Speaker 1: I was in a room, a completely white room with
Speaker 1: a brown desk, and there was a older gentleman there
Speaker 1: in a sense, and there was a contract. There was
Speaker 1: like this piece of paper and a pen, and these
Speaker 1: words were specifically uttered to me. You can either choose
Speaker 1: not to accept this and just pass peacefully and not
Speaker 1: worry about anything, or if you take this gift, you'll
Speaker 1: be in the worst pain that you've ever experienced in
Speaker 1: your entire life. And I remember sitting there and just
Speaker 1: being stubborn like I am, And I said, oh, well,
Speaker 1: I think I know about pain.
Speaker 2: Jamie Imhoff was almost certainly dreaming. Who was she bargaining with?
Speaker 2: Was it God? As her life hung in the balance,
Speaker 2: she was heavily sedated in the hospital, drifting in and
Speaker 2: out of consciousness. A month earlier, she'd collapse on the
Speaker 2: floor of her apartment, her body contorting from intense cramps.
Speaker 2: Off to Jamie's collapse, doctors at her Baltimore hospital put
Speaker 2: her on life support. Her diagnosis multiple organ failure. Most importantly,
Speaker 2: her liver had stopped working. She was only thirty eight
Speaker 2: years old.
Speaker 1: They called my family right away, and pretty much to
Speaker 1: all my family, I was unsabable and to come out
Speaker 1: here and plan to book the funeral.
Speaker 2: Acute liver failure is a rare but life threatening condition.
Speaker 2: In Jamie's case, it was very obvious what had cause
Speaker 2: all that damage.
Speaker 1: A typical day of drinking at the time I collapsed
Speaker 1: started around early morning, maybe seven am eight am. I
Speaker 1: always had a bottle of Arka next to my bed
Speaker 1: when I woke up. If I did not take that
Speaker 1: initial first drink, I couldn't function, and then from there
Speaker 1: the rest of the day would be maintained on a
Speaker 1: certain level of alcohol in my body until.
Speaker 3: I went to bed.
Speaker 1: But at that point there was no pleasure in doing stuff.
Speaker 1: This was literally what we call maintenance drinking.
Speaker 2: Jamie was aware she had a problem with drinking. She'd
Speaker 2: been to rehab and managed to get sober for a
Speaker 2: few months at a time, but she worked as a
Speaker 2: bar manager. When life got stressful, she went right back
Speaker 2: to old habits, and that's how she ended up in
Speaker 2: the hospital. At this point, her only chance at survival
Speaker 2: was a liver transplant, but because alcohol use is what
Speaker 2: destroyed her liver, the doctors told Jamie's family she wasn't
Speaker 2: eligible for a transplant, not for another six months.
Speaker 1: My family. Upon hearing the news, they were not very happy.
Speaker 1: The idea of being denied care didn't make any sense
Speaker 1: to them.
Speaker 2: Jamie's family spent the next several days making phone calls,
Speaker 2: desperate to find a transplant center that would agree to
Speaker 2: save her life, but no luck. Eventually, they gave up
Speaker 2: and started speaking with a chaplain. They wanted his help
Speaker 2: deciding whether or not to let Jamie die.
Speaker 1: The doctors told my family that I could stay on
Speaker 1: life support for a definite period of time, but they
Speaker 1: did not recommend doing so.
Speaker 2: Now, clearly we're hearing from Jamie in the present day.
Speaker 2: She did manage to survive, but how had she come
Speaker 2: so close to dying? Doctors knew the life saving treatment
Speaker 2: she needed a live a transplant, so why wouldn't they
Speaker 2: give it to her? And how is that ethical? I'm
Speaker 2: Laurena Rora Hutchinson. I'm the director of the Ideas Lab
Speaker 2: at the Johns Hopkins Berman Institute of Bioethics. This season,
Speaker 2: I'm going behind the scenes to discover how some of
Speaker 2: the most significant medical innovations have impacted people's lives and
Speaker 2: continue to whether it's saving lives or creating babies. A
Speaker 2: new technology is usually waiting in the wings, along with
Speaker 2: a whole entourage of ethical questions. On today's show, liver transplants.
Speaker 2: They're often the only option to keep people with liver
Speaker 2: failure alive, but since there aren't enough livers to go around,
Speaker 2: transplant centers have to decide what's the most ethical way
Speaker 2: to determine who gets them first, and when and what if.
Speaker 2: Solving for one ethical dilemma creates a whole host of
Speaker 2: new ethical problems for patients and families. From Pushkin Industries
Speaker 2: and the Johns Hopkins Berman Institute of Bioethics, this is
Speaker 2: playing god. To get some perspective on Jamie's story, I
Speaker 2: called up my colleague, bioethicist Jeffrey Kahn. If you're a
Speaker 2: regular listener, you've heard him on our show before. So, Jeff,
Speaker 2: why was it that someone like Jamie, who clearly desperately
Speaker 2: needed a new liver, was initially not going to get
Speaker 2: a transplant.
Speaker 4: It's a good question, Lauren, and to answer it, we
Speaker 4: need to go back to the early days of being
Speaker 4: able to transplant solid organs. Those are kidneys, livers, lungs, hearts,
Speaker 4: and there just aren't enough and never have been enough.
Speaker 4: Donated organs to transplant to everybody who needs one. In
Speaker 4: the case of livers, people who need a liver transplant
Speaker 4: are really, really sick and can only wait for a
Speaker 4: very short time before either being transplanted and surviving or
Speaker 4: not being transplanted and dying. And so people in the
Speaker 4: transplant community and then people from public policy and ethics
Speaker 4: like me got pulled in to help decide how to
Speaker 4: allocate who should get, who should not, who can wait,
Speaker 4: who in the end won't actually receive a donated organ.
Speaker 4: This is a recurring issue in ethics of transplant and
Speaker 4: bioethics generally. When there's not enough of a thing to
Speaker 4: go around, who gets access to it and therefore who
Speaker 4: does not?
Speaker 2: So how is the decision made about who gets the
Speaker 2: priority for these livers?
Speaker 4: Every organ has a somewhat different system. For kidneys, there's
Speaker 4: a waiting list, and that's because we can ask people
Speaker 4: to wait and be on a technology called dialysis until
Speaker 4: their number gets called. For livers, it's a different story.
Speaker 4: It's a weightless but it's really a scored weightless. So
Speaker 4: the higher your score, the sicker you are, and therefore
Speaker 4: the higher on the priority list you get.
Speaker 2: And so how does the system treat people like Jamie
Speaker 2: who need a new liver because of a history of
Speaker 2: harmful alcohol use.
Speaker 4: The issue of needing a liver transplant after abuse of
Speaker 4: alcohol or overuse of alcohol created an additional layer of
Speaker 4: ethical dilemma. So on top of the question about what
Speaker 4: do we do when we don't have enough livers for
Speaker 4: all the people who need a liver transplant, layered over
Speaker 4: that is the idea that the reason that the person
Speaker 4: needs a liver transplant owes to their behavior. And so
Speaker 4: the question then is, well, what's to prevent them if
Speaker 4: they get a transplant from doing the same thing that
Speaker 4: they did to cause the need for the first transplant?
Speaker 4: And so that's a kind of societal utilitarian question, is
Speaker 4: this the best way to allocate this very scarce resource?
Speaker 4: And the question about behavior and responsibility is not a
Speaker 4: trivial question in the context of liver transplant because alcohol
Speaker 4: related liver disease is now the number one reason that
Speaker 4: adults in the US need a liver transplant, and these
Speaker 4: patients tend to be really, really sick by the time
Speaker 4: they end up coming to the doctor and seeking treatment,
Speaker 4: and so they become top of the list's highest priority
Speaker 4: when they show up, and that creates or could create
Speaker 4: some really understandable resentment. Wait, why is it that this
Speaker 4: person who undertook this behavior did this to themselves? Why
Speaker 4: should they get a liver transplant before somebody with cancer
Speaker 4: or some child that may have been born with a
Speaker 4: disease that's certainly not within their control, But isn't harmful?
Speaker 2: Alcohol use also considered a disease.
Speaker 4: It is, And as we do more research about addiction
Speaker 4: and behavior, I think it's becoming more clear that there's
Speaker 4: a disease aspect, there's also some behavioral and controllable aspects,
Speaker 4: but that it's very complicated. There are genetic components, there
Speaker 4: are environmental components, there are socioeconomic components, and so these
Speaker 4: are complicated areas where it doesn't make sense to just
Speaker 4: sort of point to someone and say they're responsible for
Speaker 4: the bad health effects of their behavior.
Speaker 2: So what approach have transplant centers come up with allocating
Speaker 2: livers to people with and without a history of alcohol use?
Speaker 2: How is it fair to people with them?
Speaker 4: Without going back now a number of decades to the
Speaker 4: nineteen eighties, transplant centers that do liver transplants in the
Speaker 4: US and really has become a global practice. Have required
Speaker 4: patients with the history of alcohol abuse who need a
Speaker 4: liver transplant to show that they can be sober no
Speaker 4: use of alcohol for at least six months before they're
Speaker 4: eligible for a transplant. That's been named the so called
Speaker 4: six month rule. So, in effect, the rule requires patients
Speaker 4: to go off and cure themselves of one disease alcohol
Speaker 4: abuse before we'll treat them for another disease. That doesn't
Speaker 4: seem fair, but that's the approach that has been implemented.
Speaker 4: There were actually at least three reasons that transplant centers
Speaker 4: and the policy makers around liver transplantation decided that this
Speaker 4: was the right approach. First, there was a thought that
Speaker 4: if patients stopped using alcohol for a period of time,
Speaker 4: their livers might actually come back and heal themselves. The
Speaker 4: second and maybe more important reason for some period of
Speaker 4: sobriety was the view that they're blameworthy, like they brought
Speaker 4: it on themselves, and we shouldn't reward somebody who brought
Speaker 4: something on themselves by giving them access to a life
Speaker 4: saving liver transplant when there are other people who didn't
Speaker 4: behave badly also waiting. You know, we better make sure
Speaker 4: that the people who were going to offer this very
Speaker 4: scarce life saving treatment to are not going to do
Speaker 4: the same thing that required the transplant in the first place.
Speaker 4: And then the third reason is a sort of you know,
Speaker 4: what will the members of society think about donating their
Speaker 4: organs when they see that the people who are getting
Speaker 4: livers are the people who abused alcohol? Will that make
Speaker 4: people less likely to be willing to be organ donors.
Speaker 4: So all of that played into the decision about, you know,
Speaker 4: what to do with somebody like Jamie, how can we
Speaker 4: still think about transplants for them in a way that
Speaker 4: ethically acceptable?
Speaker 2: So what have we learned from having this six month
Speaker 2: rule in place?
Speaker 4: Well, the first thing that we learned is that making
Speaker 4: people wait six months is a death sentence for half
Speaker 4: of them. It turns out that the liver does not
Speaker 4: regenerate when given a chance to be alcohol free. It's
Speaker 4: just that people who have abused alcohol have effectively killed
Speaker 4: their liver, and so making them wait for six months
Speaker 4: is they can't survive it. Also, it turns out research
Speaker 4: has shown that the six month rule is a bad
Speaker 4: predictor of whether someone will stay sober after a transplant
Speaker 4: and it turns out it has no effect on people's
Speaker 4: willingness to donate based on survey research.
Speaker 2: Wow, so people have been dying because of the six
Speaker 2: month rule even though it doesn't really do what it's
Speaker 2: supposed to do effectively.
Speaker 4: Yes, and it's not even a rule, it's a practice.
Speaker 4: It's all the transplant centers adhere to it, but it's
Speaker 4: actually not required. And you know, at the time that
Speaker 4: it was implement it made sense for all the reasons
Speaker 4: that we have discussed to use the few livers that
Speaker 4: became available in the best possible way, and it took
Speaker 4: a while for research to be performed and information to
Speaker 4: come in that would help inform whether that was the
Speaker 4: right policy. But it's really unclear that there wouldn't be
Speaker 4: unintended negative consequences if the six month rule were to
Speaker 4: be completely abandoned. So we really just don't know all
Speaker 4: the implications of stepping away from or completely abandoning the
Speaker 4: six month rule, and that's something that needs more, maybe
Speaker 4: more nuance and more information before we decide what the
Speaker 4: right policy should be.
Speaker 2: After the break, we'll hear from someone who is challenging
Speaker 2: the six month rule. The doctor who gave Jamie Imhoff
Speaker 2: a second chance at life.
Speaker 3: I am in the second chance business, and I believe
Speaker 3: even the ability of people to with multiple chances and
Speaker 3: multiple tries to get it.
Speaker 2: Right playing God will be right back.
Speaker 3: So when I started liver transplants, everybody knew the rules
Speaker 3: and the rules were agreed upon.
Speaker 2: This is Andrew Cameron. He's a liver transplant surgeon at
Speaker 2: Johns Hopkins University. He knows all about the eligibility rules
Speaker 2: for liver transplants. These aren't cut and dry legal rules,
Speaker 2: more like common practices.
Speaker 3: To get a liver transplant after excessive alcohol use, you
Speaker 3: needed to be sober or abstinent for six months. That
Speaker 3: was the rule, and we all accepted it.
Speaker 2: But these days Andrew is doing something almost unheard of
Speaker 2: in the transplant community. At his transplant center in Baltimore,
Speaker 2: he routinely, intentionally systematic breaks the six month rule. The
Speaker 2: first time he broke this rule, or bent it, as
Speaker 2: he says, was fifteen years ago. A patient showed up
Speaker 2: at Johns Hopkins' deathly ill with liver failure and a
Speaker 2: history of heavy alcohol use.
Speaker 3: And I remember our team going to take a look
Speaker 3: at him and saying oh, well, unfortunately this is an
Speaker 3: easy one. He's been drinking recently and so isn't eligible
Speaker 3: for a liver transplant. And we didn't think much more
Speaker 3: of it. But as we were leaving his room, his
Speaker 3: family grabbed us and said, you know you're not going anywhere.
Speaker 3: You know, we are demand that year reconsider. And it
Speaker 3: was pretty tough to argue with him. In fact, it
Speaker 3: was impossible to argue with them, and they made such
Speaker 3: a compelling case that as a team, we got together
Speaker 3: and considered whether we ought to bend the rules in
Speaker 3: this case, and we struggled with that decision, but as
Speaker 3: a team, we decided to bend the rules and we
Speaker 3: went ahead with a transplant.
Speaker 2: Andrew now runs a program at Johns Hopkins that treats
Speaker 2: people with cases similar to that patient. It was this
Speaker 2: program that helped Jamie get her new liver. Can you
Speaker 2: tell me a bit more about the research that you're
Speaker 2: doing with people with a history of heavy alcohol use
Speaker 2: and their ability to get transplants?
Speaker 3: Sure? So that there was an exciting New England Journal
Speaker 3: paper in which a group of liver transplant centers in
Speaker 3: France transplanted patients like the one I just described and
Speaker 3: in fact, a relatively low percentage of those patients when
Speaker 3: followed carefully, ever, went back to drinking. Now, at Johns Hopkins,
Speaker 3: we decided to start a very similar pilot program, and
Speaker 3: we've now transplanted about one hundred and thirty patients without
Speaker 3: a six month waiting period. And when we compare them
Speaker 3: to a group of patients that got transplanted that Hopkins
Speaker 3: at the same time that did have that six month
Speaker 3: waiting period, there was no hard data that suggested that
Speaker 3: that rule made a lot of sense.
Speaker 2: And so does that mean that any patient with alcohol
Speaker 2: related liver disease is given a transplant?
Speaker 3: Well, thanks for asking that question, because people hear some
Speaker 3: of these stories and say, oh, there's no rules, and
Speaker 3: there are rules. There need to be rules. They just
Speaker 3: not this past fail test, single question have you drank
Speaker 3: in the last six months. Rather, it is a look
Speaker 3: at factors that would meaningfully predict your performance post transplant,
Speaker 3: like do you have insight into your need to change
Speaker 3: your drinking? Do you have a social support network that
Speaker 3: will help you after your transplant? Are you willing to
Speaker 3: participate in programs that would help you stay abstinent after
Speaker 3: your transplant?
Speaker 2: So you talked about insight, and I just want to
Speaker 2: pick up on that, because how do you measure insight?
Speaker 3: It's tough, isn't it. So we all maybe have a
Speaker 3: feel for it. We all maybe can think of times
Speaker 3: in our own lives when something happened that was dramatic
Speaker 3: enough to cause behavior change. So for some folks that
Speaker 3: drink alcohol, that may be getting arrested or a dui.
Speaker 3: It may be a loved one leaving them a divorce
Speaker 3: for example, if they have expressed insight, if they have
Speaker 3: expressed a willingness to participate in programs that will allow
Speaker 3: them to have success after transplant, those are all favorable factors.
Speaker 3: You could imagine almost a group decision by multiple caregivers
Speaker 3: looking at multiple factors that predict performance after transplant and
Speaker 3: making as best we can, and it's not perfect, a logical, fair,
Speaker 3: humane decision about whether this person can get through a
Speaker 3: liver transplant and do well on the back end, if
Speaker 3: the answer is yes or maybe yes, we want to
Speaker 3: go ahead and give them the benefit of the doubt.
Speaker 2: That's great. So I want to talk about Jamie. You know,
Speaker 2: we heard Jamie's story and when she was taken into hospital,
Speaker 2: she was in a coma, and so in that situation,
Speaker 2: how would you determine her insight?
Speaker 3: It's tough, You're right. We didn't have the luxury of
Speaker 3: speaking with her, but we could talk to her family,
Speaker 3: so we couldn't hear it directly from her. But we
Speaker 3: knew that she had tried in the past to achieve
Speaker 3: sobriety and it had success in doing so. And we
Speaker 3: knew that she had some profound life stressors that had
Speaker 3: caused relapse. And that is a common story, and that
Speaker 3: is not a story that we cannot work with after transplant.
Speaker 3: So a lot of things spoke to Jamie's favor enough
Speaker 3: to give her the benefit of the doubt and say,
Speaker 3: this is a young person that we're not ready to
Speaker 3: give up on.
Speaker 2: And could you say a bit more about social support. So,
Speaker 2: for example, if someone doesn't have a partner, does that
Speaker 2: mean that they're kind of like go lower in the list?
Speaker 3: Or a social support is anyone who will help you
Speaker 3: after transplant with the things you need to do to
Speaker 3: take good care of your organ transplant. It could be
Speaker 3: a partner, It could be a family member, it could
Speaker 3: be a friend, it could be somebody from your AA group.
Speaker 3: It is somebody who was willing to help. The kind
Speaker 3: of help you're going to need after transplant is I
Speaker 3: don't feel well. You may have to take me into
Speaker 3: the hospital. I have an appointment tomorrow, I need to
Speaker 3: get my labs checked out. It can also be more
Speaker 3: than that. It can be I'm not feeling great, I'm worried.
Speaker 3: I'm going to have a relapse. Can you help me?
Speaker 3: It would take a person that couldn't identify a single
Speaker 3: soul to help them to get excluded from transplant. And
Speaker 3: even in those scenarios, we have advocates and social workers
Speaker 3: and transplant psychologists that work with our patients to try
Speaker 3: and mobilize somebody. So it's not really about saying yes
Speaker 3: or no. It's about saying, if we do this, how
Speaker 3: can we predict success afterwards? What can we do to
Speaker 3: help you be successful afterwards? And therefore get.
Speaker 2: To yes and yeah, that's great. So how in this
Speaker 2: program do you measure success?
Speaker 3: The gold standard for success after Oregon transplant, as measured
Speaker 3: and reported by the government is one year patient survival,
Speaker 3: and in the large group of patients that we quote
Speaker 3: took a chance on and bent the rules for one
Speaker 3: year later ninety four percent of them were alive and well,
Speaker 3: and that is as high or higher than any other
Speaker 3: indication for liver transplant that you could name. And then
Speaker 3: we measure how many of those folks relapse in terms
Speaker 3: of using alcohol, and probably twenty percent total have any
Speaker 3: relapse at all, as measured even by a single drink.
Speaker 3: And what we saw was that when we worked together,
Speaker 3: when we utilized extra resources to help them stay sober,
Speaker 3: even the small group of folks that return to drinking
Speaker 3: were able to ultimately return to abstinence and sobriety with
Speaker 3: extra help.
Speaker 2: So the people close to death store, they're high on
Speaker 2: the priority list, and then there are going to be
Speaker 2: other people on that list, for example, a young person
Speaker 2: with a congenital liver disease who might not be as
Speaker 2: close to death's door, but they're still waiting on that
Speaker 2: list for a liver transplant. Someone might ask you, why
Speaker 2: would someone like Jamie with a history of heavy alcohol
Speaker 2: use get that liver before their loved one who's also
Speaker 2: on the waiting list.
Speaker 3: These are very difficult questions. So far, society has decided
Speaker 3: that the people that can't wait need to go first,
Speaker 3: and that the people that can wait ought to wait
Speaker 3: until it's their turn. A better system would be if
Speaker 3: we had enough organs to go around for everybody. That's
Speaker 3: not the way it is now. So as you suggest
Speaker 3: somebody who's born with a congenital anomaly, we would of
Speaker 3: course say, oh, well, this isn't your fault. You need
Speaker 3: to go to the front of the line. In this case,
Speaker 3: we were looking at folks that had a claim to
Speaker 3: the front of the line, and we were saying, but
Speaker 3: you did it to yourself, you can't go to the
Speaker 3: head of line. That was the only case in which
Speaker 3: we excluded folks from the recognition that they needed an
Speaker 3: emergent surgery to save their life. And that's probably not
Speaker 3: a modern way of looking at something like alcohol used disorder.
Speaker 3: That's treating it more as a character flaw than a disease.
Speaker 3: You know, I think I have the advantage in this
Speaker 3: discussion of having met these people. They're real people, they are,
Speaker 3: they have families, they have they're they're indistinguishable from folks
Speaker 3: that are listening to this conversation. And it just occurred
Speaker 3: to all of us that a second chance is something
Speaker 3: we all probably are going to need at some point
Speaker 3: in our lives. And if the rules of the game
Speaker 3: are stacked against you or were never made clear or unfair.
Speaker 3: That's just that's just not fair play. And we have
Speaker 3: been able to see how well people can do when
Speaker 3: given a second chance. So I guess I would ask
Speaker 3: people to withhold judgment maybe, and and imagine if it
Speaker 3: was your brother, if it was your your partner, if
Speaker 3: it was your kid that needed a life saving transplant,
Speaker 3: if there was a way for doctors to save your
Speaker 3: kid's life, and somebody tried to say we could, but
Speaker 3: we're just not going to. You wouldn't stay and for it.
Speaker 3: You wouldn't stand for it, and we're not standing for
Speaker 3: it either.
Speaker 2: Okay, So yeah, you've convinced me. And I'm just wondering
Speaker 2: how your approach has been received by other transplant centers.
Speaker 2: Have you experienced any resistance there?
Speaker 3: When we look at how widely this new approach to
Speaker 3: transplant has been adopted in the United States, the answer
Speaker 3: is disappointing. There are probably one hundred and fifty liver
Speaker 3: transplant centers in the United States, and I would say
Speaker 3: somewhere between a third and a half have done one
Speaker 3: of these transplants without a six month waiting period. And
Speaker 3: I think some of the reasons are is that, ah,
Speaker 3: these patients are heavy lifting. It takes extra resources to
Speaker 3: evaluate them before transplant and to take care of them
Speaker 3: after transplant. And I think there is also safety in
Speaker 3: traditional rules. It is just easier to say, I'm not
Speaker 3: going to get into all those controversies. I play by
Speaker 3: the rules. Six months is a rule. I understand. I'm
Speaker 3: on safe ground.
Speaker 2: And do you think that there is anything that might
Speaker 2: make clinics wary of doing these kinds of transfers.
Speaker 3: I think the barriers are stigma. I think alcohol occupies
Speaker 3: a very special place in our society which is difficult
Speaker 3: to unpack. This patient drank too much. They did it
Speaker 3: to themselves. That that's sort of an old fashioned, historic
Speaker 3: way at looking at alcohol use, which I think our
Speaker 3: country has not moved on from. It's interesting Europe rapidly
Speaker 3: adopted this new system or criteria for who should get
Speaker 3: a liver transplant for alcohol use, perhaps a more open
Speaker 3: minded or liberal approach to the problem. The United States
Speaker 3: did not. It's still coming.
Speaker 2: Andrew hopes that transplant centers across the US will see
Speaker 2: the results of his pilot program and rethink the six
Speaker 2: month ban. His patient Jamie Imhoff is working towards the
Speaker 2: same goal.
Speaker 1: I hope to break the stigma that such individuals are
Speaker 1: worth saving when a lot of programs deem them unsavable.
Speaker 2: Jamie spends a lot of her time these days raising
Speaker 2: awareness about the six month ban through social media campaigns
Speaker 2: and public events.
Speaker 1: It's been more than.
Speaker 2: A year since the day she collapsed. She's grateful to
Speaker 2: be alive, and she doesn't take it for granted.
Speaker 1: I feel my duty is to make sure that overall,
Speaker 1: not just physically but mentally, I'm as healthy as I
Speaker 1: can be for the person who gave me this new life.
Speaker 2: She says. One of the things that helps us stay
Speaker 2: healthy has been letting go of the sense of shame
Speaker 2: she used to feel about her drinking.
Speaker 1: If you have guilt, shame, resentment, these are the things
Speaker 1: that we'll make you. We'll drive you back to drinking.
Speaker 1: You're going to fail the transplant in itself, and you're
Speaker 1: going to fail the donor.
Speaker 2: Jamie is still sober, and she plans to stay that way.
Speaker 2: She thinks of her sobriety as a gift that's just
Speaker 2: as life changing is her liver.
Speaker 1: So when I wake up in the morning now I
Speaker 1: don't feel sick. I'm able to get up right away.
Speaker 1: For example, this morning went up and I already walked
Speaker 1: two miles today and got my coffee, and so I
Speaker 1: can get up and look at the trees blooming, or
Speaker 1: actually I can even smell the fresh air. Those are
Speaker 1: a lot of the side effects that you lose in
Speaker 1: full on alcoholism. So sobriety overall is just one hundred
Speaker 1: times better.
Speaker 2: Next week, I'm playing God. What if there was an
Speaker 2: eBay for kidneys? We'll hear from a transplant recipient who
Speaker 2: thinks we should legalize the sale of organs in the
Speaker 2: US and even provide compensation to incentivize living organ donation.
Speaker 2: But is it ever ethical to pay someone for a
Speaker 2: body part? Thanks so much to our guests Jamie Imhoff
Speaker 2: and Andrew Cameron. Playing God is a co production of
Speaker 2: Pushkin Industries and the Johns Hopkins Berman Institute of Bioethics.
Speaker 2: Emily Vaughan is our lead producer. This episode was also
Speaker 2: produced by Sophie Crane and Lucy Sullivan. Our editors are
Speaker 2: Karen Schakerjee and Kate Parkinson Morgan. Theme music and mixing
Speaker 2: by Echo Mountain Engineering. Support from Sarah Brugere and Amanda Kaiwang.
Speaker 2: Show art by Sean Karney, fact checking by David jar
Speaker 2: and Arthur Gompertz. Our executive producer is Justine Lang at
Speaker 2: the Johns Hopkins Berman Institute of Bioethics. Our executive producers
Speaker 2: are Jeffrey Kahan and Anna Mastriani, working with Amelia Hood.
Speaker 2: Funding provided by the Greenwall Foundation. I'm Laurena Rora Hutchinson.
Speaker 2: Come back next week for more Playing God. As you've
Speaker 2: heard through the series, I'm the director of the Ideas
Speaker 2: Lab at the Johns Hopkins Berman Institute of Bioethics. At
Speaker 2: the Ideas Lab, we are exploring new innovative ways of
Speaker 2: telling stories about the intersection of ethics, science, medicine, and
Speaker 2: public health. As well as podcasts, we do screenwriting, films,
Speaker 2: and immersive experiences. To get involved, visit Bioethics dot Jhu
Speaker 2: dot edu, Forward Slash Ideas Lab