ALMOST A third of the liver transplants carried out in the State each year are on patients with a history of alcohol abuse, the director of the national liver transplant programme has said.
Dr Oscar Traynor stressed very strict criteria must be met by these patients before they will be considered for transplantation. They must have demonstrated a commitment to staying off alcohol permanently, which is gauged by a number of factors.
“Number one they have to be abstinent for a minimum period of six months and that must be verified. The second thing is they have to undergo some form of psychiatric assessment by a psychiatrist who has special training in addiction counselling. And number three, we generally require them to get involved in a programme like Alcoholics Anonymous or some programme like that. So it’s not a simple solution. They can’t just say okay, I’ve got alcoholic liver disease, I want a liver.”
Some 38 liver transplants were carried out last year, significantly fewer than in recent years due to a fall-off in organ donations in general. There had been 64 liver transplants carried out in 2009.
Dr Traynor said he hoped the fall-off in donations last year was just a trough. Already this year organ donations have increased again. But he warned that without organ donation, patients would die waiting for transplants. Twelve patients died last year waiting for liver transplants, which would be about three times more than in other years.
Stressing the importance of organ donation, he said: “These are people who if they got a liver in time would have had a very good chance of surviving and being alive today.”
He said patients with alcoholic liver disease probably account for about 30 per cent of patients who are transplanted and patients with hepatitis C probably account for about 35 to 40 per cent.
Some two-third of the hepatitis C patients requiring liver transplants would have acquired their infection from contaminated blood, he said, while the other third would have acquired it through intravenous drug abuse.
Dr Traynor agrees with a number of patient groups including the Irish Kidney Association (IKA) and the Cystic Fibrosis Association of Ireland that greater efforts need to be made to ensure more families are approached about donating the organs of their loved ones.
Mark Murphy of the IKA said donor co-ordinators need to be appointed to hospitals to fulfil this role. This was preferable to a proposal in the programme for government to legislate for a new system whereby it would be assumed people consented to organ donation unless they had expressed the view they wanted to “opt out” of such an arrangement.
Speaking at the launch of Organ Donor Awareness Week yesterday, Minister for Health James Reilly said he would consult widely before any decisions in relation to a change in legislation was taken, stressing that the opt-out proposal was merely a way to start debate.
“There can be no question at any time of organs being used for transplant and removed without the expressed consent of the family and the relatives,” he said.
CASE STUDY 'WORKING HARD AND PLAYING HARD'
IT CAME as a shock to John Healy when he suffered a heart attack at the age of 41 and an even bigger shock when he got a second one two years later, putting him on the national heart-transplant waiting list.
Well known as the maitre d' of RTÉ's The Restaurant, there was no history of heart disease in his family and he attributes his heart failure to "working hard and playing hard" for over a decade.
“I have asked myself how did I end up like this, was it something I did that was wrong, could I have prevented it myself, and I probably could have,” he said.
“My life I suppose was that I was on a treadmill that got faster and faster and faster and with that pace of working I was under a lot of pressure and stress as well. Combine that with smoking, bad diet, a lifestyle that was late nights, early mornings,” he said.
“I did enjoy life. I did partake in alcohol, I did do a few things I shouldn’t have done maybe when I lived in London and when I was very young. There were certain substances that did come my way . . . it wasn’t that I was a regular user of anything in particular . . . I think my heart was weakened after long-term pressurised work and stress and partying.” As maitre d’ of Mezzo in London in 1995, he had a heavy workload and this continued when he came home to work at the Four Seasons in Dublin.
He is now one of fewer than 20 people on the national heart transplant waiting list. Since his second heart attack in 2009 his heart function is a third of what it should be. “That causes a lot of problems with fluid retention ... I can’t work because my energy level is very limited,” he says, explaining the current TV series was filmed last year.