A man in London has died of alcohol-induced liver failure at the age of 22. You may have seen reports of it in the news. Gary Reinbach died less than 48 hours after his mother had highlighted her son's plight at the weekend. Already some people are using it as a stick to beat the Obama health plan. This is what happens, they say, when the government gets involved in healthcare. This begs the question as to whether or not the government is already involved in the US health care – it is of course heavily involved, spending more on health as a proportion of GDP than the British government spends on the NHS.
However, in this case, no-one in government was remotely involved; these were clinical decisions made by the doctors involved, based on agreed guidelines within the medical profession.
More than 8,000 Britons are awaiting an organ transplant, 259 of whom require livers. More than 400 people died on the waiting list last year. There is undoubtedly a shortage of liver donors. Why? Partly because there are fewer people dying in road accidents, but also because since the outrageous fuss made by the Press some years ago over the Alder Hey scandal of retained organs (see my previous article on Morbid Anatomy), relatives are more reluctant to offer up parts of their dead and dying kin for transplant. In Spain, where consent for organ donation is presumed, they do it better.
So criticism of the government for not introducing a more transplant-favorable regime might be in order, but since supply of livers does not meet the demand there has to be rationing. How should they be rationed? It could be by price. Only rich people get transplants? Not acceptable in the UK; I don’t know about the US. At the moment it is by utility. Those with the greatest need who can make the best use of a transplant should be first in line. On the whole alcoholics are not good candidates for transplants. All they do is ruin the new liver with alcohol. Of course, some are redeemable, but alcoholics are notorious liars. Therefore doctors have introduced a test to see whether they are suitable recipients. Can they stay clean for 6 months out of hospital? If they can they are put on the list for a liver. For the truth is that if someone gets a liver transplant, someone else on the waiting list won’t and will die of their disease. A famous case involved the footballer George Best. He was perhaps the best footballer of his generation, but success went to his head and he drank himself into liver failure. He passed the test of being clean for six months and got his transplant. But having received his new organ he proceeded to ruin it with alcoholic binges. You can see why doctors don’t trust alcoholics.
Moralists might declare that if the disease is self inflicted they should be at the end of the line. We don’t make those judgments in the UK. The list is made up according to who would be likely to benefit.
Poor Gary Reinbach never stood a chance. He started drinking at the age of 11 when his parents’ marriage broke up and by 13 he was binge drinking. The roots of his troubles lie with a lax attitude to family break up and an even laxer attitude to under age drinking.
Binge drinking among young people has led to a sharp rise in deaths from cirrhosis of the liver in the 25-34 age group and hospital admissions among young people have been increasing. In 2007-8 the London Ambulance Service NHS Trust dealt with 8,126 alcohol-related calls for 11 to 21-year-olds, a 27% increase on 2004-5.
The regulation of alcoholic drinks has been heavily influenced by the Portman Institute, a front organization for the alcohol manufacturers. The government is highly reliant on taxes on alcohol. They ignore recommendations from the Chief Medical Officer. This is where I hold them culpable. If the same strict policing of alcohol availability were available in the UK as is present in the USA or better still in Canada, problems like that of Gary Reinbach would not exist.