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| BMJ
2000;320:1600 ( 10 June ) Letters Treatment should be available to everyone Peter Byrne EDITOR - In examining the selection process for organ transplantation, Masterston is correct in stating that doctors share the public's prejudice against people with mental illness.1 In a survey of American transplant centres, active schizophrenia was an "absolute contraindication" to transplantation in 92% of cardiac units, 67% of liver units, and 73% of renal units.2 Controlled schizophrenia was relatively contraindicated in 51%, 65%, and 62% respectively. During the first 11 years of a heart transplantation programme in Montreal, 226 transplants were completed and 28 people were denied the procedure on the basis of a psychiatric diagnosis.3 Seven of these 28 people had continuing alcohol or drug misuse, six had non-compliance with treatment, and two each had multiple suicide attempts, borderline personality, "unrealistic expectations," or mental retardation. Interestingly, when the American Psychiatric Association issued a statement on discrimination against its patients, it focused on employment, ignoring discrimination in the health service.4 Orentlicher had previously pointed out that denial of transplantation on the basis of schizophrenia or non-compliance violated the Americans with Disabilities Act.5 Masterston also comments on the increased
mortality (all causes) in people with all mental disorders1
but fails to challenge the medical profession about the
contribution doctors make to these deaths in using
assumptions and value judgments to deny access to
treatments such as transplantation. If an investigation or
treatment is medically justified then it should be available to
everyone, regardless of any psychiatric label.
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