Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you so much for this thoughtful reply, I'll try to clarify on some of the things you mentioned. I'll try to be as concise as possible.The cause for the liver failure is alcohol abuse, unfortunately.2 weeks prior to March 5th I saw my sister and she looked healthy. She had been complaining about UTI pain and she told me she saw a doctor and got antibiotics, I told her she needed to go back if she's in pain still since it could spread to her kidneys and she said she would. She never did either of those things, so that bladder infection I'm sure, is a result of a long standing infection. She didn't look jaundice two weeks prior, she has always been a drinker, however until this happened unfortunately I don't think anyone (in the family) knew just how bad it got. Apparently she was drinking very very heavily the week/2 weeks prior to collapsing. We didn't hear much from her the week prior to the hospital, her boyfriend told us she was trying to kick alcohol and wasn't feeling well. I honestly can't tell you exactly how things got to the point that they did, as she was living with her boyfriend at the time. I certainly have my own questions as to why it took her collapsing on the floor yellow as you wouldn't believe for him to get her to the hospital... But that's another story and something I'm trying to think about right now.I'm guessing her reason for not getting a spot on the transplant list is either due to your #2 or #3. We were assured when they first started speaking to us that alcoholics are eligible for liver transplants if they feel they are a good candidate, and they thought she was. We went through 3 separate interviews. We just got the news she was denied via letter in the mail just yesterday.She has a follow-up appointment via video call with a liver doctor on Wednesday.I've talked to my mom today about how we need to set up a POA. We didn't think she was going to make it while she was in the hospital/when we could still visit, so while my mom was acting as her advocate, nothing legal has been set up yet. I agree, that needs to be done asap.I forgot a couple things in my original post about how she was considered to have sepsis due to the infection, and she had aspiration pneumonia. Not sure if that's relevant at this point. I'm just taking with my mom rn were trying to make sure we're including as much info as we can remember.Your summary sounds very much on point, and that's kind of where I'm at. Do we take her to the ER? Do we wait until her video call on Wednesday? I can't figure out why she was discharged, and I don't feel like we were armed with enough information about her current condition before she was discharged and were confused on what to expect, what were working with, etc. She's currently in a lot of pain, she's not very alert today, she does have dialysis tomorrow. I'm just so confused lol.Thank you for your help, I'm trying to prepare for what my next move is going to be, everything has been so confusing having COVID19 thrown ontop of all of this. I do feel like this lack of communication wouldn't have happened before all of this, and it's just been confusing trying to figure it all out. She came back to us very very sick, and I just have so many questions.. ### Response: Sorry that you and your sister are in this situation, but for this extra information and the long standing alcohol dependency/usage, it sounds like she was denied on that basis. Yes, there are circumstances that can alcoholics can get listed but transplants are reserved for candidates that can make use of their own life and the life of the person whose liver is being transplanted. In other words, it isn't just her life that they are considering. The decision to offer or deny someone a transplant is not a light decision, it involves a whole committee that looks at all aspects of the patient being considered. They look at the usual age, sex and medical history, but also socioencomic history, psychiatric, social structure and support. They usually require a certain number of months of sobriety and vigorous compliance to AA, follow-ups, medications, etc before they can seriously consider any candidate as there is nothing worse than transplanting someone, and that person end up going back to old habits, get lost to follow-up and wasting a healthy transplant that could have gone to someone else. However, just because she was denied now, does not mean she cannot become eligible later.Long standing alcohol consumption can lead to eventual liver failure, and any binges on top of that can throw someone into fulminant hepatic failure and the resultant complications, which sounds like the situation your sister is going through.Unfortunately, she is very, very, very sick and her condition is unlikely to improve dramatically, and she will have more setbacks along the way or she may have an abrupt decline, even while waiting for a transplant. Failed livers have a very high chance of more bad things happening, even with the best therapies and intent. If she is not doing well, such as she is having increased confusion, or unable to be aroused, fevers, gastrointestinal bleeding, I would bring her back to the ER where they evaluated her for transplant (the large hospital, sounds like an academic hospital), if you can. If she cannot make it to the hospital where the transplant evaluation is possible, the closest ER will do, they can stabilize her and decide what to do once she is stable.Hoping for the best! Let us know if you have any more questions..