Long-term aftercare necessary for liver transplant patient to have a normal life
The rather emotive response of Professor Lo Chung-mau, head of the University of Hong Kong's department of surgery ('Many children have grown up normally in HK after having liver transplants', October 26) to my short and factual letter ('Ethical issues must be considered', October 20) is unfortunate.
True, I am a plastic surgeon, but I am not 'uninformed'.
I agree that worldwide the majority of paediatric liver transplant patients can enjoy an excellent quality of life, if they have the full support of a multidisciplinary team to give the necessary lifelong aftercare.
The history of liver transplantation is just too short to talk about long-term outcomes, which, in the transplant community, are still measured in years rather than decades.
In addition, there are multiple long-term complications, such as chronic rejection, renal impairment and skin cancers, mostly related to the lifelong need for powerful immunosuppressive drugs.
If the facility and commitment to high-quality follow-up care cannot be guaranteed, then a liver transplant would be unethical.
This is the issue that Professor Lo appears to be avoiding. He does make an excellent point that his objective is not about normalising life but improving it.
While other specialties can discharge their patients once they are 'normal', a transplant patient is a patient for life.
It is obvious that Professor Lo cares passionately about his patients, but it is important not to let emotion cloud professional judgment.
I hope that, when he has an opportunity to reflect upon my original letter, he will appreciate that I am not being critical of paediatric liver transplantation: rather I am putting it into a wider perspective for non-medical readers to appreciate the ethical dimensions involved.
I can only reiterate that our mature, caring and concerned thoughts go out to Professor Lo and his team as they discuss with the parents of this child the very difficult issues that relate not just to the transplant operation but, perhaps of greater importance, to the life after the transplant - a life that will never be 'normal'.
Professor Andrew Burd, department of surgery, Prince of Wales Hospital