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Should Alcoholics Get Liver Transplants?March 1, 2009

Posted Nov 04 2009 10:02pm 2 Comments

This is a “think piece.”   I’m hoping this blog will challenge your thinking and cause you to comment.   I am taking no position on this issue, I am simply asking some very important questions.


Heavy drinking or alcoholism can severely damage our organs and the liver seems to be the most susceptible to such damage.   So – if you were to ask the average person if alcoholics should be eligible for liver transplants the answer would likely be a resounding, “NO!”


As with most things in life, though, nothing is that simple.   If transplant eligibility depended on us living healthy lifestyles then there would be no organ shortage because few people would qualify for the life-saving procedure.


According to a study, published in the April 25th edition of the Archives of Internal Medicine, led by Mathew J. Reeves who is the lead researcher and epidemiologist at Michigan State University, only 3% of Americans lead a healthy lifestyle.   Reeves says a healthy lifestyle that includes not smoking, maintaining a healthy weight, regular exercise and a diet containing lots of fruits and vegetables lessens the risk of developing diabetes, cardiovascular disease and cancer.


Back to the question on heavy drinking and liver transplants.   Just what is heavy drinking?   You may be surprised to learn that population-based surveys indicate that 68 percent of adult Americans drink at least one alcoholic beverage per month. About 10 percent consume more than two drinks per day, which is a commonly used definition of “heavy drinking”.   Two drinks a day!

Let’s ask the question again, “Should alcoholics or heavy drinkers be eligible for liver transplants?”   Well, I am an alcoholic and had a heart transplant eighteen months ago.   It Is likely that my alcoholism contributed to the disease that destroyed my original heart.   I quit drinking in 1982 and have had no relapses but I am an alcoholic and always will be.   Should I have been denied a transplant?

Should the obese person suffering from diabetes be denied treatment?   Driving too fast is one of the top killers of American men, should the person with a speeding record be denied a transplant because they are likely to kill themselves?   What about people who have anorexia, bulimia and other lifestyles that could be considered self destructive?   Should prisoners be denied transplants even though they might someday be released?   I fear that once we go down this road it is unlikely we would treat or transplant anyone.  

I am not trying to justify transplanting livers into practicing alcoholics, but if you accept the American Medical Association (AMA) position that alcoholism is a disease, should the patient be punished because of it?   Do we punish cancer patients because they have cancer?   There is a school of thought based on limited research that suggestsa liver-transplant recipient was statistically more likely to reject a new liver than to destroy it from continued drinking.   The fact is that most transplant programs around the world require at least six months of alcohol abstinence before they will consider a transplant.   But if two drinks a day is heavy drinking, the average person may be only a few drinks a week away from being a member of that group.  

I began by saying that this is a “think piece.”   I wrote it because I want to hear from you.   Where do we draw the line on who is and who is not eligible for a transplant?   The medical community has some solid guidelines, for example cocaine use in most cases will automatically eliminate a person from being considered for a transplant.   The public however, as was evidenced in the Mickey Mantle case, may not agree with the medical professionals.   What do you think?   Being as there is a shortage of organs and thousands die each year because of it, should we more severely limit who is eligible for a transplant?    

Please comment here or email your comments to me at  


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Comments (2)
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i understand your article but what happens if 2 people needs a liver and one of them is an alcholic and the other is healthy (they are both a match to the organ and there was no first comes first serves policy). who would recieve the liver?

Ah...good question.  I am sure the situation you describe has happened many times in the past and I'm just as sure that if the alcoholic in question has been in recovery for a time and has not relapsed that he/she would be treated the same as any other patient.  When you say, "They are both a match" the implication is that matching organs to reciipients is a simple process.  It isn't.  There are many criteria involved in deciding who gets an organ and we have to hope that people far more qualified than us make the decision based on those criteria rather than whether one of the would-be recipients is an alcoholic.

The fact is, though, there should be no need for medical professionals or organ recipients to face this situation.  If every person became a donor and if we "tweaked" the system a little, everyone who needs an orgqn would get one.

Thank you for your thoughtful comment and excellent question.

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