Because you know this will cause controversy

[JointStrikeFighter]

If only drugs weren't addictive she might have never become addicted to drugs at all *eyeroll*

[The Duchess of Zeon]

This woman would effectively be murdering someone else by taking a second liver. She was already given one. The next one should be going to someone else because she shouldn't have fucked this one up. To try and get a second transplant is for her to essentially be trying to manipulate others into killing for her, and she deserves all of the respect and treatment of an attempted murderer. One can excuse someone their first transplant because most drug addicts have no idea what the drugs are really doing to them, but she would have been amply and rigorously informed of these things while going through the selection, transplant, and recovery process, so now she's wilfully seeking out a third organ when she wilfully ruined the second in full knowledge of the price she would be paying for doing so... And deserves her fate accordingly.

[mr friendly guy]

so, what is the criteria

For what? For donating organs, or receiving them? Right now this woman's body is so fucked up with drugs and chemicals that even a liver from her father isn't a guarantee. They may be reluctant to do the surgery especially if chance of rejection is above 50%. A father may love a child enough to give them the gift of life, but if it will do serious harm to him for little chance of success the hospital may refuse to do it.

Sorry, should had been more explicit. What is the criteria for receiving an organ transplant? Anyone here can fill me in?

this presentation for cadaveric transplants has a bit on calculating urgency. It does explain a little bit about scales such as MELD score and Child's Pugh criteria. It also lists the contraindications. Because its a PDF of a power point presentation it didn't go into too much detail about how long you have to be abstinent from.

This one purports to have guidelines for live transplants I haven't even skimmed more than the first few pages so I can't validate how good it is for you.

If only we spent more on drug rehabilitation than imprisoning people, maybe this woman would not have needed a liver transplant at all.

How much drug rehabilitation do you want? I live in WA the same state this woman does, and we do have various services we refer them to.

[LadyTevar]

Sorry, should had been more explicit. What is the criteria for receiving an organ transplant? Anyone here can fill me in?

Well, in Nitram's case:
1. Extensive damage to the organ in question, and signs that the damage is only getting worse, leading to death.
2. Serious medical conditions, side effects from the organ failure, that effect quality of life, up to and including possible fatal side-infections or injuries.
3. Strong possibility of recovery with a new organ.

In Nitram's case, he was much lower on the transplant list up until last year, when a massive infection in the ascites (one of those nasty side effects) nearly killed him. His 'score' jumped 3pts on the Scale used to determine distribution of available organs.

OT: As Nitram so aptly put it earlier, I have no sympathy for this woman. She got her second chance and blew it. No more second chances.

[LadyTevar]

One can excuse someone their first transplant because most drug addicts have no idea what the drugs are really doing to them, but she would have been amply and rigorously informed of these things while going through the selection, transplant, and recovery process, so now she's wilfully seeking out a second organ when she wilfully ruined the second in full knowledge of the price she would be paying for doing so... And deserves her fate accordingly.

As I testify, the doctors are very explicit here in the US about what to expect, how it will affect your life, and the dos and don'ts to keep yourself healthy. The doctors started the informative process with the first visit.

[Kamakazie Sith]

If only we spent more on drug rehabilitation than imprisoning people, maybe this woman would not have needed a liver transplant at all.

Maybe, but the ultimate blame is still on her shoulders. The system is fighting a losing drug war, but it is not the systems fault when a drug user pays the consequences for their abuse.

[CaptainChewbacca]

Some doctors won't do a lung transplant on a person who has smoked in the last 6 months, they'll even test your hair if they suspect you're still smoking.

[Broomstick]

I'm sorry this woman is going to die, but she is. I hope her father can be persuaded against donating part of his liver because, frankly, I doubt it will do any good. A live liver donation means the recipient receives only a partial liver, and it must be guarded more than an intact liver until it grows to full size. Under other circumstances the risk may be justified, but the fact is, a live liver donor takes a hit on his own liver function and there is a real risk of debility or even death.

Won't that depend on the donor liver function? After all, the liver has approximately 90% reserve capacity that can be called upon.

Uh... yeah. And when you do a live liver transplant you cut out half the liver which leaves....well, presumably just have the reserve. Down to less than 50%, right? Assuming nothing goes wrong. And don't forget, anti-rejection drugs have side effects. To put it bluntly, they're toxic. And what organ is the main de-toxifier? The liver. Which you have just cut down the 1/2 capacity. So don't screw it up, 'cause really with a live donor liver transplant you're only getting half a liver. Treat it gently til it all grows back.

[PainRack]

Uh... yeah. And when you do a live liver transplant you cut out half the liver which leaves....well, presumably just have the reserve. Down to less than 50%, right? Assuming nothing goes wrong. And don't forget, anti-rejection drugs have side effects. To put it bluntly, they're toxic. And what organ is the main de-toxifier? The liver. Which you have just cut down the 1/2 capacity. So don't screw it up, 'cause really with a live donor liver transplant you're only getting half a liver. Treat it gently til it all grows back.

In case it isn't clear, I was talking about the donor, not the recipient. Under other circumstances the risk may be justified, but the fact is, a live liver donor takes a hit on his own liver function and there is a real risk of debility or even death.
This statement in particular.

And god... here's something regarding phenytoin. The long term risks of a transplant and immuno-suppressive drugs is the risk of burkitts lymphoma. Given that one of the classes of chemotherapy interacts with phenytoin, expect regular bloodtaking at odd hours.

[wolveraptor]

Mr Murray said yesterday his daughter had been a happy and healthy A-grade student at a Perth private school before being diagnosed with attention deficit hyperactivity disorder at age 12. She was prescribed dexamphetamines and began abusing the drugs, later moving on to speed.

I know that this is a biased account, and that if we could contact the psychiatrist that prescribed those drugs, he'd certainly have a different story, but I honestly feel that this woman's life would be infinitely better if she had never had her ADHD "treated".

If only we spent more on drug rehabilitation than imprisoning people, maybe this woman would not have needed a liver transplant at all.

And then there's the issue of how people are rehabilitated. I don't know how things are done in Australia, but in America courts will often order you to attend some bullshit pseudo-religious 12 step program with a recidivism rate of like 80%. Hopefully rehabilitation clinics in Australia take a more scientific approach to the matter.

[Stofsk]

Mr Murray said yesterday his daughter had been a happy and healthy A-grade student at a Perth private school before being diagnosed with attention deficit hyperactivity disorder at age 12. She was prescribed dexamphetamines and began abusing the drugs, later moving on to speed.

I know that this is a biased account, and that if we could contact the psychiatrist that prescribed those drugs, he'd certainly have a different story, but I honestly feel that this woman's life would be infinitely better if she had never had her ADHD "treated".

Well it's what started the downward spiral.

If only we spent more on drug rehabilitation than imprisoning people, maybe this woman would not have needed a liver transplant at all.

And then there's the issue of how people are rehabilitated. I don't know how things are done in Australia, but in America courts will often order you to attend some bullshit pseudo-religious 12 step program with a recidivism rate of like 80%. Hopefully rehabilitation clinics in Australia take a more scientific approach to the matter.

AHAHAHAHAHAHAHAHAHA

*ahem*

Sorry. But yeah... we don't.

[Broomstick]

If only we spent more on drug rehabilitation than imprisoning people, maybe this woman would not have needed a liver transplant at all.

And then there's the issue of how people are rehabilitated. I don't know how things are done in Australia, but in America courts will often order you to attend some bullshit pseudo-religious 12 step program with a recidivism rate of like 80%. Hopefully rehabilitation clinics in Australia take a more scientific approach to the matter.

Actually, last I heard, ALL drug rehab approaches, scientific or mystical, have a success rate of about 15-20%. Doesn't matter if it's for tobacco, alcohol, heroin, cocaine, speed, whatever. Even then, the risk of relapse at some point down the road is high.

In other words, we really don't have a good solution for the problem.

[wolveraptor]

Actually, last I heard, ALL drug rehab approaches, scientific or mystical, have a success rate of about 15-20%. Doesn't matter if it's for tobacco, alcohol, heroin, cocaine, speed, whatever. Even then, the risk of relapse at some point down the road is high.

Really? I find that hard to swallow. I'm almost positive that drugs like cocaine and heroin are far more addictive than nicotine and alcohol. Heroin withdrawal in particular is said to be hellish.

As far as actual approaches to rehab go, I'm having some trouble finding research on that. Most of it seems to be in paper form (how primitive ), are there any online sources anyone could point me towards?

[Broomstick]

Actually, last I heard, ALL drug rehab approaches, scientific or mystical, have a success rate of about 15-20%. Doesn't matter if it's for tobacco, alcohol, heroin, cocaine, speed, whatever. Even then, the risk of relapse at some point down the road is high.

Really? I find that hard to swallow. I'm almost positive that drugs like cocaine and heroin are far more addictive than nicotine and alcohol. Heroin withdrawal in particular is said to be hellish.

Untrue. Nicotine is actually JUST as addictive as heroin. There are some who maintain it is even more addictive than heroin (including some recovering heroin addicts) but I think that has more to do with individual variation. A major difference is that while a heroin addict while high pretty much just slumps into a corner and dozes, a nicotine addict while high continues with a fairly normal range of activities. This gives the illusion that nicotine is somehow less addicting or harmful than heroin, but that's just not so.

Cocaine in its chemically pure form is pretty addictive, but as coca tea or chewed in the traditional manner much less so. If you mainlined caffeine it would also probably be hugely addictive. (If you mainlined nicotine you'd most likely be dead - that shit really is toxic).

Is heroin withdrawal hellish? Yes and no. It sure is unpleasant, but so is alcohol withdrawal which, actually, is significantly more likely to kill you. Outside of a hospital virtually all people can survive going cold turkey off heroin. Detoxing from alcohol without medical supervision has a death rate around 30%.

Just because a drug is legal doesn't mean it's "safer" or less addicting in a given individual.

As far as actual approaches to rehab go, I'm having some trouble finding research on that. Most of it seems to be in paper form (how primitive ), are there any online sources anyone could point me towards?

Nope. My work in the addiction industry predated the internet, as did the research I'm most familiar with. Wish I did know of an on-line source since you young'uns seem unwilling to go to a library and hold onto actual paper.

[mr friendly guy]

According to the West, the person in question had undergone the methadone program, so she most probably was addicted to opiates at one point as well. In WA we have various addiction rehab programs, including a naltrexone one (which I understand are rare, and this one has only limited government funding) as well as the aforementioned methadone program. I am a bit more optimistic about these as they involve some pharmacological approaches rather than AA lets believe in a higher power crap. We also have rapid detox programs (of course the trick is staying off).

I do wonder of course whether the Scientology approach might work. That is you pay them all your money for a course which essentially involves locking you up in a steam bath so there is no way for you to get access to the drugs and even if you were out you would have no money.

[Mayabird]

People with no money still manage to find drugs somewhere or somehow. People will sell their bodies and their children and steal crap from anybody who ever gave a shit about them for another hit. So fuck the Scientologists.

[mr friendly guy]

People with no money still manage to find drugs somewhere or somehow. People will sell their bodies and their children and steal crap from anybody who ever gave a shit about them for another hit. So fuck the Scientologists.

Thats why you lock them up as well, so they only way they can get access is to break out.

[CmdrWilkens]

Cocaine in its chemically pure form is pretty addictive, but as coca tea or chewed in the traditional manner much less so. If you mainlined caffeine it would also probably be hugely addictive. (If you mainlined nicotine you'd most likely be dead - that shit really is toxic).

Having actually been diagnosed as chemically dependent upon caffeine (I've had withdraw shocks, fevers, and repetitive migraine headaches when I would attempt to cut back consumption in the past) I can attest that it can in large enough doses fuck you up just as much as any other drug...but I was also a pretty crazy case for caffeine intake especially in proportion to my body weight at the time (I finally started getting to a more normal intake around 4-5 years ago). Caffeine tends to be addictive moreso in the fixation sense rather than chemical dependency sense as it took a LOT of caffeine even for the mild withdraw symptoms I showed.

[Stofsk]

According to the West, the person in question had undergone the methadone program, so she most probably was addicted to opiates at one point as well. In WA we have various addiction rehab programs, including a naltrexone one (which I understand are rare, and this one has only limited government funding) as well as the aforementioned methadone program. I am a bit more optimistic about these as they involve some pharmacological approaches rather than AA lets believe in a higher power crap. We also have rapid detox programs (of course the trick is staying off).

I'm an extremely biased observer on the efficacy of methadone and buprenorphine treatments for criminals who have a drug dependency (aka druggies and junkies). From a penal viewpoint, what seems to happen is abuse of said treatments usually by people who organise to have those that take it stood over for it. Prison guards usually give a quick scan of the mouth with a torch to see if its actually been swallowed or not, and people who stand over others tend to cause fights too, and all sorts of horrible things happen as a result of drugs in prison, but its a neverending cycle. It's pretty sad and I haven't got any better solutions to it (except for really obvious and unhelpful ones like don't get addicted to anything).

[Broomstick]

Part of the problem is that you really CAN'T force someone stop being an addict - that decision really does have to come from inside the person in question. You can give a person incentive, you can help them help themselves, but staying clean requires a decision by the person to change their ways. That's why something like 12 step can work - it's not the Sky Pixie, it's the way that attending regular meetings and having someone to help you when you start to waver that does the trick. The part that works is the part that helps you keep your resolve, not the woo-woo shit.

[mr friendly guy]

I'm an extremely biased observer on the efficacy of methadone and buprenorphine treatments for criminals who have a drug dependency (aka druggies and junkies). From a penal viewpoint, what seems to happen is abuse of said treatments usually by people who organise to have those that take it stood over for it. Prison guards usually give a quick scan of the mouth with a torch to see if its actually been swallowed or not, and people who stand over others tend to cause fights too, and all sorts of horrible things happen as a result of drugs in prison, but its a neverending cycle. It's pretty sad and I haven't got any better solutions to it (except for really obvious and unhelpful ones like don't get addicted to anything).

These people in my limited experience when dealing with them are also abusive to hospital staff. The thing is, hospitals don't stock a lot of these treatments normally and they get it from special dispenseries. In any event you could try naltrexone. Unlike methadone its not an agonist but an antagonist, so its highly unlikely someone will steal naltrexone since you can't get high from it. In fact if you take it to try and get high, you need even more of the stuff, and there runs the risk you can potentially overdose and still not get the high while on naltrexone.

[mr friendly guy]

Update - apparently NZ is looking less likely for the reasons already mentioned.

However they think they might be able to get the live liver procedure done in Singapore IF a compatible donor is found. From what I gathered about Singapore's health system is that relatives can tell the doctors whatever treatment they want no matter how silly it is as long as they pay. Ok I admit thats just what I heard from people who worked in Singapore before, where hospital administrators are very scared of family and relatives making a complaint.

At least over here if someone wants to make a complaint they have to make a better case, than say because the doctor was rude because he suggested someone who has faeces over the floor (such that it repulsed the ambulance staff called to see said patient) might need social services to aid with cleaning. Yes, that actually happened to me before. They were offended I suggested they might need help with cleaning. Social services which are subsidised by the government to boot.

Back to the topic, how much will this procedure cost. Estimationg $300 000. Who is going to pick up the tab, let me guess, the taxpayer.

[Stofsk]

I'm an extremely biased observer on the efficacy of methadone and buprenorphine treatments for criminals who have a drug dependency (aka druggies and junkies). From a penal viewpoint, what seems to happen is abuse of said treatments usually by people who organise to have those that take it stood over for it. Prison guards usually give a quick scan of the mouth with a torch to see if its actually been swallowed or not, and people who stand over others tend to cause fights too, and all sorts of horrible things happen as a result of drugs in prison, but its a neverending cycle. It's pretty sad and I haven't got any better solutions to it (except for really obvious and unhelpful ones like don't get addicted to anything).

These people in my limited experience when dealing with them are also abusive to hospital staff. The thing is, hospitals don't stock a lot of these treatments normally and they get it from special dispenseries. In any event you could try naltrexone. Unlike methadone its not an agonist but an antagonist, so its highly unlikely someone will steal naltrexone since you can't get high from it. In fact if you take it to try and get high, you need even more of the stuff, and there runs the risk you can potentially overdose and still not get the high while on naltrexone.

Oh don't worry, I'm well aware of how obnoxious and abusive they can be, though not from the kind of receiving end you doctors and other medical practitioners experience. Hopefully that new drug could be used instead, since the problem is people using it in prison are using it as a replacement measure for when they get out.

[PainRack]

Update - apparently NZ is looking less likely for the reasons already mentioned.

However they think they might be able to get the live liver procedure done in Singapore IF a compatible donor is found. From what I gathered about Singapore's health system is that relatives can tell the doctors whatever treatment they want no matter how silly it is as long as they pay. Ok I admit thats just what I heard from people who worked in Singapore before, where hospital administrators are very scared of family and relatives making a complaint.

Close.... sort of..... But the entire governing philosophy is different, since the patient has a huge co-payment for services. So, you want it, you pay for it.
There IS the problem of Human Organ Transplant Act, which prohibits any transplant done on foreigners who has not stayed in Singapore for a few months without special dispensation from the Medical Director.

There was this time when someone insisted on alternative medication in the form of high dose IV Vitamin C and stuff...... the consultants said look, the Health Science Authority doesn't approve your product, you want that, we give you the generic IV Vit C in high doses and Vitamin B but the ACS doesn't recommend anti-oxidants blah blah blah.....
First time I ever found out that IV Vitamin C is a ward stock in my drug fridge. And nobody knew how to dilute it:D

[mr friendly guy]

There was this time when someone insisted on alternative medication in the form of high dose IV Vitamin C and stuff...... the consultants said look, the Health Science Authority doesn't approve your product, you want that, we give you the generic IV Vit C in high doses and Vitamin B but the ACS doesn't recommend anti-oxidants blah blah blah.....
First time I ever found out that IV Vitamin C is a ward stock in my drug fridge. And nobody knew how to dilute it:D

OMG that was what happened to me with a patient whose Singaporean relatives insisted she gets vitamin supplements IV. Thing is she had an infection treated with antibiotics, but the thing that would eventually kill her was the cancer she had. She needed palliation and emotional closure, not bullshit vitamins for the anti-oxidant effects.