My three livers: how transplants gave me my life backBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1004 (Published 06 March 2019) Cite this as: BMJ 2019;364:l1004
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
One of the main issues with organ transplantation is the lack of organs being donated. The Human Tissue Act 2004 gave a significant amount of weight to appropriate consent thus causing the rates of organ donation to fall due to families not allowing organ donation (even with prior consent from the donor). With the new organ donation law being put into place, the decision lies with individual and not their families, whether they choose to “opt-out” of being an organ donor. The government hopes that this will encourage the numbers of organ donation to rise and will reduce waiting times for those such as Ms Walker. However, we have yet to see whether this new policy makes a difference in organ donation rates due to the fact that it will not be implemented until next year.
The key issue that has surprised me here is the seemingly inadequate level of support for Ms Walker’s mental health. She mentions that between transplants and after the diagnosis of primary sclerosing cholangitis she suffered from major depression and has also developed generalised anxiety disorder. She also worries about the state of her current mental health should her current liver fail. One of the key teaching points in medical schools is to treat the patient holistically. While I would assume that her symptoms are being treated as best they can, it appears that only the biological aspect of her condition and not the psychosocial aspects are being addressed.
This is something that the medical profession must draw their attention to as patients are more than just their disease. Not only this but the experience of the disease or condition, can be greatly influenced by the circumstances and the environment which surround them. Therapy and counselling are just few of the many ways in which we could help patients like Ms Walker and by treating patients holistically, we are able to reduce the burden of their disease.
Competing interests: No competing interests