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Need, not status, dictated fast treatment for Mantle


Baseball Hall of Famer Mickey Mantle waited only a day to receive a new liver to replace one riddled with disease, much of it the result of notorious drinking. Yesterday, in the wake of a 6 1/2 -hour transplant in Dallas, even his staunchest fans were asking how "the Mick" could have been helped so swiftly while some patients wait anxiously for months.

Many questioned whether his sports celebrity status rather than medical considerations catapulted him to the top of the transplant list. Some expressed surprise that a man who has admitted to four decades of drinking could receive high priority, or qualify on any basis.

"Although he was a hero of sorts when we were growing up, a champ ballplayer and all that, I was under the impression that people who abused their bodies wouldn't get one right away," said Wayne Holly, 48, of South Baltimore, who has been waiting since last November for a new liver.

"It was a life and death situation, so he got one. I'm not so crazy about the idea, but I can't fault him for getting one," said Mr. Holly, a patient of the University of Maryland of Maryland Medical Center. Mr. Holly suffers from a type of cirrhosis that appears mysteriously -- no history of infections or heavy drinking.

Mr. Mantle, 63, entered surgery at about 4 a.m. yesterday at the Baylor University Medical Center. Surgeons said that Mr. Mantle stood an excellent chance of recovery, even though he'll be on the critical condition list for 24 hours, a necessary procedure.

Surgeons and officials who control the distribution of organs insisted that the severity of Mr. Mantle's illness -- not his stature -- gave him top priority at the Baylor University Medical Center. In the formula used to decide who gets organs first, relatively little credit is given to time spent in anxious waiting.

"People have been on our waiting list for well over a year who are not in the urgent categories," said Julie Strange, director of the Transplant Resource Center of Maryland. "They're going to stay on the list while the sickest patients get transplanted."

In Dallas, Baylor's medical director, said he was concerned about the perception of special treatment.

The former slugger "was the sickest person in North Texas waiting for a liver transplant," Dr. Goran Klintmalm said. "There's no way for anyone to circumvent the system."

The average wait for a nonurgent liver transplant is 145 days in that area, he said, but only three days for an emergency such as Mr. Mantle's.

Following national rules, doctors rate patients according to their medical need. People who are expected to die within seven days if they don't receive new livers get the highest priority. They are in intensive care units, many on ventilators.

Mr. Mantle received the second-highest ranking. He was hospitalized, too ill to go home but not sick enough to need intensive care. Lower priority is given to patients who are hospitalized temporarily, and still lower ranking to people who work or attend school.

Dr. Lynt Johnson, who runs the liver transplant program at the University of Maryland Medical Center, said it is unusual but not impossible for people with "Status Two" ranking to get livers after spending only a day on the computerized list.

"It occasionally happens," he said. "We don't hear about it because we are not transplanting people who are Mickey Mantle or the governor of Pennsylvania" -- a reference to former Gov. Robert Casey, who received a heart-liver transplant two years ago after waiting less than a day.

"On the average, it generally comes out to three or four weeks or so."

Last year, 3,650 liver transplants were performed in the United States. Of those, 32 percent of the patients received new organs within 30 days of being listed.

Although designed to ensure fairness, the system of favoring the sickest patients remains controversial.

"Some people have questioned whether we should continue the scheme that gives first priority to patients who are sickest and may not have the best outcomes long-term," Dr. Johnson said. "It's a question that we as a society have a hard time answering."

Perhaps, some surgeons say, organs should go first to patients who are not necessarily in desperate need.

"This is a controversial area," said Dr. Andrew Klein, chief of transplant surgery at the Johns Hopkins Hospital. "Patients who are home waiting have shorter hospital recovery times, cost less to transplant and have higher survival. You sometimes have to question whether it's the best thing to treat the sickest patients first. I think there needs to be a compromise."

Patients living near the hospital offering the donor organ get preference over more distant patients. Also people with common blood types such as A and O are more easily matched than those with rare types such as AB. Here, too, Mr. Mantle was lucky. He is a type O.

In most states, people with histories of alcoholism and drug abuse can qualify for new livers as long as they show concrete signs of recovery. In Maryland, such patients must have at least six months of abstinence and membership in a program such as Alcoholics Anonymous.


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