"Can we have your kidney, then?"

[iNow]

Hmm, is the rise in diabetes in the U.S due to obesity, we have the same problem in the UK. I realize it's a genetic disorder, but it's also genetic to become obese, not to be obese. I think there should be restrictions on who receives a transplant if the patient doesn't take steps to make a concerted effort to change their diet, exercise regime.

 

If that's way off, someone say...

You seem to be referring to Type II Diabetes, often referred to as "behavioral" or "adult-onset." Although, the adult-onset term has fallen out of favor due to so many kids being diagnosed with Type II diabetes recently. The other kind is Type I Diabetes, often referred to as "juvenile diabetes."

 

While there are a genetic components to both, Type I is an autoimmune disorder where the immune system attacks an otherwise healthy pancreas, essentially mistaking it for an invader on the body. This immune system attack causes the pancreas to no longer be able to produce insulin, hence, diabetes.

 

Type II diabetes tends more often to be lifestyle based, and while there is a genetic component, it's more that the pancreas is unable to produce enough insulin to compensate for food intake or lack of exercise. There are also people who have insulin insensitivity, whereby the pancreas makes plenty of insulin but the body cannot use it effectively.

 

The health issues (like kidney failure, blindness, and nerve damage to the extremeties) result from the flux of toxins in the system of a diabetic. Most bodies regulate this "homeostasis" pretty much on their own, but a diabetic must take extra steps to try to bring their bodies into a normal range. This up and down swing and inefficient processing of glucose causes the toxins referenced above, resulting in blood flow problems, nerve problems, and kidney problems.

 

I am a Type I diabetic, have been for 20 years, complete with going into a coma when I was 10, and while I could take better of myself, I'd be pretty pissed off if you told me I was not eligible for a new kidney because I didn't live by some set of strict standards and guidelines that were being used to exclude people from eligibility.

[Royston]

You seem to be referring to Type II Diabetes, often referred to as "behavioral" or "adult-onset." Although, the adult-onset term has fallen out of favor due to so many kids being diagnosed with Type II diabetes recently. The other kind is Type I Diabetes, often referred to as "juvenile diabetes."

 

I am a Type I diabetic, have been for 20 years, complete with going into a coma when I was 10, and while I could take better of myself, I'd be pretty pissed off if you told me I was not eligible for a new kidney because I didn't live by some set of strict standards and guidelines that were being used to exclude people from eligibility.

 

I was referring to Type II, sorry for not making that clear. Also before anybody accuses me of being a heartless git, what I did make clear was that if 'they didn't make a concerted effort to change their lifestyle' and not making an effort clearly lead to further problems, then personally I don't think they deserve the charity of somebody who has willingly given an organ...whether that person received $ 60,000 or not. Also, such a plan could encourage people not to make an effort.

 

Like I said, I may be way off, and I appreciate that some of my comments may of come across as harsh. But, AFAIK the rise in obesity is directly linked to the rise in Type II diabetes, and people do have the choice to change their lifestyle, where as many conditions people don't have any choice, why should resources and doctors time be wasted on people that do have a choice ?

[iNow]

How do you feel about treating people emphysema and lung cancer? If a transplanted organ could be used to treat these, should they not be eligble because they caused their own sickness with their own behavior?

 

Also, I doubt that family members and friends and loved ones would see this as "wasting resources" if it were their friend needing the kidney.

 

 

(btw, I don't think you're heartless at all, but it's also important to remember the human element when applying our logic).

[Royston]

How do you feel about treating people emphysema and lung cancer? If a transplanted organ could be used to treat these, should they not be eligble because they caused their own sickness with their own behavior?

 

Personally, and whether you believe me or not is irrelevant...if I contracted lung cancer because of my habit, no I don't deserve treatment. I'm perfectly aware of the risks, there's no excuse.

 

Also, I doubt that family members and friends and loved ones would see this as "wasting resources" if it were their friend needing the kidney.

 

I realize that, and perhaps that's something the person should be considering if a lifestyle change would of prevented that. If people are denied treatment due to obesity, or illnesses related to smoking or heavy drinking, perhaps they'll think twice about they're habits. If they want to take that risk, then they should realize it's not just affecting them, but their loved ones.

 

I'm just a little sick of the millions of people not making an effort, and expecting treatment. If you're aware of the possible consequences, then you've made a choice to take that risk, nobody should be denied living whatever lifestyle they choose, but they shouldn't expect organ transplants et.c when there are people who just havn't had that choice. There are people in the UK claiming incapacity benefit for being overweight, it's sickening. Medical research / funding / treatment should all be geared towards conditions that are out of peoples control, not quick fixes for people that can control their condition.

 

(btw, I don't think you're heartless at all, but it's also important to remember the human element when applying our logic).

 

Thanks, I appreciate it.

 

People that have been given a warning that they must stop eating crap / smoking / drinking should also remember the human element, if they can't be bothered to make that change...i.e like you said, their friends and family.

[mooeypoo]

Well, excuse me, but if we're talking about *buying* an organ (technically, if you pay the 'donator' he is no longer a donating person he is a SELLER), then we have no right to claim who is eligible to buy and who isn't.

 

That, btw, is the biggest problem I do have with this system. Rich people will get donations. Poor people will lose body parts.

 

~moo

[ParanoiA]

I was referring to Type II, sorry for not making that clear. Also before anybody accuses me of being a heartless git, what I did make clear was that if 'they didn't make a concerted effort to change their lifestyle' and not making an effort clearly lead to further problems, then personally I don't think they deserve the charity of somebody who has willingly given an organ...whether that person received $ 60,000 or not. Also, such a plan could encourage people not to make an effort.

 

How about the donor's right to give their organ to whom they want to? Why would anybody else but me get to decide who gets my organ? What if I don't want healthly people to get my organ? What if I feel sorry for smokers and I want to donate exclusively to them? What gives you the moral authority to deny me of this basic right?

 

And why does anyone have to make an effort? Why is it a "given" that all of us are to be healthy and strive to be so? I don't define my quality of life merely by length, but also by enjoyment, indulging in "sin", drink, smoke - why not? And if I can do these things longer, then that's even more quality. Why must everyone adopt the philosophy of being as healthy as they can be, otherwise no organ transplants? (as if it would stop there...)

 

Like I said, I may be way off, and I appreciate that some of my comments may of come across as harsh. But, AFAIK the rise in obesity is directly linked to the rise in Type II diabetes, and people do have the choice to change their lifestyle, where as many conditions people don't have any choice, why should resources and doctors time be wasted on people that do have a choice ?

 

Because they have the money. How much personal freedom do you have to sell to be sure you'll get medical resources? And how much individuality will really be left in a society that rations medical service per personal behavior after a course of years?

 

And why do otherwise healthy people deserve organ donations? They've been taking great care of themselves, yet here they are, sick and in need of someone's organ. Apparently their bodies are inferior to those who have to smoke and drink to reach that same point. In my mind, they are less deserving of an organ.

 

I'm just a little sick of the millions of people not making an effort, and expecting treatment. If you're aware of the possible consequences, then you've made a choice to take that risk, nobody should be denied living whatever lifestyle they choose, but they shouldn't expect organ transplants et.c when there are people who just havn't had that choice.

 

I understand the sentiment, I really do. It's a smack in the face to see an alcoholic get a new liver while a slighter older guy down the hall, a non-drinker, dies from liver failure. But that's poetry. In real life, it isn't that cut and dry, and it's still wrong to cast judgement like that, anyway. You have to assume the goal of every human is to be as healthy as possible for as long as possible and that's just not the case with modern man. And I'm glad.

 

With a centralized healthcare system, I can see how this is a big issue for you and I can also see how this threatens individual liberty and personal choice. This is partly why I'm against a government run healthcare system in america.

[Royston]

Well, excuse me, but if we're talking about *buying* an organ (technically, if you pay the 'donator' he is no longer a donating person he is a SELLER), then we have no right to claim who is eligible to buy and who isn't.

 

That, btw, is the biggest problem I do have with this system. Rich people will get donations. Poor people will lose body parts.

 

~moo

 

I agree, but I'm equally perplexed that such an option has been considered, due to, what appears to me, people who have been warned time and time again the risks that come with obesity, and yet still carry on regardless. If somebody wants to lead that lifestyle, then fine, but they should be the last on the list of who is treated, if treated at all...and if they've made the choice to ignore a doctors advice, I don't feel they should get any preferential treatment, just my opinion.

 

How about the donor's right to give their organ to whom they want to? Why would anybody else but me get to decide who gets my organ? What if I don't want healthly people to get my organ? What if I feel sorry for smokers and I want to donate exclusively to them? What gives you the moral authority to deny me of this basic right?

 

With all due respect, if you offered me a kidney due to a habit which I could of stopped, I'd call you a freakin' idiot, and ask you to donate it to someone who had heeded the numerous warnings to the risks of smoking. I wouldn't think twice about it.

 

And why does anyone have to make an effort? Why is it a "given" that all of us are to be healthy and strive to be so? I don't define my quality of life merely by length, but also by enjoyment, indulging in "sin", drink, smoke - why not? And if I can do these things longer, then that's even more quality. Why must everyone adopt the philosophy of being as healthy as they can be, otherwise no organ transplants? (as if it would stop there...)

 

I'm not saying that choice should be taken away, but if you've been told 'Paranoia, unfortunately you need to knock the booze and the cigarettes on the head, otherwise you'll need an organ transplant', I would consider you incredibly selfish for not cutting down, and not allowing that organ to go to somebody who didn't have that choice...given that you could make that decision.

 

And why do otherwise healthy people deserve organ donations? They've been taking great care of themselves, yet here they are, sick and in need of someone's organ. Apparently their bodies are inferior to those who have to smoke and drink to reach that same point. In my mind, they are less deserving of an organ.

 

Quite simply because they've had no choice in the matter, and I appear to be repeating myself...again.

 

I understand the sentiment, I really do. It's a smack in the face to see an alcoholic get a new liver while a slighter older guy down the hall, a non-drinker, dies from liver failure. But that's poetry. In real life, it isn't that cut and dry, and it's still wrong to cast judgement like that, anyway. You have to assume the goal of every human is to be as healthy as possible for as long as possible and that's just not the case with modern man. And I'm glad.

 

I'm not casting judgement, if you choose to have a short, but highly enjoyable life so be it, but it should not be at the cost of others, who havn't chosen a short life.

 

With a centralized healthcare system, I can see how this is a big issue for you and I can also see how this threatens individual liberty and personal choice. This is partly why I'm against a government run healthcare system in america.

 

Just for the record....

 

http://www.iotf.org/media/euobesity.pdf

 

Obesity is rising at an alarming rate throughout Europe. It forms a pan-

European epidemic that presents a major barrier to the prevention of chronic

non-communicable diseases. At least 135 million EU citizens are affected

and perhaps another 70 million in those countries seeking to join. In many

countries now significantly more than half the adult population is overweight

and up to 30% of adults are clinically obese. The prevalence among children

is rising significantly with as many as one in four affected in some regions.

Childhood obesity is an acute health crisis and the rapidly emerging feature of

type 2 diabetes among obese children should be sounding alarm bells for the

immediate and well as long-term health of 80 million youngsters in the EU.

While obesity is itself an avoidable chronic disease, it is a substantial risk

factor for others. The most significant health consequences include

hypertension, type 2 diabetes, cardiovascular disease, gallbladder disease,

certain types of cancer and psychosocial problems. It also conveys increased

risks of dyslipidaemia, insulin resistance, breathlessness, sleep apnoea,

asthma, osteo-arthritis, hyperuricaemia and gout, reproductive hormone

abnormalities, polycystic ovarian syndrome, impaired fertility, and lower back

pain.

The costs of obesity have been estimated at up to 8% of overall health

budgets and represent an enormous burden both in individual illness,

disability and early mortality as well as in terms of the costs to employers, tax

payers and society.

A growing proportion of adults in both the European Union and accession

countries are in need of more effective therapeutic management to control

their obesity and to reduce their risks for type 2 diabetes, cardiovascular

disease and cancer. Indeed an estimated 78,000 new cancer cases in the EU

each year have been attributed to overweight, reflecting the even greater

challenge to introduce population-wide approaches to weight management as

- 4 -

existing health and medical provisions do not have the capacity to cope. New

data show clearly how to prevent type 2 diabetes through weight management

strategies.

[Mr Skeptic]

Snail, ParanoiA: are you two disagreeing about different things? Is the problem the location of eg alcoholics on the waiting list, or whether they should get a replacement liver at all if there is an extra one available?

 

Regardless, is not one of the bigger issues one of compatibility of tissues? There's thousands of different tissue compatibility problems, which could be minimized by choosing the most compatible person to receive an organ. Otherwise, it's major immunosuppressant time.

 

Disclaimer: I'm not very familiar with how organ donations work.

[Royston]

Snail, ParanoiA: are you two disagreeing about different things? Is the problem the location of eg alcoholics on the waiting list, or whether they should get a replacement liver at all if there is an extra one available?

 

I don't feel they should get a replacement organ, if they've been told to quit. Paranoia is arguing that somebody should have the right to choose where that organ should go, alcoholic or not, I don't agree. The person who has made a choice not to adopt a lifestyle that has potential risks, should get preference. I feel the person who has not taken measures to change their lifestyle, despite being told, has abused their right to treatment.

 

Regardless, is not one of the bigger issues one of compatibility of tissues? There's thousands of different tissue compatibility problems, which could be minimized by choosing the most compatible person to receive an organ. Otherwise, it's major immunosuppressant time.

 

Well, yes, that's also an issue, but the people receiving organ transplants should be lessened by denying them treatment, if they've decided not to adopt the doctors advice. I'm really thinking the source of the problem should be alleviated, rather than, as I said before, a quick fix. As my link illustrates, the magnitude and burden of obesity is what should be tackled, not relying on the poor to give transplants.

[Pangloss]

Hmm, is the rise in diabetes in the U.S due to obesity, we have the same problem in the UK. I realize it's a genetic disorder, but it's also genetic to become obese, not to be obese. I think there should be restrictions on who receives a transplant if the patient doesn't take steps to make a concerted effort to change their diet, exercise regime.

 

You forget how our society works. Overeating, like smoking or alcoholism, isn't a matter of personal responsibility, it's a disease.

 

Your idea will work right up until the media does its first story about a cute little girl who just can't seem to keep her hand out of the cookie jar, and YOU WANT TO KILL HER!

[ParanoiA]

With all due respect, if you offered me a kidney due to a habit which I could of stopped, I'd call you a freakin' idiot, and ask you to donate it to someone who had heeded the numerous warnings to the risks of smoking. I wouldn't think twice about it.

 

And yet, a subjective opinion. Call me an idiot. I call you an idiot for giving a good kidney to someone who couldn't keep theirs running under the "best" of maintenance.

 

I'm not saying that choice should be taken away, but if you've been told 'Paranoia, unfortunately you need to knock the booze and the cigarettes on the head, otherwise you'll need an organ transplant', I would consider you incredibly selfish for not cutting down, and not allowing that organ to go to somebody who didn't have that choice...given that you could make that decision.

 

Another, subjective opinion, that I agree with.

 

I'm not casting judgement, if you choose to have a short, but highly enjoyable life so be it, but it should not be at the cost of others, who havn't chosen a short life.

 

You are placing a value judgement on behavior that you believe should even supercede the wishes of the donor, presumably as a matter of law. While I agree with you on a subjective, personal level on much of what you say, it should not be a matter of law to be so obviously subjective. It's murder, to me.

[Dak]

hmm... if (say) lungs are in short supply, and there'd not be enough to go around even if everyone took care of their lungs, and yet people use up what few spare lungs that we have by ruining theirs with known risky behaviour like smoking, then tbh i don't see the problem with, not denying smokers new lungs, but prioritising non-smokers. same with livers and alcoholics, etc.

[Royston]

You forget how our society works. Overeating, like smoking or alcoholism, isn't a matter of personal responsibility, it's a disease.

I know full well how a fickle society works, hence my distain at such a decision. The West is geared towards the progress of self indulgence, and when self indulgence presents health risks, well, there are plenty of poor people, lets take their organs...great ! I know you don't agree with the idea, but it's a pretty twisted proposal nevertheless.

Your idea will work right up until the media does its first story about a cute little girl who just can't seem to keep her hand out of the cookie jar, and YOU WANT TO KILL HER!

Or how about, little cute girl gets overlooked and dies due to overcrowded hospital.

It's murder, to me.

Person A: Hmm, I might stab myself in the throat

Person B: Don't stab yourself in the throat, it presents an incredibly high risk to your health.

Person A: Well, that's great advice, and you're a professional in the field, but I'm going to do it anyway.

Person A stabs himself in the throat...Murder !

Couldn't you accuse patients who could control their condition, and hampering the health service of priority care to patients who can't control their condition of murder...why not?

hmm... if (say) lungs are in short supply, and there'd not be enough to go around even if everyone took care of their lungs, and yet people use up what few spare lungs that we have by ruining theirs with known risky behaviour like smoking, then tbh i don't see the problem with, not denying smokers new lungs, but prioritizing non-smokers. same with livers and alcoholics, etc.

Exactly, it's completely a matter of priority, and it's one Tory policy I agree with, although I'm personally Liberal. What's worse is there are future cuts on the EU health budget, but no sign of obesity declining...the complete opposite in fact.

So what are the options...we can't ban fat, that's ridiculous. We can't control discipline, that's impossible. We can deny patients treatment through prioritizing, when they've been given adequate warning to control their condition. Personally I think patients should be warned that they won't receive treatment unless there is evidence they have tried to alleviate their symptoms through, cutting back, exercise et.c. I'm not entirely sure how easy it is to spot the evidence, but I'm convinced the option highlighted from the OP is short term, and will not prevent the rise in obesity from the source...that is, forcing people to take control and reduce the rise in obese related illness. The same goes for smoking and alcohol related illness.