Case 3: Organ Allocation

Case 3: Organ Allocation

Case 3: Organ Allocation

B.W. is a 47-year-old male who presents with alcoholic cirrhosis.  He drank heavily for 20 years, but states that he quit recently.  He has a past medical history of posttraumatic stress disorder, diabetes, and gastrointestinal bleeding due to portal hypertension He is edematous, jaundiced, has low blood pressures, and has periods of confusion.  B.W. has good financial and family support. At his bedside are his wife and two teenage daughters who often tell the nurses that their father “didn’t act like the alcoholics you see on TV” and “was a great dad.”  His laboratory results indicate that his likelihood of mortality in the next three months is 71.3%.

J.C. is a 48-year-old male who presents with acute liver failure.  He has a past medical history of autoimmune hepatitis, diabetes, and gluten intolerance.  He came to the hospital for transplant workup because he was suffering from intractable prurtis (“unpleasant sensation that provokes the desire to scratch”), ascites (“protein-contained fluid accumulation in the abdomen”), and intermittent confusion.  When talking with doctors, he notes that recently his quality of life has been unacceptable and he is always feeling fatigued.  J.C. has a large extended family that is often at his bedside and he is financially secure.  His laboratory results predict his likelihood of mortality in the next three months to be 52.6%.

1.    Which patient should receive the organ? Please explain your reasoning.