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Old Aug 13, 2013, 12:01 PM   #1
jnpy!$4g3cwk
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Teenager Denied Heart Transplant Over History of 'Noncompliance' and Trouble With Law

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A Georgia teenager needs a lifesaving heart transplant, but his family says low grades and trouble with the law have kept him off the transplant list.

Doctors at Children's Healthcare of Atlanta at Egleston told the family of 15-year-old Anthony Stokes that they won't put him on the transplant list because of his history of "noncompliance," according to ABC's Atlanta affiliate WSBTV.

"They said they don't have any evidence that he would take his medicine or that he would go to his follow-ups," Melencia Hamilton, Anthony's mother, told WSBTV.

Anthony has an enlarged heart and has been given six months to live, according to WSBTV.

http://abcnews.go.com/Health/story?id=19936940

I don't doubt the kid is "noncompliant", since, I think I've met three "compliant" 15-year-olds in my entire life.

Grades?

I understand that there may be a lot of things they can't talk about. But, the visible public rationale stinks.
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Old Aug 13, 2013, 12:16 PM   #2
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Quote:
Originally Posted by jnpy!$4g3cwk View Post
http://abcnews.go.com/Health/story?id=19936940

I don't doubt the kid is "noncompliant", since, I think I've met three "compliant" 15-year-olds in my entire life.

Grades?

I understand that there may be a lot of things they can't talk about. But, the visible public rationale stinks.
I too, think it's saddening.
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Old Aug 13, 2013, 12:21 PM   #3
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Quote:
Originally Posted by jnpy!$4g3cwk View Post
http://abcnews.go.com/Health/story?id=19936940

I don't doubt the kid is "noncompliant", since, I think I've met three "compliant" 15-year-olds in my entire life.

Grades?

I understand that there may be a lot of things they can't talk about. But, the visible public rationale stinks.
I'd need to know what "trouble with the law" meant before I could make any judgement call. If he is being denied a heart transplant I doubt it was a typical teenage run in with police.

Also the family is the one who brought up grades, last I checked they don't check your academic records before deciding to give you surgery.
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Old Aug 13, 2013, 12:37 PM   #4
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Old Aug 13, 2013, 12:39 PM   #5
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But yet they gave Bartolome Moya a transplant. If you don't know who that is, Google his name and read how he wasted a perfectly good heart.
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Old Aug 13, 2013, 01:29 PM   #6
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From Reuters

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ATLANTA, Aug 12 (Reuters) - The family of a 15-year-old Atlanta boy who could have less than six months to live said Monday he is being unfairly denied a heart transplant because of past failure to take medicine and appear for doctor's appointments.
http://www.huffingtonpost.com/2013/0...n_3746072.html
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Old Aug 13, 2013, 01:38 PM   #7
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Old Aug 13, 2013, 01:46 PM   #8
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Originally Posted by AhmedFaisal View Post
Still not a lot of detail. Gut feeling says there is a valid reason for it...
Same gut feeling as information regarding the reasons for denial are appearing slowly, and bit by bit.

I don't buy, for one moment, that bad grades had anything to do with the denial. Non-compliance with medical treatment is far more likely. If a patient has a history of non-compliance with medication, keeping follow up appointments, and the like...they are considered a bad risk for a procedure which require extensive aftercare, medication compliance, etc.

"Bad grades" make a better story...but not very believable.
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Old Aug 13, 2013, 01:57 PM   #9
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Old Aug 13, 2013, 02:07 PM   #10
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Quote:
Originally Posted by Shrink View Post

I don't buy, for one moment, that bad grades had anything to do with the denial. Non-compliance with medical treatment is far more likely. If a patient has a history of non-compliance with medication, keeping follow up appointments, and the like...they are considered a bad risk for a procedure which require extensive aftercare, medication compliance, etc.
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The grades thing is silly and only people with the intelligence of Glen Beck audiences would buy that.
The parents could very well have been given an explanation of "non-compliance" that included academic effort. Most people, including most newspeople, are not going to understand the algorithm by which someone's priority is assigned, because most people have trouble with algorithms.

Back to the non-compliance part. I have spent a lot of time around teenagers, and, I can only think of one "compliant" 15-year-old boy I have met over the years, and, even he wasn't that compliant. Does that mean that 15-year-old boys will never get transplants while 67-year-olds can? Organ transplantation can seem like a true zero-sum game ...
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Old Aug 13, 2013, 02:26 PM   #11
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Quote:
Originally Posted by jnpy!$4g3cwk View Post
The parents could very well have been given an explanation of "non-compliance" that included academic effort. Most people, including most newspeople, are not going to understand the algorithm by which someone's priority is assigned, because most people have trouble with algorithms.

Back to the non-compliance part. I have spent a lot of time around teenagers, and, I can only think of one "compliant" 15-year-old boy I have met over the years, and, even he wasn't that compliant. Does that mean that 15-year-old boys will never get transplants while 67-year-olds can? Organ transplantation can seem like a true zero-sum game ...
Having spent many years working with adolescents, I agree completely that compliance with anything, other than their peers' opinions, is anathema to adolescents. However, if compliance is not a trait most adolescents possess, and their parents are unable to encourage or enforce compliance with the complicated and life long medical regimen necessary to support a heart transplant, then the heart will likely be wasted as the non-compliant individual will die...taking a heart which might have kept someone else alive.

I would suggest the 15 year old...or 67 year old argument is a bit of a straw man. There are many in between who might benefit from the heart (a very scarce commodity) and live many years by carefully following the medical regimen necessary to support an organ transplant. And even if we accept the 67 year ols example, a non-compliant patient will not live very long, while a 67 year old compliant patient could well live a long life...other health issues being equal.

I am not totally disagreeing with the quoted poster that this is not a simple issue...but compliance with a post organ transplant regiment is complicated and time consuming.
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Old Aug 13, 2013, 02:50 PM   #12
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Don't you just LLLLOOOOVVVVEEEE death panels?

Anyways, since the government has created an artificial shortage of organs available for transplant, it only makes sense that those the government does allow go to people who contribute to society.
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Old Aug 13, 2013, 02:54 PM   #13
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Originally Posted by ThisIsNotMe View Post
Don't you just LLLLOOOOVVVVEEEE death panels?

Anyways, since the government has created an artificial shortage of organs available for transplant, it only makes sense that those the government does allow go to people who contribute to society.
How has the government created a shortage. They don't demand you donate your organs when you die, well maybe she should. Organ donation should be opt out not opt in.
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Old Aug 13, 2013, 02:58 PM   #14
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How has the government created a shortage. They don't demand you donate your organs when you die, well maybe she should. Organ donation should be opt out not opt in.
Opt out implies that the government has default ownership of your organs. I don't agree with that mindset. It should stay opt in
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Old Aug 13, 2013, 03:02 PM   #15
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Opt out implies that the government has default ownership of your organs. I don't agree with that mindset. It should stay opt in
Agreed. While I think more people should opt in, it should remain opt in regardless of the shortage of organs.
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Old Aug 13, 2013, 03:08 PM   #16
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Opt out implies that the government has default ownership of your organs. I don't agree with that mindset. It should stay opt in
The only way our organs get donated is after you die, the government won't be chasing you down with a scalpel for a lung.
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Old Aug 13, 2013, 03:13 PM   #17
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Originally Posted by ThisIsNotMe View Post
Anyways, since the government has created an artificial shortage of organs available for transplant, it only makes sense that those the government does allow go to people who contribute to society.
Please explain how the Government has "created" an artificial shortage of organs?

Have they imposed too many regulations on companies that grow new hearts? Have they taken too much in taxes from all those John Galts out there, who have since decided to opt-out of the business of making new organs?

I know that it is illegal to sell my own organs (everywhere except for Iran, of all places...) but even if it weren't - I doubt you'd get a lot of people offering up their hearts to get the downpayment on a starter home.

Since the only reliable source of healthy hearts to transplant is young people killed in accidents, maybe you blame OSHA and the Government's campaign against drunk driving for the shortage?
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Old Aug 13, 2013, 03:15 PM   #18
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Since the only reliable source of healthy hearts to transplant is young people killed in accidents, maybe you blame OSHA and the Government's campaign against drunk driving for the shortage?
And who defines 'healthy'?
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Old Aug 13, 2013, 03:15 PM   #19
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Quote:
Originally Posted by ThisIsNotMe View Post
Don't you just LLLLOOOOVVVVEEEE death panels?

Anyways, since the government has created an artificial shortage of organs available for transplant, it only makes sense that those the government does allow go to people who contribute to society.
What death panels...source please.

There are organ transplant algorisms. Many factors are taken into account in the assignment of scarce transplant organs.

Also, please demonstrate and source how " the government does allow go to people who contribute to society".

Thank you...
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Old Aug 13, 2013, 03:16 PM   #20
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Originally Posted by jnpy!$4g3cwk View Post
The parents could very well have been given an explanation of "non-compliance" that included academic effort.
From a medical perspective non-compliance means that a patient does not take their medications and/or attend clinic appointments. It does not include academic effort.

For a young person with heart failure it means that they would have to take a large range of medications which are pretty vital to their health. This would include diuretics and fluid restrictions to ensure they don't get fluid overload (requiring hospitalisation) and cardiac meds that would help slow/reverse some of their failure. This is a pretty objective outcome and a good correlate for how most people will do taking even more medications and attending more clinic appointments post transplant.

Given heart transplants are so expensive and organs are so rare they need to go to the best candidates. It's the same with any organ. It's very strict about what one has to demonstrate to be included on the waiting list. One of the factors included for all transplant patients is a psychological assessment to ensure that they will cope with the enormous stress of surgery and the countless follow-up appointments. They will be on large doses of prednisolone and anti-rejection drugs that can further decompensate people psycholigically. It is weeks in hospital, then rehab, and then daily clinic visits to ensure their drug levels are satisfactory. It's lifelong intense therapy.

If a person is non-compliant with their medications the heart can be rejected acutely. This means death for the patient who would then have been better off with their failing heart.

I think the story is BS and there is far more going on here. The only place academic effort would be included would be the psychological assessment. There are far more factors that are assessed.
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Old Aug 13, 2013, 04:20 PM   #21
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Quote:
Originally Posted by jnpy!$4g3cwk View Post
The parents could very well have been given an explanation of "non-compliance" that included academic effort. Most people, including most newspeople, are not going to understand the algorithm by which someone's priority is assigned, because most people have trouble with algorithms.

Back to the non-compliance part. I have spent a lot of time around teenagers, and, I can only think of one "compliant" 15-year-old boy I have met over the years, and, even he wasn't that compliant. Does that mean that 15-year-old boys will never get transplants while 67-year-olds can? Organ transplantation can seem like a true zero-sum game ...
It's important to be clear about what is being complied with - or not, in this case. The very few details imply he doesn't comply with the transplant recipient priority criteria, not that he doesn't comply with orders from adults or acceptable social behavior. I suspect that if your 67-year-old example shows a history of not taking medication and not showing up for doctor appointments, they would be equally "noncompliant."
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Old Aug 13, 2013, 11:00 PM   #22
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Originally Posted by Shrink View Post
Having spent many years working with adolescents, I agree completely that compliance with anything, other than their peers' opinions, is anathema to adolescents. However, if compliance is not a trait most adolescents possess, and their parents are unable to encourage or enforce compliance with the complicated and life long medical regimen necessary to support a heart transplant, then the heart will likely be wasted as the non-compliant individual will die...taking a heart which might have kept someone else alive.

I would suggest the 15 year old...or 67 year old argument is a bit of a straw man. There are many in between who might benefit from the heart (a very scarce commodity) and live many years by carefully following the medical regimen necessary to support an organ transplant. And even if we accept the 67 year ols example, a non-compliant patient will not live very long, while a 67 year old compliant patient could well live a long life...other health issues being equal.

I am not totally disagreeing with the quoted poster that this is not a simple issue...but compliance with a post organ transplant regiment is complicated and time consuming.
Quote:
Originally Posted by .Andy View Post
From a medical perspective non-compliance means that a patient does not take their medications and/or attend clinic appointments. It does not include academic effort.

For a young person with heart failure it means that they would have to take a large range of medications which are pretty vital to their health. This would include diuretics and fluid restrictions to ensure they don't get fluid overload (requiring hospitalisation) and cardiac meds that would help slow/reverse some of their failure. This is a pretty objective outcome and a good correlate for how most people will do taking even more medications and attending more clinic appointments post transplant.

Given heart transplants are so expensive and organs are so rare they need to go to the best candidates. It's the same with any organ. It's very strict about what one has to demonstrate to be included on the waiting list. One of the factors included for all transplant patients is a psychological assessment to ensure that they will cope with the enormous stress of surgery and the countless follow-up appointments. They will be on large doses of prednisolone and anti-rejection drugs that can further decompensate people psycholigically. It is weeks in hospital, then rehab, and then daily clinic visits to ensure their drug levels are satisfactory. It's lifelong intense therapy.

If a person is non-compliant with their medications the heart can be rejected acutely. This means death for the patient who would then have been better off with their failing heart.
Quote:
Originally Posted by elistan View Post
It's important to be clear about what is being complied with - or not, in this case. The very few details imply he doesn't comply with the transplant recipient priority criteria, not that he doesn't comply with orders from adults or acceptable social behavior. I suspect that if your 67-year-old example shows a history of not taking medication and not showing up for doctor appointments, they would be equally "noncompliant."
OK, well, I probably picked the wrong fight here, but, the general societal hysteria about, and fear of, young men is really getting old. Some of us were not that nice, and, some of them are not that nice, but, back when I was their age, the authorities had a way of making things stick without pulling out their guns and shooting us. The thing they need more than anything right now is work experience, and, modern urban society can't seem to deliver jobs for young men. I guess today is a grumpy day; I should have taken a nap yesterday.
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Old Aug 14, 2013, 05:23 AM   #23
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OK, well, I probably picked the wrong fight here, but, the general societal hysteria about, and fear of, young men is really getting old. Some of us were not that nice, and, some of them are not that nice, but, back when I was their age, the authorities had a way of making things stick without pulling out their guns and shooting us. The thing they need more than anything right now is work experience, and, modern urban society can't seem to deliver jobs for young men. I guess today is a grumpy day; I should have taken a nap yesterday.
Sorry, maybe I'm missing something here...it's early and I'm goofier than usual, but I thought we were discussing the issue of heart transplantation and the candidate selection process. I'm not understanding the quote above about young men and guns.
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Old Aug 14, 2013, 06:00 AM   #24
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@OP: .Andy's replies explains this well. Is is not in a patient's interest to perform a transplant unless they comply with medical advice. Otherwise, the patient will wind up with a rump of rotting meat in their chest.

However, given that this is a 15 year old, then perhaps support should be provided, even if that entails sheltered housing where medical compliance can be guaranteed. Please note that adults can be bad at medical compliance as well, just look at the number of people who smoke or drink against the advice of their physician, or the number of adults who do not properly monitor their insulin levels, etc.
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Old Aug 14, 2013, 06:26 AM   #25
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Hospital reverses their decision.

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Anthony Stokes will get a chance at a new heart.
According to Stokes’ family, Children’s Healthcare of Atlanta at Egleston reversed course this afternoon and has agreed to add the 15-year-old to its donor list. The decision comes days after the hospital officials sent the family a letter saying Anthony would not be a good candidate for transplant because he had a “history of non-compliance.”

“We met with hospital officials about 30 minutes ago,” family spokesman Mark Bell said this afternoon. “After reviewing the situation, they said Anthony would be placed on the list for a heart transplant and that he would be first in line, due to his weakened heart condition.”
http://www.ajc.com/news/news/change-...year-ol/nZNQM/
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