Failing livers, anticipated futures and un/desired transplants

Abstract

This article looks at liver transplants as life-prolonging treatment for chronic liver failure and examines the role anticipation plays in the context of chronic liver conditions. Based on anthropological fieldwork in Germany, this article draws on three exemplary patient accounts to show how the anticipatory experience of waiting for a liver transplant serves as an important period in transplant trajectories, and how the lack of a wait may have long-term consequences for patients’ wellbeing. A focus on waiting and anticipation in the context of chronic livers enables new understandings of the complex temporal qualities that living with chronic conditions entails. As the sole long-term treatment available for failing livers, the possibilities of transplant medicine shape patients’ anticipation of their future. Conversely, the particular futures that patients anticipate mould how they make sense of their transplant and their chronic pre- and post-transplant lives. This article shows that rather than offering a unilinear treatment with a clear-cut end, liver transplants, as treatment for a wide range of chronic conditions, reproduce chronic lives.

Keywords:

• Liver transplants
• anticipation
• waiting
• chronicity
• Germany

Acknowledgements

I wish to thank the anonymous reviews for their constructive feedback on earlier versions of this article, Steph Meysner for her valuable comments and Julene Knox for her amazing editing skills. Special thanks to all who shared their valuable time, stories and experiences.

Ethical approval

Ethics approval was granted by the University of Leipzig (301-15-24082015).

Disclosure statement

There is no conflict of interest arising from the publication of this research.

Notes

1 For more details on the wait list see Rehsmann (2021), where I discuss the invisible but powerful workings of the wait list and its allocation algorithm.

2 All names have been anonymised by the author.

3 Linda Hogle (1999) has also pointed out the differences in clinical practices and structures among German hospitals in her ethnography on organ donation.

4 Similar to the possibility of donating one kidney during one’s lifetime, it is possible to donate parts of the liver before death. Nonetheless, as this procedure is significantly more invasive and riskier than the removal of one kidney, the possibility of living liver donations is neither promoted by the Ministry of Health and other organisations involved with organ donation, nor is it usually suggested by transplant doctors as it poses a significant health risk to the donor.

5 See also Mona Motakef’s (2011) book on organ donation in Germany.

6 Anna suddenly looked ‘pregnant again’ due to ascites, an excess of fluid caused by liver failure, which may lead to up to fifteen litres of water being retained in the abdomen and legs, causing pain, discomfort and breathlessness (Runyon 1994).

7 On organ failure and transplants as ‘will’ or ‘trial’ of God (from an Islamic perspective) see Sherine Hamdy’s ethnography (2012) on organ transplantation and donation in Egypt.

Additional information

Funding

The research was funded by the Swiss National Science Foundation (project number 149368 and 175223).