Less than two months after a transplant replaced his cancerous liver, Mickey Mantle is being treated for cancer that has spread to his lungs, doctors said yesterday, reopening questions about the fairness of the transplant process.
Doctors at Baylor University Medical Center said if they had known the liver malignancy had spread, Mantle -- who waited only two days for a donor organ -- would not have received the transplant. But tests done at the time did not show any cancer outside the liver.
"Whenever you have someone with tumor in the liver, we bend over backward to do every test at our disposal, to make sure there is no cancer," said Dr. Daniel DeMarco, Mantle's gastroenterologist at Baylor, adding that the Baseball Hall of Famer got biopsies, a CAT scan and a bone scan, among other tests for possible metastases. "If there is cancer outside the liver, we're not helping much by transplant."
After receiving a system-wide dose of chemotherapy during his several-day stay at the Dallas hospital, Mantle was sent home yesterday, DeMarco said. While doctors had two weeks ago detected a few spots of cancer, ranging from the size of peas to marbles, primarily in Mantle's right lung, the former New York Yankee did not want to go public until yesterday, DeMarco said.
Doctors would not predict Mantle's chances for survival as they had after the initial transplant, when they listed his five-year survival expectancy rate at about 60 percent.
"I think that it's difficult to say at this point," said Dr. Robert Goldstein, Mantle's transplant surgeon. "It's very early and we're rTC still taking it day by day. We are still hopeful that this will respond to therapy."
Goldstein said no spread of cancer had been detected and added that a second patient had been waiting as a backup recipient in case such a situation had occurred.
"If we had found any evidence of cancer outside the liver before we did the transplant, we would have backed out," he said. "Right now what we have is a new problem."
Some medical ethicists and transplant surgeons said yesterday they worry that this development could create a backlash against organ donation, although Mantle's physicians say his case was handled by the book. Mantle, 63, a Dallas resident, is part of a special treatment plan at Baylor to try to improve the survival rates of patients with the same sort of aggressive cancer. Mantle's liver was also damaged by alcohol abuse and hepatitis.
"Every bit of publicity seems bad. It always seems to hurt," said Dr. Roger Jenkins, chief of liver surgery at Deaconess Hospital in Boston. Deaconess does not do transplants in patients with the liver cancer that Mantle had because of the poor survival rate, Jenkins said.
"Philosophically, I don't believe people with this aggressive cancer should be transplanted," Jenkins said, especially since such patients have a median survival of three months.
DeMarco said it will be weeks to months before Mantle's prognosis will be known. Mantle will undergo more chemotherapy.
George J. Annas, professor of health law at Boston University School of Medicine, said he believes there was special treatment in the way that Mantle got on the waiting list for a liver to begin with -- by being referred to Baylor for the special treatment plan for patients with aggressive cancer, which most transplant centers do not offer.
But Mantle's getting the organ after only a two-day wait may very well have been justified by his being the sickest on the list, Annas said.
DeMarco disputed the perception. "Let me emphasize -- we take extra special care of Mickey, just as we take extra special care of everybody who comes to Baylor. He got no special treatment."
Annas said considering the shortage of organs, a larger ethical question may be posed by doing liver transplants at all on patients who, like Mantle, have aggressive cancer.
Nationwide, as of July 26, there were 4,928 people waiting for a liver transplant.
But DeMarco responded, "People with tumors need transplants too. . . . We've got a lot of people alive now who would otherwise be dead."
As for the organ shortage, the best approach is not to minimize the number of people considered good candidates, but to increase donations, DeMarco said.