She won the case, but she died before she knew it.

AFAICS the National scheme allowed her to receive a transplant but a US State apparently broke the Federal law and got caned for it.

FWIW these events ocurred between 28 November and December 8 when the Judge ruled for her- a <2-week period. She died shortly after that.

You need to consider the nature of a liver transplant. First, it's a serious procedure conducted by a highly specialized team for whom there is a waiting list. Second, a liver for transplant is an incredibly precious thing (especially when you consider where it comes from) and there is a huge waiting list- 17,000 people waiting for a liver in the US according to a recent study. When a compatible liver appears, hard decisions have to be made about who will receive it.

This unfortunate woman was very sick with weeks to live, meaning that she might have higher priority assuming that she wasn't already too sick for such an onerous procedure. Even so, had a compatible donor crashed his car or otherwise died suddenly in the 2-week window, there is no guarantee that one of the other waiting thousands would not have been assessed as a better recipient. Even had a compatible relative been found willing and able to donate 55% of their liver for her benefit, still she may not have been seen as the best candidate for the highly specialized surgical team.

Where the state of Vermont seems to have failed is that it didn't have a formal policy relating to liver transplants. Instead it simply declared she was too old. They tried to impose an informal rationing policy rather than using the national rationing policy which is the waiting list. It was a mistake that I doubt they will repeat.

It sounds harsh but you have to wonder whether this poor woman was better using her last days fighting the State of Vermont rather than throwing snowballs with her grandkids or saying goodbye one last time to a tree she first climbed as a 5-year-old. This is the greatest failure of all IMHO. She must have been very, very sick by the time she was admitted with edema.

And what about the 22 year old in Britain who was refused a liver under the NHS?

You mean the unfortunate fellow with alcohol-induced cirrhosis who kept drinking? Of course I feel very sorry for him but it's the same deal, too many recipients and not enough livers, especially when alcohol abuse is an absolute contra-indication for transplant.

Had either of these patients needed an expensive procedure like a hip transplant you can be sure they would have been referred without further ado. Liver transplant is a special case for all the reasons itemised above and there *will* be rationing. Rationing can be as assessed by physicians or perhaps clerks can impose rules or maybe it could be an auction so whoever pays the most wins, but it is going to happen.