer. As a result I have had to make medical decisions from time to time. The Doctor caught thyroid cancer in the very early stage (full recovery) and I had a full hysterectomy because medical tests showed I had a high likelihood of developing some type of uterine cancer (five out of six family members died of cervical or uterine cancer). I have always paid attention to my family medical history and been able to make important decisions on my time frame not under dire circumstances.

[Drahthaardogs]

51. I do not see it as Karma, nor judging, it is simple mathematics and physiology

There are not enough hearts to be transplanted into everyone who needs them. As such, doctors want them to go to those most likely to benefit the most. Smoking is hard on the cardiovascular system. Nicotine is also highly addictive. Putting a new heart in a smoker is statistically speaking "wasting it" or at least increasing the odds you are wasting it.

It is brutal, but surgeons are scientists and they play the statistics. I had a lumbar spinal fusion two years ago and my doctor would not touch me unless I was nicotine free for 6 weeks. Nicotine slows bone growth and interferes with the fusion process.

I hope this girl lives long enough to get her heart.

[JVS]

78. LOL!

Do you see the contradiction within your post?

BTW, I am in no way endorsing The Secret by pointing out the humor here.

[TheDebbieDee]

83. I wasn't endorsing The Secret either.....

The total premise that people, especially poor people, have done something to invite their misfortunes is absolute Shiite! Bad things happen to everybody. But some people have more resources to deal with these bad events than others.

[JVS]

85. I agree with you completely.

But then invoking the idea of bad karma seems an endorsement of the idea that some invite their misfortune.

[TheDebbieDee]

87. Oh, well maybe I should have used bad vibes instead of bad karma.....

[Ino]

103. The book does NOT say that people DESERVE bad things.

It espouses the Law of Attraction, which says you attract what you focus on. Ironically, you show an understanding & acceptance of that very principle by referring to "bringing bad karma into my home." Bad vibrations (vibes) is the same thing.

[TheDebbieDee]

107. Whatever..............

[Marr]

121. What deserving recipient would see denied a transplant so that this woman could get one?

I mean it's not like there's a surplus of hearts-- that's why there's a waiting list.

[moriah]

133. While the smoking probably didn't help matters, there's no indication it *caused* the condition.

At least in the OP.

I might be wrong.

[avebury]

145. According to what came out over the thread,

the girl herself had a known heart condition and she evidently chose to smoke. If she is as sick as has been reported then that decision (to smoke) has come with a powerful cost - time. Instead of being on the transplant list now, she has to wait until she is tobacco free at least 6 months. Even if she makes to the transplant list, who know if a viable heart will become available as there are no guarantees. And at what point does her condition deteriorate to the point that she is not a good candidate for surgery?

[Blanket Statements]

7. Wait! Her father dies of a cardiac problem

And she took up smoking?

While I feel sorry that she has the problem, she wouldn't be in her current predicament if not for her choice in vices

[FarPoint]

10. That is easy to say at the moment....

but....not so easy to accept when you have looked into her eyes and those of her child. Sitting in the same room seeing her suffer changes things....My heart aches tonight.

[Blanket Statements]

14. I have no doubt that it is heartbreaking

[Mojorabbit]

12. She is a kid for cripes sake. Good grief.

I spent my youth doing lots of things that I can't believe I did looking back from the benefit of time.

[Blanket Statements]

16. 21 is not a kid

[Demit]

21. Yes it is.

[Blanket Statements]

24. And unicorns are real

She's an adult, has been for some time.
Choices have consequences, she's learning the hard way

[babylonsister]

28. She's learning the hard way? Your compassion knows no bounds. nt

[Blanket Statements]

30. I feel bad for her but she put herself in this predicament

[Demit]

69. What are you, twenty-two?

Whatever age you are, you haven't attained enough smarts to know just how young 21 is.

[Blanket Statements]

76. So at what age should people be responsible for their choices in life?

[Chan790]

96. I'll let you know when I get there.

Wednesday is 34! I do think we may be getting close.

[ChazII]

111. When it comes to smoking 21

is old enough, imho. The harm smoking can do has been taught for ages. I graduated in 1976 and we had the horror stories of what smoking can do to our lungs. I taught at the elementary level from 1980 until 2010 and each year all grade levels spent 3 weeks on drug education.

[OwnedByCats]

149. Except when you develop the habit in your

teens, you continue doing it because it's an addictive habit. Now she knows she must stop and she has.

[Puzzledtraveller]

157. for some people, never

as they will always find a reason to blame something else. If you mention accountability you get slammed as a right wing troll.

[Comrade Grumpy]

77. Spoken like a GOP committee chairman. n/t

[Blanket Statements]

86. Anyone

Could figure out smoking might not be a good idea for someone with a family history such as hers.

She even had a doctor advise her to stop smoking.

I feel bad for her but she made a choice and it's the reason she's in trouble now

[Chan790]

95. I find that worldview cold and a bit cruel. n/t

[Blanket Statements]

97. Who should be denied a heart so a girl

Who couldn't quit smoking gets one first?

That's cruel

[Chan790]

105. I know. I really do. The callousness of it irritates me.

I mean I know. Lots of people that need them, few to go around.

It frustrates me that this is a problem too...I mean I understand how we don't have artificial lungs, livers at this point as the functions of each are complex (less-so kidneys, dialysis presents a means of artificially performing the function of kidneys, though not an ideal or permanent solution)...but really a heart performs a fairly simple function, it keeps oxygenated>>deoxygenated blood moving...it's a rudimentary pump and that's the only job it's doing. It's not even a good one by most engineering standards (they're pretty inefficient and prone to damage)...but we've never managed to build a better permanent or even a semi-permanent artificial heart? Are we even trying? We have artificial eyes and cochlear implants, limbs that work off brain signals...all of which strike me as way harder to make work than something to pump a complex solution (blood) through biological plumbing.

[Samantha]

112. I totally agree with you - I can't believe the remarks on this thread

Sounds like she inherited this condition from her father. If she had never smoked a cigarette, she probably would have the same problem today. The point was made below that people who smoke do not heal as quickly from surgery, but if she has gone 40 days, she obviously is trying. She is too young to be written off. She needs to be given a second chance.

Sam

[fujiyama]

169. That's why she has been given six months

I'm not a doctor or public health expert and don't know her condition or history, but she hasn't been written off altogether. We also don't know the efficacy of a new heart in her situation and whether it would significantly extend her life. It's possible her congenital condition also adds doubt to the probability of longer term survival.

[cemaphonic]

118. But it's not a punishment or judgement or anything, just basic medical triage.

She's not being denied out of moral outrage over smoking or to "teach her a lesson," or because "she deserves it." The demand for healthy organs for transplant vastly outnumbers the supply, so someone has to make the difficult decision of who gets them, and the guiding principle behind those decisions is "who is most likely to have a successful outcome." It might be cold and dispassionate, but that's by necessity.

[Brigid]

130. 21 is plenty old enough to understand the dangers of smoking.

Back in the early '70's, when I was about 12 or 13, I tried a cigarette. By that time, the word was already out about smoking, but I did it anyway. I about choked to death, so that was the end of my smoking career. Point is, I knew long before I was 21. But then, I come from a family of non-smokers.

[Demit]

146. From your description, it's clear you didn't start smoking b/c you found it unpleasant.

That's all. You tried it & didn't like it. That's not "understanding the dangers of smoking." In fact, you admit that you had heard it was dangerous but you went ahead and did it anyway. That's the very opposite of understanding.

Whatever point you are trying to make, well, you didn't make it with your story. Your experience only shows that some kids try things & don't like them (versus some kids who try them and do). Also that when a child's family doesn't smoke, the child is less likely to take it up.

[OwnedByCats]

150. Everybody coughs and chokes on their first cigarette, that's nothing new

Kind of hard to get the true effect on your first few puffs. You were bothered enough by it not to want to get used to it, and in truth that was a blessing for you. However others are different. Why do you think people continue to smoke after they get used to it? Because they end up enjoying it. Then it becomes an addictive habit. When it comes to addiction, unfortunately one can have no idea how difficult it is unless they have been there. This I know from experience. It's easy for others to say "just stop doing it!". If it were that easy, you'd see a huge drop in those who chronically smoke, drink or take drugs. Fact is the addiction free people have not one iota how hard it is. This woman started young and I'm betting she's really regretting that now. She's gone 40 days, which is extremely good. She's done with the worst part of it. Heck by now the smell or taste of a cigarette could very well make her gag, at least that is according to most people I've known who successfully quit smoking.

After seeing some people continue smoking after a lung cancer diagnosis, this girl has already made a huge effort.

[Mojorabbit]

23. Um, yes it is. n t

[Blanket Statements]

26. Not in the real world

[dflprincess]

102. our brains are not fully developed until we're 25

Last edited Tue Dec 10, 2013, 10:15 PM - Edit history (1)

And the last part to mature is the part that says "That would be a dumb thing to do." The car insurance companies always knew this think back to when your rates dropped.

[Blanket Statements]

126. Soooo why is it legal to sell her cigs or booze?

Clearly she has no business making decisions about such things...based on science

[Foolacious]

131. Are you suggesting...

... that the law has a scientific basis?

[Blanket Statements]

132. I'm not the one arguing a 21yr old is a kid

[dflprincess]

135. You must be the rare person who never made a stupid move when young

Most of us can remember things we did that make us cringe at our youthful stupidity.

And 21 is still very young.

[Blanket Statements]

137. It's old enough to know smoking isn't smart when

You have a family history of CV problems and a warning from a Dr.
And I wouldn't be appalled about the transplant rules regarding nicotine when the bad news came

[OwnedByCats]

148. She started smoking younger than 21

and 21 year olds aren't exactly chock full of wisdom.

[avebury]

98. Further down this thread it is

mentioned that the girl was treated for cardiac issues as a child and she still chose to smoke knowing that her father smoked and died young because of heart issues. On top of that, choosing to smoke with a pre-existing heart condition she then has a child. I imagine that she was probably young when her Dad died and she is now doing to her child what her father did to her. I am sorry but the girl was just totally stupid!

Her child will now pay the penalty of having an irresponsible mother. Hopefully, the child will know better then to smoke when she is older. My sympathy goes to the child and one can only hope that the bad decisions of now 2 generations does not pass to a 3rd generation.

[LanternWaste]

123. You should put that on a Hallmark card and send it to her to better assuage her discomfort.

You should put that on a Hallmark card and send it to her to better assuage her discomfort-- and maybe teach her a lesson...

[Blanket Statements]

125. She's learning a lesson

[OwnedByCats]

147. I think if a little psychic birdie told her

that when she hit 21, she would need a heart, but would need to wait 6 months nicotine free before she would be on the list and even considered for a heart, therefore she might actually die during this wait, AND she was going to be a mom, I'm sure her decision probably would have been very different. As a teenager, she probably had no idea that the smoking would be the determining factor in not getting a transplant. Hindsight is 20/20, people make mistakes, especially young people. She's 40 days clean of smoking, so she's been through the worst of it and the longer she goes, the better her odds of not smoking again. She's young enough to turn this completely around, if she gets the chance.

[malaise]

11. No substance abuse beyond cigarettes

Are you serious?
You must have bought the cigarette company propaganda. Cigarettes are a gazillion times worse than ganja.

[FarPoint]

19. I understand....

I didn't mean to minimize nicotine here...just trying to clarify it is not related to IV drug use or something of that nature. Cigarettes are legal.

[malaise]

22. Well given the volume of propaganda she may have felt they were harmless

but her generation had way better knowledge than we did - still it's hard.
Hope her son never smokes.

[SheilaT]

106. The Surgeon General's report about smoking

came out in what was it? 1964? Long before this young lady was born. So it is hardly breaking news that smoking is bad for you. Unfortunately, it's been my experience that smokers make climate deniers look like amateurs.

And she is 21. She is old enough to take responsibility for her actions.

[OwnedByCats]

153. It's bad for you to eat too much sugar, fat and calories

but that doesn't stop people from eating junk. Illicit drugs are even worse than cigarettes (not including marijuana in territories where it is illegal) but people do them. Abusing prescription drugs, still happens. Drinking too much alcohol is bad but people still do it. Dangerous activities such as driving too fast, even though they could die doing it, they still do it.

Most human beings have some kind of vice that is bad for them. That's human nature I'm afraid. She started when she was young and naive, it became an addictive habit but now she has stopped. That was the first step in taking responsibility. It's just too bad that she can't get on the list and be tested regularly while waiting. If she tests positive for nicotine, they can suspend her place on the list but I guess they don't operate that way.

I understand the complications with smokers and rejection of the organ. However, if she's as bad off as the OP feels she is, she would have a better chance of making it through 40+ days clean of smoking than waiting an additional several months to be 6 months clear, then the amount of time it would take after that to find a match.

[Ms. Toad]

171. No - they don't operate that way.

Once you are on the list, you are eligible for a transplant that day - they don't maintain a separate listed but not yet eligible for transplant list. It is challenging enough to juggle imminent death crises (which make you eligible for broader than local organs), with limiting the distance donor organs travel, with the urgency to move quickly once an organ is available, and tissue/blood matching matching, etc. How long you wait has nothing to do with how long you have been on the list, so there is not even any point in getting on the list until you are eligible to be transplanted. Who gets the organ is based on which (of the potential recipients who match) is most likely to die if they don't get this heart. At least with livers that is a very complex sorting process - without adding in people who could not be given a heart that day, even if they were the closest to death.

[mitchtv]

187. you will be rejected for smoking Cannibis,

but they would certainly use whatever organs are viable if you die

[malaise]

188. LOL

Don't smoke anything and I'm sure they don't want these old organs

[Aristus]

13. You know what the irony is for me in all this? As a medical provider?

That she listens to, believes, and follows the directives of the provider who told her she needs a heart transplant.

But she didn't listen to, believe, or follow the directive of the provider who told her to quit smoking.

There's an old joke: A guy read in the newspaper that smoking can kill.

Did he quit smoking?

No, he quit reading the newspaper.

[FarPoint]

25. That is a rationale....

I struggle to accept it....nothing I can do of course....

[Gormy Cuss]

47. Nicotine is addictive, no?

Do you know that she had a provider who not only told her to quit smoking but pointed her to affordable tools for doing so? Just saying "don't smoke" is not enough. If this woman is from a low income household she may have been smoking for years before she saw a provider when she was pregnant.

Most of my neighborhood friends who smoke started between age 11-15. They've all paid for it in terms of their health but most don't have access to health care providers unless they're pregnant or land in the emergency room. There aren't enough sliding scale clinics out there. Even when there's one available, paying for wellness is a luxury they can not afford. Some of them will be helped by ACA but many won't because they live in a state opting out of expanded Medicaid. That's their reality.

[FarPoint]

56. She has been treated for cardiac as a child

since she has been through Children's Hospital in her history.

I just don't think the family dynamics were strong enough regarding compliance. I'm thinking once the crisis is over...they let their guard down and become complacent.

[FrodosPet]

93. To some people, if a parent enforces discipline they are an authoritarian

To tell a child what they should do is teabaggerish. Children are just young adults and need to be allowed to find their own path in life.

A parent has no right to tell a young lady what to do with her body if she gets pregnant, correct? Her body, her choice. Any laws that restrict the right of a woman OF ANY AGE are regularly attacked. We celebrate when the ability of a parent to block their daughter from having an abortion is restricted.

Yes, it sucks that she will likely perish young. I don't know the young lady from any other stranger in the world, but reading about what she is going through, and knowing her child may lose their mother, is a gut punch.

But do we have the standing to say her parents should have restricted the choices she was making with her body? To me, the phrase "My body, my choice" is about a whole lot more than abortion.

[Sheldon Cooper]

68. I started smoking when I was 14. Hardly an age to make rational decisions,

even if I had a family history of medical conditions. People make immature and stupid decisions, and the penalty is death, apparently.

[Gormy Cuss]

74. Many of my childhood friends had disabling respiratory conditions by their 40s.

One even died from COPD at 44. I never smoked because when I tried at 15 I hated it.

[Mojorabbit]

101. I did too and it took almost 40 years of trying to finally quit.

She is still a child and it is a sad situation. I don't fault her at all.

[dballance]

18. Nicotine has an effect on the vascular system.

The reason for the six months may be to increase the chances of a successful transplant and her ability to survive surgery. Not to be punitive.

[FarPoint]

27. I can accept that rationale much better.

[csziggy]

55. Thanl you for a rational reason and for not blaming the victim

[Nine]

20. I have a relative who needs a liver but he's an alcoholic.

He's a really hard-drinking alcoholic as I understand it. Started in high school, now he's barely 30 and has already ruined his liver. Father and grandfather were also hard-drinking alcoholics. I wish he could get a liver but he's still (unbelievably) in denial that he even has a problem. A liver would be wasted on him and even his closer relatives understand this.

[FarPoint]

32. Now I don't struggle with this guideline for the liver due to alcholol so much.

I should be just as heart broken.....I see some similarity here....

With the cardiac girl, cigarettes affect, damage her cardiac status...yet,that said...I sense alcohol directly caused the liver disease.

Thank you for sharing.

[magical thyme]

164. now you seem to be the one treating the restrictions as punitive

The alcoholic isn't denied a liver transplant because they caused their own disease. They too are denied liver transplants because of the poor chance of survival unless they stay off alcohol for good.

The restrictions aren't about morality, judgement or blame. They are about who has the best chance for making it through the surgery, healing, and staying in compliance so they have the best chance of survival.

Organ transplantation doesn't mean you go back to living the way you did before the surgery. It is a lifetime of compliance with a strict medical regimen. You are on immunosuppresant drugs for life to ensure your immune system doesn't attack the "invading" organ. You are at higher risk of serious infection.

Part of the requirements up front are to get the patient as toxin-free and strong as possible before any surgery. Part of the requirements up front are to ensure patient compliance, that is ensure that the patient has the mental and physical means and determination to follow instructions to the letter, including making all required doctor's appointments, taking all required medications, sticking exactly to a prescribed diet, and will do so not just while they are desperate, but when they are feeling better, and for the rest of their life.

[Bohunk68]

70. I can relate to this one.

In 1984, my younger brother and I stood at our dad's casket where he was only 63 and died from lung cancer from walking that mile for a Camel. I stopped, but my partner did not. After about a year, the news came out that second hand smoke was just as dangerous as smoking, so I started up again. 14 months later, a dear friend died a horrible death from lung cancer. We then and there resolved to stop smoking and tapered down until a month and a half later, in Oct. 1987 had stopped. Never touched another. My bro, OTOH, did not stop. In 1998, he had a liver transplant even though he was an alcoholic. He continued to drink and lived for another 6 years, one year longer than expected. What did he die of? Lung cancer, because he continued to smoke. It was a horrible death for him, too. I still don't smoke anything other than Mother Nature now and then and that doesn't cause cancer.

[Nine]

79. Addiction of any kind is a terrible thing.

Nothing else ruins so many lives.

[lostincalifornia]

31. There is a reason the standards are high. They want those who have the best chance, and smokers are

Damaging to the heart along with other organs. Transplants are in a very limited supply, especially cardiac, and because of that as you acknowledged they want to insure this rare organ used for transplant gets the chance.

Don't assume that she won't make it in time, the humans spirit is amazing

[FarPoint]

34. Oh, I hope you are right about her survival.

Maybe her child will be all inspiring.....it can happen...you are right.

[lostincalifornia]

40. I do too. There are inequities in the system, and we all have heard of those such as David Crosby

Able to obtain a liver transplant in spite of his past drug and alcohol problems, and the same with Steve Jobs

Rules at times seem only for those without the means.

My best thoughts and wishes to your friend

[FarPoint]

45. Yea...such individuals came to mind

when they told me about the 6 month wait to qualify for the list. It inflamed my activist characteristic. The client is on medicaid so I was slightly suspicious.....but then....

The discussion in this thread has been enlightening regarding clinical rationale standards which put my fears and defenses to rest.

[riderinthestorm]

37. As hard as it is for you to believe right now, this isn't a punitive measure

The standards are in place for several reasons:

1. The banned substance is known to interfere with anti-rejection meds. For example my sister received a kidney/liver transplant and could not have ingested any licorice (amongst many other things) for 12 months before her transplant. There are agents in licorice that interfere with the meds she was on immediately post-transplant. Seems like it would be a harmless substance right? But the pharmacology for these surgeries is extremely intense. In fact, the pharmacist is one of the most important members of the transplant team for the first months. The chemistry of it is very complex.

2. They need to make sure that the patient is completely compliant with the protocols. The organs are precious. If you don't demonstrate that you are completely compliant for several months (and in some cases a year), then you won't be allowed on - or you will be removed.

I am so, so very sorry for your friend FarPoint. I'm sending out vibes of healing and strength that she makes it through the 6 month wait... please know there are a few of us here on DU who are really familiar with this. Feel free to pm me.

[FarPoint]

42. Whoa....that make so much sense!

The facts are the facts...it's harder to accept the facts when you see how fragile her current status is today....Yet..it does make sense.

I believe I will PM you as I follow this girl.I can talk more liberally then too with clinical data. Thank You so much.....

[babylonsister]

38. Smoking

affects oxygen in your blood, I think, and blood vessels.
I had to stop smoking to have a surgery, though it wasn't life-threatening.
Tough stuff; I'm sorry for your friend, and you.

[FarPoint]

39. Hey DU'ers....I feel better now...

not having such doom and gloom-like feelings now as I did when I was so compelled to post/talk about this issue. Really...this has been therapeutic!

I'm finding acceptance.

[CFLDem]

41. What a travesty

21 is way to young for anyone to die for any reason.

And yet people have the gall to judge this young woman for unhealthy activities that almost everyone has committed at least an equivalent risk in their youth.

Disgusting...

On a positive note I look forward to the day when someone in her position just has to wait as long as it takes to print the heart to get a new one.

[Ilsa]

43. The post-op regimen is difficult enough without

adding in the effects of nicotine on blood pressure, pulse. There is enough stress without adding in craving for a drug which affects the vascular system so much.

[FarPoint]

53. Your right...

I imagine they, the girl and her family have had the non-smoking education many times....denial is strong....Heck, she has a 1 year old...I sense she was told not to get pregnant too. She did not go to term with the pregnancy...6 weeks early I believe.

[0rganism]

44. how long is the waiting list?

maybe she can time it so that she gets to the front of the line when she's been cig-free for 6 months.

[FarPoint]

49. I sense if she gets thru the six months she indeed

will be in the front line. Age, 21 has impact and cardiac wise, she is weak.

Oh, the cardiologist do random nicotine screenings by the way.

[0rganism]

52. well, the best of luck to her

it sounds like she'll need all she can get. Very sad situation. i hope she can see her child as a strong reason to keep going and not give up.

i hope she's on a strict diet as well -- no sense taking chances imbibing extra LDLs.

[Ms. Toad]

172. The list isn't a queue.

Where you are on the list depends on your proximity to death. You could receive the next heart the day you are listed - or you may wait months or years if others are more needy (but still healthy enough to survive the transplant).

[LittleBlue]

46. That's awful

Poor girl

I hope she gets her heart.

[RedCappedBandit]

48. It's sad, and a shitty situation. But it's logical.

Much demand, limited supply. It only makes sense to restrict the available organs to the recipients who are most likely to succeed.

[tabasco]

50. I can't believe

that you can't believe that.

[FarPoint]

59. I'm working on it.

This discussion has been excellent!

[pnwmom]

58. Different transplant centers have different standards.

And it is possible to get yourself on more than one transplant list. Someone should investigate different transplant centers, and find one, if possible, that doesn't require non-use for six months. Then apply on the list for that center.

http://optn.transplant.hrsa.gov/about/transplantation/transplantProcess.asp

As an informed participant, it is important that transplant candidates know their treatment options. Some patients choose to list at hospitals in different parts of the country, change hospitals, and transfer their waiting time to a different center or receive a transplant from a living donor.

Multiple Listing: Sometimes patients choose to register for a transplant at more than one hospital. When a patient lists at a transplant hospital, they are generally considered for organs from a donor in that local area first. If a patient is put on the list at more than one transplant hospital, they will be considered for donor organs that become available in more than one local area.

National transplant policy allows a patient to register for a transplant at more than one transplant hospital. However, each hospital may have its own rules for allowing its patients to be on the list at another hospital. Patients should ask each hospital whether it allows its patients to list at more than one transplant hospital. Being listed in more than one area does not guarantee an organ will become available faster than for patients registered at only one transplant hospital. Generally, each transplant center will require the patient to go through a separate evaluation, even if the patient is already listed at another hospital.

Transferring Waiting Time: Patients may switch to a different transplant hospital and transfer their waiting time to that hospital. Waiting time from the original center is added to the time collected at the new hospital.

The transplant teams at the first hospital and the new hospital will be responsible for coordinating the exchange of information and notifying UNOS of the transfer of waiting time. Patients should ask each hospital if transferred waiting time will be accepted.

Variability among Transplant Centers: Hospitals can vary widely in the number of transplants they perform and the characteristics of the donor and recipient pool. Organ procurement organizations can vary widely in the number and types of donors they receive each year.

[FarPoint]

62. Thank you for the link....

I'm not sure if the family is capable of expanding options such as multi-lists. Medicaid is her only funding. Finances are minimal. She needs a recliner chair...no money to buy one...so, I put out some feelers looking for a used one to be donated.

[Ms. Toad]

173. That is the one of three advantages people with resources have -

they can afford to be listed in multiple locations, which greatly increases the likelihood they will receive an organ sooner rather than later. (The other two being that they can more easily pass the financial screening, and are often more likely to have a support structure which is required to pass the social/emotional portion of the screening.)

[FarPoint]

65. Oh...I don't know either

if she is a candidate for an L-VAD....? I need to check this out too. I was too stunned to really get into details...

[Texasgal]

64. Liver transplants due to Cirrhosis

is the same way.

You have to stop drinking to get a liver. Ofcourse My husband had Hep C from poor dental work when he was a child and has not had a drop of alcohol since 2001. Still cannot get a transplant. Long drawn out story, but there you go.

[FarPoint]

66. Oh my....

does he need a transplant? If so...my heart aches for you and your family as well...

[Texasgal]

84. He needs it badly

but the only way for him to get it is to be able to PAY for it.

We work, he still does too although barely. We would need him to go on federal disability before there would even be an option. Oh yea... and we would need to divorce too. Apparently my salary of 36,000 is too much for us to afford an over 150,000 dollar surgery. Not to mention the post care.

Not all transplant people are "users" many times they simply cannot pay. Welcome to my world.

[FMalone]

67. To be fair, I wouldn't accept a lung, kidney, or liver transplant. I did my own damage.

I'm an organ donor but my eyes are probably all they would use. I abused the rest. I don't mean to belittle her in any way, at all. But they do place organs from the best donors with the most needy recipients. I'm not one of those recipients. My heart is in good shape. They might take that too. And I'm pretty sure my spleen is functional. The rest, not so much.

What is really frightening is that less than 2% of organ donors actually get to donate organs. If you don't die in the hospital, there's virtually no chance of anything being used. There is research into keeping lungs alive in a space capsule like thing, but it's early in the research and only because you can pump air into dead lungs and they will be slow to deteriorate. It's years out at this point, but it does have promise.

I have no intention of seeking replacement parts for myself, but I seriously hope she can find one for herself. And for the record, smoking is a minor detail in heart condition compared to McDonald's. The medical community has its stardards all screwed up.

Give her a hug for me.

[Texasgal]

92. Thing is many organ people

in need have not continued issues with drug or alcohol abuse. The main thing is how to pay for it. Much deeper issue if you ask me.

[Ms. Toad]

174. Yep.

There is the direct financial test (do you have the means to pay for your share of the cost of the operation and a lifetime of anti-rejection drugs) and the indirect financial test (do you have the means to be listed in several locations, to take the time out from your active life, etc.)

[Texasgal]

176. I don't think most people know

what it even takes to GET on the transplant list in the first place.

The federal guideline exam is thousands of dollars and not available in many places, you have to travel for it! Many times to other states. It's no easy and not a financially viable choice for alot of people! Not only that but you are placed depending on your condition, that's after you've met all the financial requirements. And ALOT of insurance companies will not pay for that.


Alot of people just die. It's easier.

[lob1]

71. I had a friend, age 72-74, who needed a lung transplant.

He couldn't get the transplant because they said he was too old. He died.

[FarPoint]

73. I am so sorry for the loss of your friend.

These parameters are terrifying.

[SheilaT]

108. Unfortunately, since the supply of organs is

limited, lines have to be drawn, as harsh as that sounds.

I'm 65, and although I'm in amazingly good healthy, I think that if I were to suddenly need some sort of transplant, and even if they were willing to do it at this age, I might want to pass. Even though I hope to live another 32 years (I have plans for my 97th birthday) I have already had a pretty good run.

[RAFREE]

152. That's what happened with my step dad

He needed a heart and was told he his name would be placed on the wait list if he was accepted. Well, he and my mother waited and waited. One morning she got up and found him. He died in the night and was on the floor in another room of their home. Usually if he wasn't feeling well which was often he'd get up so as not to disturb her. She didn't find him till six a.m.

That same day she got a letter in the mail saying that he was rejected to be put on the list for a new heart because they felt he was "too healthy" Yes, the very day he died. Talk about a macabre joke. I don't know who made the decision his heart was "too healthy" but, it certainly was not.

I'm sorry to hear of your loss.

[IdaBriggs]

72. I remember this being discussed on a television show once.

Taking the source for what it is worth (I think it was "Scrubs"?) the surgeon (actor) talked about the challenge of actually *living* with an organ transplant and how they needed to be absolutely sure the patients were committed/capable of the level of self discipline required to ensure success. There are lots of reasons people make "bad" decisions like smoking, or alcohol/drug abuse, but at the end of the day, if you won't do what the doctors tell you ("DON'T DO THESE THINGS!&quot odds are good you probably won't be diligent about obeying the rest of their rules either (which are apparently necessary for success).

The surgeon/actor considered it a duty to honor the gift being given by making sure it went to someone who wouldn't take it for granted, and would obey the rules/do everything possible to increase the odds of success.

That was the reasoning used on the show anyway, and sadly I think it was a pretty realistic analysis. Maybe someday when organs are available for anyone who needs them, they won't have to be so strict about appraising the recipients.

I am sorry about your young friend. Odds are good she knew the rules long ago; I am sorry her choices have created the situation where she might not live to see her son grow up. It sounds like she was in denial about her situation / rebelling about it. Unfortunately...sigh.

[FarPoint]

75. Your right....

I need to hear this...all of it.

[4 t 4]

88. no, no you don't

have to hear all of this. It is just a bunch of opinions - everyone has one like other things. Smokers are no less worthy of living than non smokers. It is human fault. We all have faults. Are we putting worth on people with faults. If you do this or that you are not worthy to live. Where is the help and compassion there are non smokers that jog and exercise constantly and drop dead and there are smokers that live to 100 . How can you judge now? Who is worth the organs of this time and who isn't is rather new. All these posts telling you it is more or less her fault must live a perfectly clean lives and would only except life saving procedure because they lived a perfect life and you only deserve it if you are perfect . If you draw the line AT Smoking, think again. What do you swallow or drink or ingest that might be harmful? FarPoint I wish your family all the best, she is just part of her environment

[Ms. Toad]

175. Some of us who have been sharing information

are sharing factual information based on our own close proximity to the transplant system. This isn't a judgment on smoking, per se, it is directly related to making the wisest decision about allocating scarce resources where they are likely to (1) succeed (as has been mentioned, smoking impairs the ability of the body to efficiently heal) and (2) not be abused (by requiring a 6 month period of abstinence to establish the ability to comply with very rigid lifelong restrictions which accompany living with someone else's organ, and an ability to stick to abstain more for more than just a brief period when you are critically at risk of dying.)

[JVS]

80. Can't she get a pacemaker or something short of a transplanted heart?

[FarPoint]

91. She already has a pacemaker and defibrillator.

Not sure if an L- VAD is and option.. Left ventricular assist device.

[tammywammy]

99. She has a pacemaker and a defibrillator and just quit smoking 40 days ago??"

I can't imagine before her heart surgeries to install those devices her doctors didn't tell her to stop smoking. Or warn her that she'd need a transplant in the future.

Unfortunately life's decisions are not without consequences.

[GeorgeGist]

81. Its science. Nicotine is a risk factor.

When hearts are scarce risks must be minimized.

[littlewolf]

89. I remember both my parents smoking as I grew up,

a teacher in 5th grade showed us what tar did to your lungs
and what Nic did to you. I never touched tobacco, nor did my sister.
we did watch our parents die slow deaths, my mom had 1 stroke and 2 heart attacks. my dad was worse, he had emphysema, he had a bubbler
that gave him O2. He could go from his bed to a chair in the living room,
anything past that and he had to have a pony bottle of O2.
he died slowly fighting for each breath.
I remember begging them both to stop, I was on the cancer society mailing lists as a 5th grader, nothing worked. they told me before they died
they wish they had listened. sad and too late.
I still worn ppl, explain what emphysema is and how it effects you.
no one listens.

I truly am sorry for this young lady and for her child.
where there is life there is hope, she may make it on the list.
they may make an exemption for her, anything could happen.

[egduj]

90. They should make an exception in this case.

[WillowTree]

94. Sad situation, but it's not an unreasonable standard.

I mean, one assumes that her "grave cardiac condition" didn't crop up out of nowhere 40 days ago. And until someone's been smoke free for at least six months s/he hasn't quit, just stopped. And I say that from personal experience. Even then it's a crapshoot whether they'll start again.

I wish her well and will say a few for her. Hope it all works out.

[LeftyMom]

100. Transplant organs are in short supply. You can't get one if you're trying to kill yourself.

[libdem4life]

104. A thought...cigarettes are around $5 a pack, so a 2-pack a day smoker spends $300 a month.

That's a payment on a nice car or groceries for two for a month. Two smokers in a family...$600, etc. That's a lot for a working family.

[SheilaT]

109. It is amazing how much they cost.

I may not have earned a lot of money all along, but I never smoked, and so had a lot more left over than the smokers at my wages.

[Ino]

114. Not so much necessarily

depending on where you live (state taxes) and what brand. My 2-pack-a-day habit cost me about $90/month. (Quit 2 years ago)

[libdem4life]

128. That much difference? Last time I almost passed out watcing somebody buying them in California

...agreed, high taxes. I quit when they got past $10 a carton way back in the 80s.

[Mariana]

138. My friends made their own cigarettes

using pre-made filter tubes and loose pipe tobacco. I was shocked at how little it cost. It was a tiny fraction of the price of ready-made cigs.

They've quit now, I think for good this time. I wonder if switching to pipe tobacco made a difference in their ability to quit - maybe it doesn't have the same additives that they put in ready-made cigs, the ones that make cigs more addictive.

[OwnedByCats]

154. My aunt starting smoking those

because the cost of cigarettes rose to $10 a pack in NY. Instead of spending $60 a week, she spends about $10 between the tobacco and the papers with the filters in them. I never knew it was that cheap, probably because everyone else I know who smokes buys the ready made ones. I would think most smokers would want to go this route if they aren't ready to quit. You do have to spend about $50 on the little contraption to make them with, but that's a one time cost that pays for itself in just one month.

[xmas74]

110. It's the transplant list in general.

My aunt has to be six months tobacco free before she can be put on the list for a lung transplant.

[Xithras]

115. There's another major reason for the prohibition that hasn't been mentioned yet.

Your lungs are lined with tiny hair-like fibers called "cilia" that help to clear mucus debris from the lungs and prevent infection. Smoking paralyzes and destroys the cilia, which is where "smokers cough" comes from, and dramatically increases the odds of lung infections. In fact, smokers have a five fold greater likelihood of getting lung infections than nonsmokers because of this one important detail.

Most young smokers have vibrant immune systems that can combat any infections before they become serious, and don't have any immediate health problems from the loss. Transplant patients, on the other hand, will end up on immunosuppressants which will seriously hinder their ability to fight off those infections. With no cilia to clear the lungs, and no immune system to fight off infections, the odds that a smoker will contract a fatal lung infection after a transplant are astronomically higher than those of a nonsmoker.

On average, it takes 5-6 months for your cilia to regrow after you quit smoking. That's why smokers have to wait.

[OwnedByCats]

156. Your explanation

makes the best sense of all I think. Some replies sound kind of cold, like it's just too bad for her because she was stupid enough to smoke, or she doesn't deserve it because she'll smoke after the transplant (which they do not know that for a fact). People make bad choices sometimes, especially young people. I don't think she deserves to die because of it. It being about the risk factors, higher chances of infection etc, is what should be the focus.

My father needs a hip replacement but had a bad infection on his leg. They wouldn't operate until the infection was gone because between the risk of infection from the surgery and the chances that the existing infection could be made worse, they felt it was a risk not worth taking. However they now have the infection largely controlled so he's been meeting with the surgeon to make a plan to get it done.

I just wonder if her condition deteriorates sharply before the 6 months are up, would they do it anyway? Sometimes the treatment is risky - non treatment in some cases is even riskier.

[ismnotwasm]

116. I'm a transplant nurse

Look at it this way; there are for more people in need than there are organs. The criteria is designed for survivability. It's not perfect--for instance, people with substance abuse or alcohol abuse problems need to be sober for six months before being listed-- is that too much time or not enough?

I have seen exceptions made when people are running out of time.

Nicotine is an ugly drug that adversely affects a number of systems. This can't be overstated. That being said there is more to being listed that being drug free.

One of the primary criteria is good social support, a record of medical compliance, Health insurance of some sort--Medicare covers transplants---I'm sure this young lady was told to quit smoking, and I suspect there is more to the story, because part of the work up process is a psychological evaluation.

Another option, but unfortunately only for those who can afford it is check into different transplant centers. Some will accept a candidate another will reject.

And, transplant meds are many and complicated and expensive, you have to fully understand what you're taking, or at least understand who to ask.

[Hekate]

117. Cigarette smoking causes heart disease in healthy hearts. I'm sorry, but that is a fact.

The addiction is very hard to kick -- 40 days for her? Good. But 6 months would put a helluva lot more distance between her and her addiction. No one wants this girl to die, but in order for her to receive a new heart, someone else will definitely have to die first.

I've said this before: There is a shortage of available organs for transplantation, and there will always be people who die while waiting for a new organ, even if they have the money, and even if they live in Canada. In addition, there will always be people who die after receiving a new organ.

Medical ethics committees exist for a reason: It's Not Personal.

[sibelian]

119. There are similar standards in place for drinking and liver transplants in my country.

I used to work in a transplant unit, very briefly, and found this out. Many of those requiring the liver needed them from excessive alcohol consumption. Alcoholics had to be able to demonstrate getting off the junk.

I can't fault it. It's not as if we can reliably order a fresh batch of 30,000 viable, transplantable human livers from our huge, publically funded human liver orchards to waste on experiments...

I imagine it's the same for hearts.

Yes, it's cold. Very cold. It's also impossible to avoid seeing how else you're going to manage matching donor to recipient when, mostly, you have more recipients than donors. Giving a liver to someone who's going to need another in ten years through having poisoned the crap out of it is not a very good strategy.

[SomethingFishy]

120. Maybe instead of using this thread as yet another opportunity to shit on smokers

You use it to shit on people who don't donate their organs. Maybe if more people became organ donors there would be enough for everyone who needs it.

That wasn't directed at you Mr OP, but at the responses of all these compassionate liberals.

[Egalitarian Thug]

122. But how would that feed my sense of righteousness?

Thanks for posting what I'm sure many are thinking.

[totodeinhere]

139. I assume you are referring to posthumous donations. I don't care to donate my heart

while I am still alive. The same applies to my liver. Donating a kidney leaving one healthy one would be another matter.

[dflprincess]

141. It is possible to donate a portion of your liver

it all depends on how it's connected to you and if it can be bisected in a way that allows a connection in another person.

My friend's husband was hoping to receive a donation from his nephew. They were a match, but the nephew's liver wasn't made in a way to make it possible. (This was a few years ago, I imagine the techniques for living donor donations may have improved.)

[totodeinhere]

143. Thanks. I'll add that to my "learn something new every day" file. n/t

[SomethingFishy]

155. Seriously?

You actually asked that question?

[totodeinhere]

161. Yes I did. Do you have a problem with that? n/t

[SomethingFishy]

165. No not at all. Just confused as to why someone would think

I was advocating suicide as a form of organ donation. Most people wouldn't need to ask something that is normally so easily understood.

[moriah]

167. I know you wouldn't advocate it, but there are moments....

... usually the same moments I wish it'd be possible to give some people brain transplants....

[dflprincess]

142. +1000

I too have been "impressed" by the compassion demonstrated here.

[markpkessinger]

124. There aren't enough hearts available for transplant . . .

. . . Therefore, decisions -- really, really hard decisions -- must be made as to who gets the ones that become available. Given that it is such a limited resource, it is important to try to allocate it where it has the best chance of being successful, and that involves identifying risk factors that are likely to negatively impact the chances for a successful transplant (such as a smoking habit). If you allocated available hearts for transplant randomly, through some kind of lottery, would it really be fair to those who are likely to benefit from a transplant to have some of those hearts going to patients who are not, given their risk factors? If you think allocating available hearts for transplant based on the likelihood of long-term success of the transplant, then tell us how you would propose doing it in a way that is both fair and equitable and makes the best use of a limited resource.

[HockeyMom]

129. She is friggen 21 years old?

When did she start smoking? At 2 years old? Her father died at the same age? From smoking TOO? Hello, anti-smoking people, mabye there is something MORE genetically going on HERE?

Try using your BRAINS instead of your agenda on this one.

[JustABozoOnThisBus]

134. Does it matter when she started?

Maybe she started when she was 12 or 13. That wouldn't be unheard-of.

Maybe the smoking is keeping her off a list. Maybe genetic markers are keeping her off a list.

It's a sad story, if true.

[moriah]

166. Uh, actually, yeah, it does. Pack/years are how exposure is measured.

My pulmonary specialist said that he did not think my lungs had been permanently damaged by the cigarette smoking I did. I'm quit now, but half a pack a day for about 10 years, some years a full pack so go ahead and call it 10 pack/years even though it really wasn't that, haven't damaged my heart or my lungs themselves.... though they certainly didn't help and it's a good thing I've quit. He said the only permanent damage to my lungs came from constant infections that I've had -- that my lung scarring is from pneumonia, and old -- I had pneumonia many times before I started smoking cigarettes.

Was I stupid as hell to ever start? There's no question.

There's a time in some people's lives, though, when they're old enough to know better and still too young to care. I was 22 when I started smoking, despite a history of severe recurrent pneumonia that required a bronchoscopy and needle biopsies to do cultures and has left calcified granulomas.

Ya know what? For whatever reason, maybe it was the menthol, maybe it was people staying further away from me because I reeked of cigarette smoke, whatever, for the first five years I didn't have nearly as many infections, and only two episodes of bronchitis. I started trying to quit in 2009, when I was about to turn 30 (though before that I'd tried Chantix because I knew it was a good idea to try to quit), and my problems were no worse than they'd been prior to smoking cigarettes at that time. It's NOT easy. They weren't improved anymore like they had been (paradoxically and probably coincidentally), but my lungs up until only a few years ago were generally good in between times of me getting sick. I still, however, needed to quit.

And I did so.

So has she. It may have only been for the last 40 days. I wish someone would be saying "Good on her for quitting, only 143 days to go!"

[JustABozoOnThisBus]

184. You're right. "Good on her" for quitting.

I don't know what damage I did to myself. I started when I was 13. I finally quit about 15 years ago, but many packs were smoked. I still want a cigarette occasionally, so I know quitting is hard.

Hopefully, the young lady in question will survive long enough to get a heart, and that an underlying cause will be discovered and treated.

[moriah]

163. Thank you.

While I'm sure smoking didn't help and wasn't smart, I doubt it made the heart transplant necessary in the first place. It's just making it impossible now, and for sadly understandable reasons. Nicotine really isn't good for the body.

[RobinA]

144. The Level

of self-righteousness on this thread is beyond disgusting. It would do any winger proud.

[fredamae]

151. Believe it. They already

flexed their muscles by letting this patient die because he was under dr. care/advice-used Cannabis to fight pain, nausea etc...because The Feds say Cannabis is a Fed Shed I without any medicinal use.

http://www.komonews.com/news/health/18475224.html

I know someone who is on a trx list and UNOS is VERY strict! If you test positive for Anything they disapprove of? It's a "death sentence". They'll kick you off the list in a NY Second.
Hell, even the Red Cross will NOT accept Blood Donations if you are a MedCanna patient.

But apparently donations of both organs and blood are just hunky dory if you use a myriad of pharma drugs?

Congress has the power to change all of this, I believe.

[JustABozoOnThisBus]

183. "MedCanna"? Medical Marijuana?

I don't remember the Red Cross asking about marijuana. They asked about illegal drugs take with a needle.

Nothing about medical (or recreational) marijuana use.

[fredamae]

186. Under Fed Law

Cannabis Is an Illegal Drug-I specifically asked them about Medical Cannabis.
I was curious because a friend had advised me about that--so I called the Red Cross and specifically asked about people who reside in states where Cannabis is legal for medical use (and in the State of Oregon the CSA is reduced to a Sched II).
They cannot accept, by rule/policy, donations from those folks because of Cannabis use.

The Red Cross (and All other similar orgs) have to follow the same standards/practices established, I understand, by the Feds.

[fujiyama]

168. You have to keep in mind that this rule isn't put in place for moralizing purposes

and I don't believe in karma and have no interest in being sanctimonious about this.

But this just comes down to cold hard numbers - statistics - and the likelihood of long term survival if she were given a new heart. Hearts, like all other organs are scarce resources. So physicians have to find a framework to ensure that they are going to those who will live the longest with a new organ. That's why we don't see heart transplants going all that often to an 80+ year old. We know their long term survival isn't that great. Likewise, certain lifestyles or behaviors could be causing harm (like drinking or smoking) - and that increases the risk that he or she won't live long term if they were to receive a new organ (say a new liver in the case of an alcoholic).

I hope your friend is able to quit the habit and makes it six months and gets a new heart. That would be wonderful. This issue is obviously emotionally difficult - we are after all talking about allocating scarce resources that determine life or death in a society. The system could be worse. Organs could simply be bought or sold. As it is there is controversy about being able to get placed in multiple locale wait lists. Or if it were completely "first come, first serve", we'd have organs simply not having a long term impact. The same goes with a patient that isn't able to show that they have to discipline to take the required anti-rejection drugs throughout their life. A transplant for such a person would not be very beneficial.

[Recursion]

170. If we had an infinite supply of hearts, that would be unconscionable

Since we don't, not doing that would be unconscionable.

Nicotine, regardless of the delivery mechanism, is a stimulant and screws with the vascular system. There's probably a ten page list of stuff that recipients can't have even traces of in their bodies.

[Warpy]

177. It's not that frightening

Most of the people on the transplant list have been in failure for months or years. Given nicotine's effect on the cardiovascular and pulmonary systems, the long term avoidance of it is a valid criterion. Current smokers who plan to resume smoking post op are poor risks and donor hearts are scarce.

While they might make an exception for this woman if the right heart comes along, they generally do require cardiomyopathy patients to quit the day they are diagnosed.

ETA: they can now have people wait for transplant using implanted ventricular assist devices. I think she is likely a prime candidate for that.

[appleannie1]

180. They refused a friend of mine because he was gay. They did not say it that way, they said he led a

dangerous lifestyle and that was the reason. He did not smoke or drink or do drugs or race or own a motorcycle. He had been in the same relationship for 16 years. But according to them he led a dangerous lifestyle. He died 2 years ago. His heart is what killed him. Not his lifestyle.

[AngryOldDem]

185. Seems reasonable. A lifestyle change is a small price to pay for a second chance at life. n/t