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Speaker 1: I was in a room, a completely white room with

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Speaker 1: a brown desk, and there was a older gentleman there

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Speaker 1: in a sense, and there was a contract. There was

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Speaker 1: like this piece of paper and a pen, and these

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Speaker 1: words were specifically uttered to me. You can either choose

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Speaker 1: not to accept this and just pass peacefully and not

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Speaker 1: worry about anything, or if you take this gift, you'll

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Speaker 1: be in the worst pain that you've ever experienced in

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Speaker 1: your entire life. And I remember sitting there and just

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Speaker 1: being stubborn like I am, And I said, oh, well,

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Speaker 1: I think I know about pain.

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Speaker 2: Jamie Imhoff was almost certainly dreaming. Who was she bargaining with?

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Speaker 2: Was it God? As her life hung in the balance,

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Speaker 2: she was heavily sedated in the hospital, drifting in and

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Speaker 2: out of consciousness. A month earlier, she'd collapse on the

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Speaker 2: floor of her apartment, her body contorting from intense cramps.

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Speaker 2: Off to Jamie's collapse, doctors at her Baltimore hospital put

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Speaker 2: her on life support. Her diagnosis multiple organ failure. Most importantly,

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Speaker 2: her liver had stopped working. She was only thirty eight

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Speaker 2: years old.

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Speaker 1: They called my family right away, and pretty much to

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Speaker 1: all my family, I was unsabable and to come out

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Speaker 1: here and plan to book the funeral.

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Speaker 2: Acute liver failure is a rare but life threatening condition.

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Speaker 2: In Jamie's case, it was very obvious what had cause

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Speaker 2: all that damage.

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Speaker 1: A typical day of drinking at the time I collapsed

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Speaker 1: started around early morning, maybe seven am eight am. I

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Speaker 1: always had a bottle of Arka next to my bed

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Speaker 1: when I woke up. If I did not take that

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Speaker 1: initial first drink, I couldn't function, and then from there

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Speaker 1: the rest of the day would be maintained on a

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Speaker 1: certain level of alcohol in my body until.

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Speaker 3: I went to bed.

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Speaker 1: But at that point there was no pleasure in doing stuff.

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Speaker 1: This was literally what we call maintenance drinking.

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Speaker 2: Jamie was aware she had a problem with drinking. She'd

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Speaker 2: been to rehab and managed to get sober for a

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Speaker 2: few months at a time, but she worked as a

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Speaker 2: bar manager. When life got stressful, she went right back

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Speaker 2: to old habits, and that's how she ended up in

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Speaker 2: the hospital. At this point, her only chance at survival

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Speaker 2: was a liver transplant, but because alcohol use is what

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Speaker 2: destroyed her liver, the doctors told Jamie's family she wasn't

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Speaker 2: eligible for a transplant, not for another six months.

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Speaker 1: My family. Upon hearing the news, they were not very happy.

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Speaker 1: The idea of being denied care didn't make any sense

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Speaker 1: to them.

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Speaker 2: Jamie's family spent the next several days making phone calls,

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Speaker 2: desperate to find a transplant center that would agree to

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Speaker 2: save her life, but no luck. Eventually, they gave up

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Speaker 2: and started speaking with a chaplain. They wanted his help

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Speaker 2: deciding whether or not to let Jamie die.

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Speaker 1: The doctors told my family that I could stay on

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Speaker 1: life support for a definite period of time, but they

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Speaker 1: did not recommend doing so.

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Speaker 2: Now, clearly we're hearing from Jamie in the present day.

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Speaker 2: She did manage to survive, but how had she come

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Speaker 2: so close to dying? Doctors knew the life saving treatment

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Speaker 2: she needed a live a transplant, so why wouldn't they

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Speaker 2: give it to her? And how is that ethical? I'm

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Speaker 2: Laurena Rora Hutchinson. I'm the director of the Ideas Lab

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Speaker 2: at the Johns Hopkins Berman Institute of Bioethics. This season,

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Speaker 2: I'm going behind the scenes to discover how some of

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Speaker 2: the most significant medical innovations have impacted people's lives and

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Speaker 2: continue to whether it's saving lives or creating babies. A

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Speaker 2: new technology is usually waiting in the wings, along with

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Speaker 2: a whole entourage of ethical questions. On today's show, liver transplants.

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Speaker 2: They're often the only option to keep people with liver

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Speaker 2: failure alive, but since there aren't enough livers to go around,

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Speaker 2: transplant centers have to decide what's the most ethical way

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Speaker 2: to determine who gets them first, and when and what if.

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Speaker 2: Solving for one ethical dilemma creates a whole host of

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Speaker 2: new ethical problems for patients and families. From Pushkin Industries

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Speaker 2: and the Johns Hopkins Berman Institute of Bioethics, this is

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Speaker 2: playing god. To get some perspective on Jamie's story, I

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Speaker 2: called up my colleague, bioethicist Jeffrey Kahn. If you're a

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Speaker 2: regular listener, you've heard him on our show before. So, Jeff,

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Speaker 2: why was it that someone like Jamie, who clearly desperately

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Speaker 2: needed a new liver, was initially not going to get

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Speaker 2: a transplant.

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Speaker 4: It's a good question, Lauren, and to answer it, we

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Speaker 4: need to go back to the early days of being

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Speaker 4: able to transplant solid organs. Those are kidneys, livers, lungs, hearts,

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Speaker 4: and there just aren't enough and never have been enough.

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Speaker 4: Donated organs to transplant to everybody who needs one. In

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Speaker 4: the case of livers, people who need a liver transplant

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Speaker 4: are really, really sick and can only wait for a

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Speaker 4: very short time before either being transplanted and surviving or

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Speaker 4: not being transplanted and dying. And so people in the

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Speaker 4: transplant community and then people from public policy and ethics

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Speaker 4: like me got pulled in to help decide how to

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Speaker 4: allocate who should get, who should not, who can wait,

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Speaker 4: who in the end won't actually receive a donated organ.

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Speaker 4: This is a recurring issue in ethics of transplant and

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Speaker 4: bioethics generally. When there's not enough of a thing to

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Speaker 4: go around, who gets access to it and therefore who

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Speaker 4: does not?

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Speaker 2: So how is the decision made about who gets the

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Speaker 2: priority for these livers?

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Speaker 4: Every organ has a somewhat different system. For kidneys, there's

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Speaker 4: a waiting list, and that's because we can ask people

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Speaker 4: to wait and be on a technology called dialysis until

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Speaker 4: their number gets called. For livers, it's a different story.

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Speaker 4: It's a weightless but it's really a scored weightless. So

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Speaker 4: the higher your score, the sicker you are, and therefore

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Speaker 4: the higher on the priority list you get.

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Speaker 2: And so how does the system treat people like Jamie

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Speaker 2: who need a new liver because of a history of

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Speaker 2: harmful alcohol use.

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Speaker 4: The issue of needing a liver transplant after abuse of

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Speaker 4: alcohol or overuse of alcohol created an additional layer of

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Speaker 4: ethical dilemma. So on top of the question about what

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Speaker 4: do we do when we don't have enough livers for

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Speaker 4: all the people who need a liver transplant, layered over

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Speaker 4: that is the idea that the reason that the person

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Speaker 4: needs a liver transplant owes to their behavior. And so

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Speaker 4: the question then is, well, what's to prevent them if

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Speaker 4: they get a transplant from doing the same thing that

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Speaker 4: they did to cause the need for the first transplant?

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Speaker 4: And so that's a kind of societal utilitarian question, is

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Speaker 4: this the best way to allocate this very scarce resource?

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Speaker 4: And the question about behavior and responsibility is not a

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Speaker 4: trivial question in the context of liver transplant because alcohol

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Speaker 4: related liver disease is now the number one reason that

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Speaker 4: adults in the US need a liver transplant, and these

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Speaker 4: patients tend to be really, really sick by the time

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Speaker 4: they end up coming to the doctor and seeking treatment,

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Speaker 4: and so they become top of the list's highest priority

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Speaker 4: when they show up, and that creates or could create

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Speaker 4: some really understandable resentment. Wait, why is it that this

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Speaker 4: person who undertook this behavior did this to themselves? Why

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Speaker 4: should they get a liver transplant before somebody with cancer

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Speaker 4: or some child that may have been born with a

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Speaker 4: disease that's certainly not within their control, But isn't harmful?

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Speaker 2: Alcohol use also considered a disease.

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Speaker 4: It is, And as we do more research about addiction

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Speaker 4: and behavior, I think it's becoming more clear that there's

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Speaker 4: a disease aspect, there's also some behavioral and controllable aspects,

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Speaker 4: but that it's very complicated. There are genetic components, there

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Speaker 4: are environmental components, there are socioeconomic components, and so these

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Speaker 4: are complicated areas where it doesn't make sense to just

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Speaker 4: sort of point to someone and say they're responsible for

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Speaker 4: the bad health effects of their behavior.

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Speaker 2: So what approach have transplant centers come up with allocating

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Speaker 2: livers to people with and without a history of alcohol use?

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Speaker 2: How is it fair to people with them?

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Speaker 4: Without going back now a number of decades to the

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Speaker 4: nineteen eighties, transplant centers that do liver transplants in the

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Speaker 4: US and really has become a global practice. Have required

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Speaker 4: patients with the history of alcohol abuse who need a

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Speaker 4: liver transplant to show that they can be sober no

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Speaker 4: use of alcohol for at least six months before they're

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Speaker 4: eligible for a transplant. That's been named the so called

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Speaker 4: six month rule. So, in effect, the rule requires patients

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Speaker 4: to go off and cure themselves of one disease alcohol

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Speaker 4: abuse before we'll treat them for another disease. That doesn't

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Speaker 4: seem fair, but that's the approach that has been implemented.

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Speaker 4: There were actually at least three reasons that transplant centers

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Speaker 4: and the policy makers around liver transplantation decided that this

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Speaker 4: was the right approach. First, there was a thought that

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Speaker 4: if patients stopped using alcohol for a period of time,

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Speaker 4: their livers might actually come back and heal themselves. The

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Speaker 4: second and maybe more important reason for some period of

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Speaker 4: sobriety was the view that they're blameworthy, like they brought

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Speaker 4: it on themselves, and we shouldn't reward somebody who brought

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Speaker 4: something on themselves by giving them access to a life

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Speaker 4: saving liver transplant when there are other people who didn't

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Speaker 4: behave badly also waiting. You know, we better make sure

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Speaker 4: that the people who were going to offer this very

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Speaker 4: scarce life saving treatment to are not going to do

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Speaker 4: the same thing that required the transplant in the first place.

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Speaker 4: And then the third reason is a sort of you know,

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Speaker 4: what will the members of society think about donating their

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Speaker 4: organs when they see that the people who are getting

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Speaker 4: livers are the people who abused alcohol? Will that make

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Speaker 4: people less likely to be willing to be organ donors.

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Speaker 4: So all of that played into the decision about, you know,

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Speaker 4: what to do with somebody like Jamie, how can we

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Speaker 4: still think about transplants for them in a way that

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Speaker 4: ethically acceptable?

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Speaker 2: So what have we learned from having this six month

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Speaker 2: rule in place?

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Speaker 4: Well, the first thing that we learned is that making

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Speaker 4: people wait six months is a death sentence for half

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Speaker 4: of them. It turns out that the liver does not

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Speaker 4: regenerate when given a chance to be alcohol free. It's

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Speaker 4: just that people who have abused alcohol have effectively killed

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Speaker 4: their liver, and so making them wait for six months

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Speaker 4: is they can't survive it. Also, it turns out research

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Speaker 4: has shown that the six month rule is a bad

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Speaker 4: predictor of whether someone will stay sober after a transplant

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Speaker 4: and it turns out it has no effect on people's

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Speaker 4: willingness to donate based on survey research.

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Speaker 2: Wow, so people have been dying because of the six

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Speaker 2: month rule even though it doesn't really do what it's

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Speaker 2: supposed to do effectively.

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Speaker 4: Yes, and it's not even a rule, it's a practice.

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Speaker 4: It's all the transplant centers adhere to it, but it's

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Speaker 4: actually not required. And you know, at the time that

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Speaker 4: it was implement it made sense for all the reasons

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Speaker 4: that we have discussed to use the few livers that

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Speaker 4: became available in the best possible way, and it took

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Speaker 4: a while for research to be performed and information to

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Speaker 4: come in that would help inform whether that was the

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Speaker 4: right policy. But it's really unclear that there wouldn't be

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Speaker 4: unintended negative consequences if the six month rule were to

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Speaker 4: be completely abandoned. So we really just don't know all

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Speaker 4: the implications of stepping away from or completely abandoning the

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Speaker 4: six month rule, and that's something that needs more, maybe

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Speaker 4: more nuance and more information before we decide what the

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Speaker 4: right policy should be.

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Speaker 2: After the break, we'll hear from someone who is challenging

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Speaker 2: the six month rule. The doctor who gave Jamie Imhoff

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Speaker 2: a second chance at life.

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Speaker 3: I am in the second chance business, and I believe

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Speaker 3: even the ability of people to with multiple chances and

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Speaker 3: multiple tries to get it.

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Speaker 2: Right playing God will be right back.

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Speaker 3: So when I started liver transplants, everybody knew the rules

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Speaker 3: and the rules were agreed upon.

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Speaker 2: This is Andrew Cameron. He's a liver transplant surgeon at

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Speaker 2: Johns Hopkins University. He knows all about the eligibility rules

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Speaker 2: for liver transplants. These aren't cut and dry legal rules,

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Speaker 2: more like common practices.

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Speaker 3: To get a liver transplant after excessive alcohol use, you

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Speaker 3: needed to be sober or abstinent for six months. That

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Speaker 3: was the rule, and we all accepted it.

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Speaker 2: But these days Andrew is doing something almost unheard of

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Speaker 2: in the transplant community. At his transplant center in Baltimore,

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Speaker 2: he routinely, intentionally systematic breaks the six month rule. The

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Speaker 2: first time he broke this rule, or bent it, as

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Speaker 2: he says, was fifteen years ago. A patient showed up

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Speaker 2: at Johns Hopkins' deathly ill with liver failure and a

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Speaker 2: history of heavy alcohol use.

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Speaker 3: And I remember our team going to take a look

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Speaker 3: at him and saying oh, well, unfortunately this is an

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Speaker 3: easy one. He's been drinking recently and so isn't eligible

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Speaker 3: for a liver transplant. And we didn't think much more

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Speaker 3: of it. But as we were leaving his room, his

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Speaker 3: family grabbed us and said, you know you're not going anywhere.

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Speaker 3: You know, we are demand that year reconsider. And it

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Speaker 3: was pretty tough to argue with him. In fact, it

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Speaker 3: was impossible to argue with them, and they made such

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Speaker 3: a compelling case that as a team, we got together

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Speaker 3: and considered whether we ought to bend the rules in

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Speaker 3: this case, and we struggled with that decision, but as

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Speaker 3: a team, we decided to bend the rules and we

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Speaker 3: went ahead with a transplant.

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Speaker 2: Andrew now runs a program at Johns Hopkins that treats

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Speaker 2: people with cases similar to that patient. It was this

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Speaker 2: program that helped Jamie get her new liver. Can you

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Speaker 2: tell me a bit more about the research that you're

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Speaker 2: doing with people with a history of heavy alcohol use

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Speaker 2: and their ability to get transplants?

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Speaker 3: Sure? So that there was an exciting New England Journal

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Speaker 3: paper in which a group of liver transplant centers in

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Speaker 3: France transplanted patients like the one I just described and

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Speaker 3: in fact, a relatively low percentage of those patients when

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Speaker 3: followed carefully, ever, went back to drinking. Now, at Johns Hopkins,

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Speaker 3: we decided to start a very similar pilot program, and

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Speaker 3: we've now transplanted about one hundred and thirty patients without

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Speaker 3: a six month waiting period. And when we compare them

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Speaker 3: to a group of patients that got transplanted that Hopkins

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Speaker 3: at the same time that did have that six month

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Speaker 3: waiting period, there was no hard data that suggested that

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Speaker 3: that rule made a lot of sense.

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Speaker 2: And so does that mean that any patient with alcohol

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Speaker 2: related liver disease is given a transplant?

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Speaker 3: Well, thanks for asking that question, because people hear some

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Speaker 3: of these stories and say, oh, there's no rules, and

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Speaker 3: there are rules. There need to be rules. They just

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Speaker 3: not this past fail test, single question have you drank

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Speaker 3: in the last six months. Rather, it is a look

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Speaker 3: at factors that would meaningfully predict your performance post transplant,

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Speaker 3: like do you have insight into your need to change

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Speaker 3: your drinking? Do you have a social support network that

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Speaker 3: will help you after your transplant? Are you willing to

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Speaker 3: participate in programs that would help you stay abstinent after

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Speaker 3: your transplant?

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Speaker 2: So you talked about insight, and I just want to

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Speaker 2: pick up on that, because how do you measure insight?

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Speaker 3: It's tough, isn't it. So we all maybe have a

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Speaker 3: feel for it. We all maybe can think of times

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Speaker 3: in our own lives when something happened that was dramatic

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Speaker 3: enough to cause behavior change. So for some folks that

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Speaker 3: drink alcohol, that may be getting arrested or a dui.

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Speaker 3: It may be a loved one leaving them a divorce

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Speaker 3: for example, if they have expressed insight, if they have

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Speaker 3: expressed a willingness to participate in programs that will allow

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Speaker 3: them to have success after transplant, those are all favorable factors.

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Speaker 3: You could imagine almost a group decision by multiple caregivers

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Speaker 3: looking at multiple factors that predict performance after transplant and

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Speaker 3: making as best we can, and it's not perfect, a logical, fair,

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Speaker 3: humane decision about whether this person can get through a

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Speaker 3: liver transplant and do well on the back end, if

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Speaker 3: the answer is yes or maybe yes, we want to

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Speaker 3: go ahead and give them the benefit of the doubt.

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Speaker 2: That's great. So I want to talk about Jamie. You know,

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Speaker 2: we heard Jamie's story and when she was taken into hospital,

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Speaker 2: she was in a coma, and so in that situation,

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Speaker 2: how would you determine her insight?

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Speaker 3: It's tough, You're right. We didn't have the luxury of

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Speaker 3: speaking with her, but we could talk to her family,

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Speaker 3: so we couldn't hear it directly from her. But we

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Speaker 3: knew that she had tried in the past to achieve

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Speaker 3: sobriety and it had success in doing so. And we

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Speaker 3: knew that she had some profound life stressors that had

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Speaker 3: caused relapse. And that is a common story, and that

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Speaker 3: is not a story that we cannot work with after transplant.

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Speaker 3: So a lot of things spoke to Jamie's favor enough

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Speaker 3: to give her the benefit of the doubt and say,

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Speaker 3: this is a young person that we're not ready to

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Speaker 3: give up on.

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Speaker 2: And could you say a bit more about social support. So,

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Speaker 2: for example, if someone doesn't have a partner, does that

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Speaker 2: mean that they're kind of like go lower in the list?

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Speaker 3: Or a social support is anyone who will help you

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Speaker 3: after transplant with the things you need to do to

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Speaker 3: take good care of your organ transplant. It could be

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Speaker 3: a partner, It could be a family member, it could

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Speaker 3: be a friend, it could be somebody from your AA group.

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Speaker 3: It is somebody who was willing to help. The kind

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Speaker 3: of help you're going to need after transplant is I

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Speaker 3: don't feel well. You may have to take me into

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Speaker 3: the hospital. I have an appointment tomorrow, I need to

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Speaker 3: get my labs checked out. It can also be more

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Speaker 3: than that. It can be I'm not feeling great, I'm worried.

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Speaker 3: I'm going to have a relapse. Can you help me?

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Speaker 3: It would take a person that couldn't identify a single

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Speaker 3: soul to help them to get excluded from transplant. And

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Speaker 3: even in those scenarios, we have advocates and social workers

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Speaker 3: and transplant psychologists that work with our patients to try

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Speaker 3: and mobilize somebody. So it's not really about saying yes

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Speaker 3: or no. It's about saying, if we do this, how

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Speaker 3: can we predict success afterwards? What can we do to

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Speaker 3: help you be successful afterwards? And therefore get.

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Speaker 2: To yes and yeah, that's great. So how in this

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Speaker 2: program do you measure success?

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Speaker 3: The gold standard for success after Oregon transplant, as measured

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Speaker 3: and reported by the government is one year patient survival,

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Speaker 3: and in the large group of patients that we quote

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Speaker 3: took a chance on and bent the rules for one

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Speaker 3: year later ninety four percent of them were alive and well,

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Speaker 3: and that is as high or higher than any other

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Speaker 3: indication for liver transplant that you could name. And then

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Speaker 3: we measure how many of those folks relapse in terms

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Speaker 3: of using alcohol, and probably twenty percent total have any

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Speaker 3: relapse at all, as measured even by a single drink.

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Speaker 3: And what we saw was that when we worked together,

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Speaker 3: when we utilized extra resources to help them stay sober,

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Speaker 3: even the small group of folks that return to drinking

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Speaker 3: were able to ultimately return to abstinence and sobriety with

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Speaker 3: extra help.

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Speaker 2: So the people close to death store, they're high on

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Speaker 2: the priority list, and then there are going to be

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Speaker 2: other people on that list, for example, a young person

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Speaker 2: with a congenital liver disease who might not be as

359
00:21:43,560 --> 00:21:46,159
Speaker 2: close to death's door, but they're still waiting on that

360
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Speaker 2: list for a liver transplant. Someone might ask you, why

361
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Speaker 2: would someone like Jamie with a history of heavy alcohol

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Speaker 2: use get that liver before their loved one who's also

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Speaker 2: on the waiting list.

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Speaker 3: These are very difficult questions. So far, society has decided

365
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Speaker 3: that the people that can't wait need to go first,

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Speaker 3: and that the people that can wait ought to wait

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Speaker 3: until it's their turn. A better system would be if

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Speaker 3: we had enough organs to go around for everybody. That's

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Speaker 3: not the way it is now. So as you suggest

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Speaker 3: somebody who's born with a congenital anomaly, we would of

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Speaker 3: course say, oh, well, this isn't your fault. You need

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Speaker 3: to go to the front of the line. In this case,

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Speaker 3: we were looking at folks that had a claim to

374
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Speaker 3: the front of the line, and we were saying, but

375
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Speaker 3: you did it to yourself, you can't go to the

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Speaker 3: head of line. That was the only case in which

377
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Speaker 3: we excluded folks from the recognition that they needed an

378
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Speaker 3: emergent surgery to save their life. And that's probably not

379
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Speaker 3: a modern way of looking at something like alcohol used disorder.

380
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Speaker 3: That's treating it more as a character flaw than a disease.

381
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Speaker 3: You know, I think I have the advantage in this

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Speaker 3: discussion of having met these people. They're real people, they are,

383
00:23:04,920 --> 00:23:09,760
Speaker 3: they have families, they have they're they're indistinguishable from folks

384
00:23:09,840 --> 00:23:13,920
Speaker 3: that are listening to this conversation. And it just occurred

385
00:23:13,920 --> 00:23:16,840
Speaker 3: to all of us that a second chance is something

386
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Speaker 3: we all probably are going to need at some point

387
00:23:19,040 --> 00:23:21,560
Speaker 3: in our lives. And if the rules of the game

388
00:23:21,680 --> 00:23:24,800
Speaker 3: are stacked against you or were never made clear or unfair.

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Speaker 3: That's just that's just not fair play. And we have

390
00:23:27,920 --> 00:23:32,480
Speaker 3: been able to see how well people can do when

391
00:23:32,520 --> 00:23:35,800
Speaker 3: given a second chance. So I guess I would ask

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Speaker 3: people to withhold judgment maybe, and and imagine if it

393
00:23:41,600 --> 00:23:45,560
Speaker 3: was your brother, if it was your your partner, if

394
00:23:45,600 --> 00:23:50,040
Speaker 3: it was your kid that needed a life saving transplant,

395
00:23:50,960 --> 00:23:54,000
Speaker 3: if there was a way for doctors to save your

396
00:23:54,119 --> 00:23:57,800
Speaker 3: kid's life, and somebody tried to say we could, but

397
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Speaker 3: we're just not going to. You wouldn't stay and for it.

398
00:24:01,320 --> 00:24:03,439
Speaker 3: You wouldn't stand for it, and we're not standing for

399
00:24:03,520 --> 00:24:03,880
Speaker 3: it either.

400
00:24:04,440 --> 00:24:08,680
Speaker 2: Okay, So yeah, you've convinced me. And I'm just wondering

401
00:24:09,119 --> 00:24:14,360
Speaker 2: how your approach has been received by other transplant centers.

402
00:24:14,480 --> 00:24:16,399
Speaker 2: Have you experienced any resistance there?

403
00:24:17,720 --> 00:24:22,560
Speaker 3: When we look at how widely this new approach to

404
00:24:22,720 --> 00:24:25,600
Speaker 3: transplant has been adopted in the United States, the answer

405
00:24:25,640 --> 00:24:29,800
Speaker 3: is disappointing. There are probably one hundred and fifty liver

406
00:24:29,880 --> 00:24:32,680
Speaker 3: transplant centers in the United States, and I would say

407
00:24:32,720 --> 00:24:37,720
Speaker 3: somewhere between a third and a half have done one

408
00:24:37,920 --> 00:24:42,000
Speaker 3: of these transplants without a six month waiting period. And

409
00:24:42,080 --> 00:24:44,800
Speaker 3: I think some of the reasons are is that, ah,

410
00:24:44,880 --> 00:24:49,119
Speaker 3: these patients are heavy lifting. It takes extra resources to

411
00:24:49,200 --> 00:24:51,880
Speaker 3: evaluate them before transplant and to take care of them

412
00:24:52,040 --> 00:24:57,879
Speaker 3: after transplant. And I think there is also safety in

413
00:24:58,400 --> 00:25:03,320
Speaker 3: traditional rules. It is just easier to say, I'm not

414
00:25:03,359 --> 00:25:05,880
Speaker 3: going to get into all those controversies. I play by

415
00:25:05,880 --> 00:25:09,840
Speaker 3: the rules. Six months is a rule. I understand. I'm

416
00:25:09,880 --> 00:25:10,800
Speaker 3: on safe ground.

417
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Speaker 2: And do you think that there is anything that might

418
00:25:16,760 --> 00:25:20,760
Speaker 2: make clinics wary of doing these kinds of transfers.

419
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Speaker 3: I think the barriers are stigma. I think alcohol occupies

420
00:25:27,080 --> 00:25:30,240
Speaker 3: a very special place in our society which is difficult

421
00:25:30,359 --> 00:25:33,600
Speaker 3: to unpack. This patient drank too much. They did it

422
00:25:33,600 --> 00:25:37,040
Speaker 3: to themselves. That that's sort of an old fashioned, historic

423
00:25:37,119 --> 00:25:39,959
Speaker 3: way at looking at alcohol use, which I think our

424
00:25:40,000 --> 00:25:44,840
Speaker 3: country has not moved on from. It's interesting Europe rapidly

425
00:25:44,920 --> 00:25:49,159
Speaker 3: adopted this new system or criteria for who should get

426
00:25:49,160 --> 00:25:52,240
Speaker 3: a liver transplant for alcohol use, perhaps a more open

427
00:25:52,280 --> 00:25:55,720
Speaker 3: minded or liberal approach to the problem. The United States

428
00:25:55,720 --> 00:25:57,320
Speaker 3: did not. It's still coming.

429
00:26:00,440 --> 00:26:04,040
Speaker 2: Andrew hopes that transplant centers across the US will see

430
00:26:04,040 --> 00:26:07,520
Speaker 2: the results of his pilot program and rethink the six

431
00:26:07,600 --> 00:26:11,800
Speaker 2: month ban. His patient Jamie Imhoff is working towards the

432
00:26:11,880 --> 00:26:12,520
Speaker 2: same goal.

433
00:26:13,560 --> 00:26:18,320
Speaker 1: I hope to break the stigma that such individuals are

434
00:26:18,640 --> 00:26:23,240
Speaker 1: worth saving when a lot of programs deem them unsavable.

435
00:26:24,000 --> 00:26:26,879
Speaker 2: Jamie spends a lot of her time these days raising

436
00:26:26,920 --> 00:26:31,000
Speaker 2: awareness about the six month ban through social media campaigns

437
00:26:31,000 --> 00:26:32,119
Speaker 2: and public events.

438
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Speaker 1: It's been more than.

439
00:26:33,920 --> 00:26:36,919
Speaker 2: A year since the day she collapsed. She's grateful to

440
00:26:36,920 --> 00:26:39,600
Speaker 2: be alive, and she doesn't take it for granted.

441
00:26:40,040 --> 00:26:44,040
Speaker 1: I feel my duty is to make sure that overall,

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Speaker 1: not just physically but mentally, I'm as healthy as I

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Speaker 1: can be for the person who gave me this new life.

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Speaker 2: She says. One of the things that helps us stay

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Speaker 2: healthy has been letting go of the sense of shame

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Speaker 2: she used to feel about her drinking.

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Speaker 1: If you have guilt, shame, resentment, these are the things

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Speaker 1: that we'll make you. We'll drive you back to drinking.

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Speaker 1: You're going to fail the transplant in itself, and you're

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Speaker 1: going to fail the donor.

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Speaker 2: Jamie is still sober, and she plans to stay that way.

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Speaker 2: She thinks of her sobriety as a gift that's just

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Speaker 2: as life changing is her liver.

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Speaker 1: So when I wake up in the morning now I

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Speaker 1: don't feel sick. I'm able to get up right away.

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Speaker 1: For example, this morning went up and I already walked

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Speaker 1: two miles today and got my coffee, and so I

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Speaker 1: can get up and look at the trees blooming, or

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Speaker 1: actually I can even smell the fresh air. Those are

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Speaker 1: a lot of the side effects that you lose in

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Speaker 1: full on alcoholism. So sobriety overall is just one hundred

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Speaker 1: times better.

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Speaker 2: Next week, I'm playing God. What if there was an

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Speaker 2: eBay for kidneys? We'll hear from a transplant recipient who

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Speaker 2: thinks we should legalize the sale of organs in the

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Speaker 2: US and even provide compensation to incentivize living organ donation.

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Speaker 2: But is it ever ethical to pay someone for a

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Speaker 2: body part? Thanks so much to our guests Jamie Imhoff

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Speaker 2: and Andrew Cameron. Playing God is a co production of

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Speaker 2: Pushkin Industries and the Johns Hopkins Berman Institute of Bioethics.

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Speaker 2: Emily Vaughan is our lead producer. This episode was also

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Speaker 2: produced by Sophie Crane and Lucy Sullivan. Our editors are

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Speaker 2: Karen Schakerjee and Kate Parkinson Morgan. Theme music and mixing

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Speaker 2: by Echo Mountain Engineering. Support from Sarah Brugere and Amanda Kaiwang.

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Speaker 2: Show art by Sean Karney, fact checking by David jar

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Speaker 2: and Arthur Gompertz. Our executive producer is Justine Lang at

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Speaker 2: the Johns Hopkins Berman Institute of Bioethics. Our executive producers

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Speaker 2: are Jeffrey Kahan and Anna Mastriani, working with Amelia Hood.

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Speaker 2: Funding provided by the Greenwall Foundation. I'm Laurena Rora Hutchinson.

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Speaker 2: Come back next week for more Playing God. As you've

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Speaker 2: heard through the series, I'm the director of the Ideas

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Speaker 2: Lab at the Johns Hopkins Berman Institute of Bioethics. At

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Speaker 2: the Ideas Lab, we are exploring new innovative ways of

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00:29:28,080 --> 00:29:32,120
Speaker 2: telling stories about the intersection of ethics, science, medicine, and

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Speaker 2: public health. As well as podcasts, we do screenwriting, films,

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Speaker 2: and immersive experiences. To get involved, visit Bioethics dot Jhu

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Speaker 2: dot edu, Forward Slash Ideas Lab