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Transplant Q&AQuestion: My grandson, age 3, was diagnosed with hepatoblastoma April 1999. The liver is the primary and only location of the cancer. He has undergone chemo and had a liver resection removing 70% of his liver. In January 2000, a small area was detected which had begun to grow again.Some doctors have said he is eligible for a liver transplant, others have said he is not. Our angel has a mild genetic syndrome (Rubinstein-Taybi) which mainly is evident in slow growth. It is a very livable syndrome. What we are wondering: is he being discriminated against receiving a liver transplant because of this syndrome?Answer: It really isn't possible to pass judgment regarding a particular case without seeing the patient for a complete evaluation. I can say with certainty that hepatoblastoma is a well recognized indication for liver transplantation. The fact that it has "reappeared" is something of a negative prognostic sign, but many surgeons would not consider that an absolute barrier to proceeding with a transplant. I am not familiar with the Rubinstein-Taybi syndrome. If the issue is mild mental retardation, that should not preclude him from benefiting from a transplant. If the mental retardation is profound, the issue becomes more difficult, but it becomes a judgment call. The description of the child sounds as if this shouldn't be an issue, but it isn't possible to say this without meeting him. If the issue is that the syndrome is associated with other anomalies that either complicate the operation (such as cardiac problems) or that limit his life span otherwise, the decision to proceed with a transplant becomes very complex. As always, a second opinion is always a good idea if there are doubts
about the medical decision making process.
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