Confined Live(r)s

2018 ◽  
Vol 27 (2) ◽  
pp. 45-64 ◽  
Author(s):  
Julia Rehsmann

This article traces the trope of self-infliction for the moral economy of liver transplantation. Drawing on ethnographic fieldwork in Germany, I discuss the trope of self-infliction to explore intimate uncertainties that people with an alcoholic liver disease face when looking for medical care. I claim that the moralising trope of self-infliction plays a significant role in considerations about who is deserving of a liver transplant and a ‘second chance’. As access to transplantation becomes a life-and-death matter when livers fail, I see the trope of self-infliction as a tool for triaging lives for liver transplantation. Moreover, I claim that the trope of self-infliction, with its emphasis on self-responsibility, has a gendered dimension that puts women with an alcoholic liver disease under particular moral scrutiny. Furthermore, I demonstrate how this moralising trope shapes regulatory practices, like the ‘six-month abstinence rule’, which consequently confine livers and thus, eventually, confine lives.

2013 ◽  
Vol 27 (11) ◽  
pp. 643-646 ◽  
Author(s):  
Natasha Chandok ◽  
Mohammed Aljawad ◽  
Angela White ◽  
Roberto Hernandez-Alejandro ◽  
Paul Marotta ◽  
...  

BACKGROUND/OBJECTIVE: Alcoholic liver disease (ALD) is a controversial yet established indication for liver transplantation (LT), and there is emerging evidence supporting a survival benefit in selected patients with severe acute alcoholic hepatitis. The aim of the present survey was to describe policies among Canadian transplant centres for patients with ALD.METHODS: A survey was distributed to the medical directors of all seven liver transplant centres in Canada.RESULTS: All seven liver transplant programs in Canada participated in the survey. Every centre requires patients to have a minimum of six months of abstinence from alcohol before listing for LT. Completion of a rehabilitation program is only mandatory in one program; the remaining programs do not mandate this if patients have demonstrated prolonged abstinence, and sufficient insight and social supports. No program considers LT for patients with severe acute alcoholic hepatitis, although six of the seven programs are interested in exploring a national policy. Random alcohol checks for waitlisted patients are performed routinely on patients listed for ALD at only one centre; the remaining centres only perform checks if there is clinical suspicion. In the past five years, the mean (± SD) number of patients per centre with graft dysfunction from recidivism was 10±4.36; a mean of 2.5±4.36 patients per centre developed graft failure.CONCLUSIONS: With minor exceptions, LT policies for subjects with ALD are uniform across Canadian transplant programs. Presently, no centres perform LT for acute alcoholic hepatitis, although there is broad interest in exploring a national policy. Recidivism resulting in graft loss is a rare phenomenon.


2009 ◽  
Vol 29 (02) ◽  
pp. 233-237
Author(s):  
Stephen Ward ◽  
Charissa Chang ◽  
Lan Peng ◽  
Lawrence Liu

2014 ◽  
Vol 25 (3) ◽  
pp. 159-162 ◽  
Author(s):  
Clara Tan-Tam ◽  
Pamela Liao ◽  
Julio S Montaner ◽  
Mark W Hull ◽  
Charles H Scudamore ◽  
...  

BACKGROUND: The demand for definitive management of end-stage organ disease in HIV-infected Canadians is growing. Until recently, despite international evidence of good clinical outcomes, HIV-infected Canadians with end-stage liver disease were ineligible for transplantation, except in British Columbia (BC), where the liver transplant program of BC Transplant has accepted these patients for referral, assessment, listing and provision of liver allograft. There is a need to evaluate the experience in BC to determine the issues surrounding liver transplantation in HIV-infected patients.METHODS: The present study was a chart review of 28 HIV-infected patients who were referred to BC Transplant for liver transplantation between 2004 and 2013. Data regarding HIV and liver disease status, initial transplant assessment and clinical outcomes were collected.RESULTS: Most patients were BC residents and were assessed by the multidisciplinary team at the BC clinic. The majority had undetectable HIV viral loads, were receiving antiretroviral treatments and were infected with hepatitis C virus (n=16). The most common comorbidities were anxiety and mood disorders (n=4), and hemophilia (n=4). Of the patients eligible for transplantation, four were transplanted for autoimmune hepatitis (5.67 years post-transplant), nonalcoholic steatohepatitis (2.33 years), hepatitis C virus (2.25 years) and hepatitis B-delta virus coinfection (recent transplant). One patient died from acute renal failure while waiting for transplantation. Ten patients died during preassessment and 10 were unsuitable transplant candidates. The most common reason for unsuitability was stable disease not requiring transplantation (n=4).CONCLUSIONS: To date, interdisciplinary care and careful selection of patients have resulted in successful outcomes including the longest living HIV-infected post-liver transplant recipient in Canada.


2007 ◽  
Vol 13 (5) ◽  
pp. 757-761 ◽  
Author(s):  
Yesim Erim ◽  
Michael Böttcher ◽  
Uta Dahmen ◽  
Olof Beck ◽  
Christoph E. Broelsch ◽  
...  

2019 ◽  
Vol 54 (9) ◽  
pp. 1146-1154 ◽  
Author(s):  
Andreas Schult ◽  
Knut Stokkeland ◽  
Bo-Göran Ericzon ◽  
Rolf Hultcrantz ◽  
Johan Franck ◽  
...  

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