For those unfamiliar with this process, getting evaluated for a liver transplant is a very deliberate and arduous process, requiring extensive medical testing and counseling.  And this is all to determine if you are eligible to be listed for an organ.  Actually receiving an organ can take years.  And sadly, for patients awaiting liver transplantation many patients die before ever receiving an organ.

A localized focus of hepatocellular carcinoma was identified during his work-up, and a few weeks ago he underwent successful treatment.  And his evaluation has still not been completed, so it is still unknown as to whether or not he will be deemed a candidate to be placed on the waiting list for an organ.

Mr V was recently admitted to our hospital with symptoms due to his worsening liver disease.  And now his renal function is declining which carries with it a very poor prognosis.  Although reluctant to do so, the nephrologists have started him on acute hemodialysis in hopes that his kidney function will improve.  But so far, there is no evidence of this.  Because the cause of his renal failure is his liver disease, long term dialysis is not the answer.  A new liver is.

I have been called in to meet with he and his family.

And the first thing from Mr V and his family upon attempting to talk about his ongoing medical issues was:  “Can’t I get a transplant now?  Will you contact the transplant center?”

So I did.  Your coordinator confirmed his ongoing evaluation, but no decision regarding suitability for transplant had been decided, so he was not deemed eligible for transfer.  Which was pretty hard for Mr V and his family to understand.

Although fully expecting you to turn down the request (because truly ‘everything’ was being done for Mr V to help him at our facility), his gastroenterologist sent you a referral to see if you would accept him for general transfer,  for a higher level of care.  And you surprised us all by accepting Mr V for general transfer.   You can’t imagine how relieved and hopeful Mr V and his family were.

So here he has waited….

Day after day we call you for a bed, and are told there are none.

Now Mr V and his family are in purgatory.

Because the reality is that without a new liver, there is no chance for Mr V to recover, and if he’s not yet on the list, he’s not getting a transplant.  And because you accepted him in transfer, the family is wondering if there’s something out there Mr V is missing out on by remaining in our hospital.

Now everyday Mr V and his family are continuing aggressive interventions while hoping for a transfer for the miracle they feel you are capable of providing.

As his symptoms of pain and shortness of breath have become more pronounced, they are impossible to adequately manage, because he still “wants everything” i.e., intubation, etc… should his condition decline.

Only when Mr V was no longer able to tolerate dialysis, did he say “enough”.  He then decided to forego aggressive treatments, and transition to comfort focused care.  So he was finally comfortable and surrounded by family when he died in our hospital several hours later, never having been transferred to your facility.

So now the family is left wondering- what would have happened if Mr V had gotten to the your center?  Would Mr V have still died?

I’m confident the answer is yes.

But by accepting this patient without having an available bed, in your attempt to be kind to this patient/family, you may have inadvertently left his family

with a lifetime of regret and bitterness….