Doctors right to deny girl a transplant

Doctors were right to deny a liver transplant to a 15-year-old girl who had taken the drug ecstasy, a judge ruled yesterday. But Michelle Paul's life might have been saved if she had been given a early test for liver failure.

Giving judgment after an eight-day fatal accident inquiry in Aberdeen, Sheriff Graeme Warner said that doctors at the Edinburgh Royal Infirmary's liver unit made their decision not to transplant Michelle on medical, not moral, grounds despite claims by the girl's mother and grandmother that she had been rejected because of a family background of drug abuse.

But Sheriff Warner criticised doctors at Aberdeen Royal Infirmary, where Michelle was first admitted, for failing to carry out the routine liver- function test. She was transferred to the Edinburgh unit only when her condition deteriorated and it became obvious she was suffering from liver failure. By then it was too late for a transplant and she died on 27 November 1995 - 23 days after taking half a tablet of ecstasy at a rave near her home.

The case aroused controversy over the grounds on which patients are selected for liver transplant after Michelle's grandmother, Margaret Pirie, compared her grand-daughter's experience with that of the former Rangers and England football player, Jim Baxter, a reformed alcoholic who has had two liver transplants. She said doctors had told her the decision had been made on moral grounds because Michelle's mother and sister were drug users and Michelle herself had dabbled in drugs. "As I see it, we were just not worth bothering with," she told the court.

But Sheriff Warner said Mrs Pirie and Michelle's mother, Carolann, were "simply wrong" in their recollection that doctors had told them the transplant was being refused on moral grounds. He said the case showed how memory could be distorted under stress, saying: "This was perhaps the greatest emotional upset they will ever experience".

Dr Hilary Sanfey, head of the Edinburgh unit at the time of Michelle's death who now works in the United States, told the court Michelle had suffered irreversible brain damage and a transplant, costing pounds 60,000, would not have been appropriate on medical grounds. But she acknowledged under questioning that behavioural problems had to be taken into account when considering which patients were suitable for transplant. Her decision was challenged by Professor Roger Williams, head of the liver unit at King's College hospital, London, who said the pupils of Michelle's eyes were still reacting on the day before she died, indicating that she had not suffered irreversible brain damage. He said "moralistic interpretations" that appeared to have underlain Dr Sanfey's opinion were "not acceptable for a life-or-death decision on a young person".

The judgment calls for the formation of an expert gathering of the medical profession to discuss the selection of patients for organ transplantation and the drawing up of a code of practice for all transplant centres. It says an inquiry should be held at Aberdeen Royal Infirmary to ensure routine tests are carried out.