Overdose with suicidal intent: Ethical considerations for liver transplant programs

Abstract

Liver transplantation (LT) programs encounter patients with fulminant hepatic failure resulting from suicide attempts involving acetaminophen or multidrug ingestion. Members of transplant teams often have different opinions about whether these patients should be offered transplantation. Disagreements can delay the transfer of these patients to a transplant facility and negatively affect their management. Currently, transplant programs have no guidelines to help them with their decisions about the appropriateness of LT for these patients. Here we present a clinical case encountered at our facility, and we discuss ethical principles that should help programs to make informed decisions about transplantation for these patients. Liver

Ethical dilemmas in psychiatric evaluations in patients with fulminant liver failure

“…The decision whether to transplant in FHF patients must be rendered rapidly -in a matter of days or even hours [39]. The decentralized and subjective nature of eligibility assessments likely results in disparities among institutions and individual assessors.…”

“…Members of transplant teams often have different opinions about whether these patients should be offered transplantation. Currently, transplant programs have no guidelines to help them with their decisions about the appropriateness of liver transplantation for these patients [17]. Medical and surgical teams may experience counter transference toward patients with comorbid psychiatric illness or histories of substance abuse.…”

Ethnopharmacological Applications Targeting Alcohol Abuse: Overview and Outlook

“…Acetaminophen (paracetamol) is implicated as the causative agent of 42% of all the cases of acute liver failure (ALF) in the USA (Larson et al, 2005). A high risk factor of ALF is associated with consumption of acetaminophen in elderly, alcoholics, and in those cases where there is an overdose with this drug (Sass and Shakil, 2005;Dart and Bailey, 2007;Rhodes et al, 2011). There are higher incidences of acetaminophen toxicity in case of chronic alcoholics, people suffering from malnutrition, and the elderly (Larson et al, 2005;Dart and Bailey, 2007).…”

Self-Inflicted Gunshot Wound as a Consideration in the Patient Selection Process for Facial Transplantation

“…In solid organ transplantation, an intentionally self-inflicted MOI is generally not sufficient to deny an individual a liver transplant, 81,82,83,84,85,86,87,88,89,90,91,92,93 nor does it serve as a criterion in liver allocation priority. 94,95,96,97,98 These conclusions are derived from data suggesting that long-term outcomes for those with intentional self-inflicted injury are comparable to those with non-self-inflicted injury, which supports ethical arguments that the circumstances creating the need for liver transplantation should not influence whether transplant will be offered as a treatment option.…”