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Should Alcoholics with Liver Failure Receive Liver Transplants?

Posted Nov 11 2011 12:00am

Here's an interesting question. Should alcoholics with liver failure be candidates for liver transplants, some of which will presumably paid for by health insurance or public funds? A recent article raised this controversial topic (see: Liver Transplant Can Give Some Alcoholics a Second Chance, Says French Study ). Below is an excerpt from the it

More than 16,000 Americans are waiting for a liver transplant, according to federal data from the Organ Procurement and Transport Network. Only 6,000 organs are available a year and nearly 2,000 people will die waiting for one to become available. Should [an alcoholic] who is committed to abstinence from alcohol and has the family support to keep his promise, be allowed an early transplant, before his liver is fatally scarred by cirrhosis? Even as thousands of others who have not abused their bodies with alcohol or drugs await a new liver....Now, a new study by French researchers...concludes that early liver transplantation can improve survival in patients with a first episode of severe alcoholic hepatitis who aren't responding to medical therapy. A six-month abstinence from alcohol is usually required before patients with acute alcoholic hepatitis are considered for liver transplantation, but some doctors want to rethink the rule. Only 30 percent of those who do not respond to treatment live beyond six months and most die within two months, according to the study....With supportive families, no other severe medical conditions and a commitment to future abstinence, patients can do well, the study revealed. But study authors say that although early liver transplantation is "attractive," many doctors are reluctant to treat patients with alcoholism because they are "responsible for their illness" and are likely to resume drinking....Up to 70 percent of all alcoholic hepatitis patients will develop cirrhosis, a scarring of the liver that is a major cause of death in the United States, according to NIAAA. But those who stop drinking can have a complete recovery from alcoholic hepatitis and a liver transplant can save their lives.

I admit to feeling very ambivalent about this question. Ideally, moral judgements should be withheld with regard to medical treatments, perhaps even the more heroic ones. On the other hand and as noted above, there is a waiting list for liver transplants so that this organ supply issue needs to be taken into consideration when answering the question. Also significant is the high rate of recidivism among alcoholics. I am not sure that a six-month test of sobriety is adequate. However, an early transplant for patients with alcoholic cirrhosis seems to greatly enhance their chance of survival. This is truly a controversial issue with no easy answers. One thing that I am sure about is that the choice should not rest solely in the hands of transplant surgeons who like to operate. Left to their own devices, they may be inclined to rationalize about their selection of patients. This whole question needs to be addressed, in part, as a mater of public policy with special attention to the availability of livers for organ transplant.

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