Gravely Ill Mantle Gets New Liver; Doctors Optimistic : Health: Officials say need, not the baseball great’s wealth and fame, was key reason for giving him quick transplant.

Baseball great Mickey Mantle was given an excellent chance for recovery after his diseased liver was replaced Thursday during a 6 1/2-hour transplant operation at Baylor University Medical Center in Dallas.

“Everything went very, very well,” said Dr. Robert Goldstein, the lead surgeon. “He now has an excellent chance for recovery. The liver seems to be functioning, and that’s the key to immediate postoperative recovery. He’s very stable, but still critical.”

Goldstein said that Mantle, severely jaundiced and stricken with liver cancer, had two to four weeks to live had he not received a new liver. He said the condition was caused by a lifetime of heavy drinking and a hepatitis-tainted blood transfusion, possibly decades ago after an athletic injury.

The 63-year-old Mantle, a former New York Yankees center fielder and member of baseball’s Hall of Fame, is expected to remain in intensive care for 24 to 48 hours and to be hospitalized for two to three weeks. He entered the hospital May 28 complaining of stomach pains, but his condition worsened to the point that he could neither sit up nor speak at the time of his surgery, Goldstein said.

The drama surrounding Mantle’s rapidly deteriorating medical condition and the quick match of a donor liver has rekindled a national debate over the role that celebrity or money plays in organ transplants.

Underscoring the debate were questions raised about Mantle’s age and his history of alcoholism and severe medical problems.

Mantle went on a national waiting list for liver transplants Tuesday, according to Alison Smith of the Southwest Organ Bank, a federally certified nonprofit agency that coordinates organ donations in the Greater Dallas area.

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Although the normal waiting period in the transplant program is 130 days, Smith said, patients as critically ill as Mantle, who was classified as Status 2, the second most urgent status, receive transplants within an average of three days.

The organ bank said that 141 people were waiting for transplants in the Dallas region along with Mantle, but the former ballplayer was the only Status 2 level patient who matched the organ donor in blood type, height and weight.

“When a patient is admitted to the hospital and is suffering as severely as Mr. Mantle, that candidate is given priority because of their extreme need to be transplanted as soon as possible,” Smith said. “This is standard practice here and throughout the nation, regardless of age, gender, race or social status.

“His . . . condition was worse than any other recipient we had listed from the local area,” Smith said. “I’m sure there will be people who refuse to believe there wasn’t some special consideration given because of who he is, but that [was] not the case. He was the sickest person with blood type O in the weight range.”

The donor who provided Mantle’s liver also donated six other organs to five other people, doctors said. The donor’s identity was not revealed and will remain secret unless that person’s family and Mantle’s family agree to publicize it.

David Mantle, one of the Hall of Fame ballplayer’s three remaining sons, said that “later on, down the line, we’d like to meet them. There’s always that curiosity, but it will probably take time for them. We lost a brother just over a year ago, so we know it takes time. We’re really grateful and thankful.”

Doctors said the surgery appeared to remove all of the cancer and that Mantle’s kidneys responded to the new liver immediately. The kidneys rid the body of waste after receiving the waste from the liver.

“The first year survival rate at Baylor is 85%,” said Dr. Goran Klintmalm, head of the transplant institute at Baylor, adding that the odds might be slightly lower in Mantle’s case because he is older than most transplant recipients. “Over five years it’s 70%, and over 10, it’s 65%.”

Mantle was the centerpiece of the Yankee dynasties of the 1950s and ‘60s. He hit 536 home runs to rank eighth on the all-time list and holds the World Series record of 18. He was a three-time winner of the American League’s most valuable player award.

The surgery took place on the 26th anniversary of the day his No. 7 uniform was retired by the Yankees.

Mantle had been sober since entering the Betty Ford Center for treatment of his alcohol abuse in January, 1994. He and drinking pal Billy Martin, a former Yankee teammate who was killed in an alcohol-related car accident, had often needled each other as to whose liver would fail first. Mantle liked to say that if he knew he was going to live until he was 50 he would have taken better care of himself.

His father died at 41 from Hodgkin’s disease. A grandfather and two uncles died of the same lymphatic cancer before they were 40. One of Mantle’s sons, Billy, also had a long struggle with the disease before dying of a heart attack last year at 36.

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The questions about whether he should have received the potentially lifesaving transplant have been raised, despite Mantle’s popularity with the public as well as his long battle to overcome a series of disabling injuries and medical problems.

But they are questions that go on every day within medical circles.

In 1994, 3,650 liver transplant operations were performed in the United States, according to the United Network for Organ Sharing, the Richmond, Va.-based computerized organ sharing agency. There is a waiting list of 4,657 patients.

Every day, eight to 10 people die waiting for a heart, liver or other organs, said Elizabeth Flynn, director of community affairs for the Regional Organ Procurement Agency of Southern California, a group affiliated with UCLA Medical Center. “We are currently experiencing a severe shortage of donated organs and tissues,” she said.

With those mortality rates, each organ transplant assumes a huge importance. In addition to questions raised about the top priority given to finding Mantle a liver, others were raised about giving a transplanted liver to a longtime alcoholic.

Flynn said she heard the same complaints when the university gave rock musician David Crosby a liver transplant in November. Crosby also had a history of admitted alcohol and drug abuse.

“If they had been a mechanic from down the street, nobody would be arguing about this,” Flynn said.

She said the question about whether alcoholics should be given new organs “comes up quite often, but . . . it doesn’t give us the right to sit in judgment and say, ‘No, you don’t get a second chance.’ ”

Doctors at Baylor indicated that they considered Mantle’s long history of alcohol abuse, but said the former ballplayer had been sober since he checked himself into the Betty Ford Center in 1994.

But biomedical ethicists openly wonder if special rules are made for the celebrities and the well-to-do such as Mantle and point out that the ballplayer was the beneficiary of a health care system that responds quickly to those with financial resources and denies it to those who are less fortunate.

“The biggest barrier and greatest unfairness in the transplant program is funding,” said Alex Capron, director of the Pacific Center for Health Policy and Ethics at USC. “If you don’t have a couple of hundred thousand [dollars] or an insurance plan that would pay for a transplant, you don’t get in the front door, and you don’t get on the list.”

Dr. Arthur Caplan, a University of Pennsylvania bioethicist, said that Mantle, because of his critical health status, met all the criteria for a transplant.

But he said the baseball Hall of Famer was part of a relatively select group in America--those who have insurance or the ability to pay for a $250,000 to $300,000 transplant.

“Americans are very strongly committed to trying to rescue people from death’s door,” he said. “We are less likely to admit that there are lots of people, millions of them, who can’t even get to the door of the hospital.”

Caplan, along with other experts interviewed, said he did not believe that the rules of the national organ transplant program were bent for Mantle. “Right now, the system rewards the sickest, and he is undoubtedly a very sick man,” Caplan said.

“As long as you have an organ shortage, you will have a debate on who gets them and who doesn’t,” said Jim Warren, editor and publisher of Transplant News, a national organ transplant newsletter. “It all comes down to being as fair as you can in allocating a scarce resource.”

He said the trickiest part of the Mantle transplant was giving it to the former baseball player in light of his other serious medical problems. He said other potential recipients had been turned down because they had liver cancer that may have spread elsewhere in the body. In Mantle’s case, doctors believed that the cancer was confined to the removed liver.

Steve Miles, of the University of Minnesota’s Center for Biomedical Ethics, said that although the issue is debated, society does not appear ready to begin denying health care on the basis of personal responsibility.

“If you smoke and get lung cancer, you get treated for lung cancer. If you ski and break a leg, we treat your broken leg,” he said.

Times correspondent Carol Smith and Associated Press contributed to this story.

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How It’s Done

Three-fourths of liver transplant recipients survive for a year, at which time the risk of rejection or other complications drops sharply. The success rate for this transplant is better than that of heart, lung or kidney transplants.

The Operation

1. Once the liver removed, surgeons connect the upper and lower ends of the recipient’s vena cava, the principal vein that returns blood from the lower half of the body into the heart, to the vena cava of the donor organ.

2. The portal vein, which drains blood from the recipient’s intestinal tract and spleen, is attached. Next the artery that supplies blood to the abdominal area is attached.

3. The final steps include connecting the gallbladder by linking the bile ducts. Ligaments are then attached to hold the organ in place.

Sources: Atlas of Organ Transplantation, The Surgical Technologist