Liver Transplantation for Alcoholic Liver Disease

Liver transplantation is presently the only definitive treatment for end-stage liver failure, including alcoholic liver disease (ALD), caused by long-term heavy drinking. The limited number of livers currently available for donation, compared to the number of patients in need of a new liver, has brought into question the donation of livers to individuals with ALD, who came to their current state essentially through their own actions. Should former alcoholics, who have since reformed completely, and who have a good prognosis for a successful liver transplantation, be considered with equal weighting among other patients suffering from end-stage liver disease? It is the contention of this essay that ALD patients should in fact be allowed to compete equally with non-alcohol-related patients currently waitlisted for live transplantation, provided that the necessarily thorough, multidisciplinary screening processes are performed before consideration.

Because it is well known that heavy drinking damages one’s liver, alcoholism is seen as a choice to directly and negatively impact one’s own well-being. This position is contrasted with those who have never done anything of their own free will to inflict harm on their organs, but still have failing livers and the need for transplantation. By simply allowing any alcoholics to be placed on the waitlist, mixed in with non-alcoholic patients, more of the non-alcoholics, who never attempted to harm their livers, will die, while the alcoholics who were above them on the list will get their transplants and survive.

These alcoholics may then proceed with their usual alcoholic behavior, causing damage to their newly transplanted livers, while the patient who would’ve taken care of his new liver dies. For this reason, simply allowing anybody with ALD onto the waitlist should be frowned upon. This belief seems to be held by most everyone. Instead, it is suggested that ALD cases for transplantation be restricted to specially-screened individuals-those who have abstained from drinking for a specific period of time, and for whom all tests indicate a high prognosis for successful transplantation and a successful, alcohol-free life afterward.

The question as to whether or not abstinent alcoholics, who would most likely not harm their livers after a successful transplantation, should even be allowed on the waitlist has been the center of debate for quite some time. While they have no intention of future harm, they did physically choose to destroy their original livers, thus placing themselves in the position to need a transplant. Because this choice was made, regardless of the addictive and socially-accepted nature of alcohol, waitlist preference should still be allocated to those who never actively harmed their organs, so as to not promote alcoholism. Rather than prevent abstinent alcoholics from ever being waitlisted, it might be preferred for them to be placed at the bottom of the current waitlist, sorted by screening results and prognoses for healthy transplantation and future success.

Others may argue that this waitlist sorting method will not matter, because there are so many individuals waiting for livers, and so few donor organs available, that those near the bottom of the list will be dead before they can ever hope to have a transplant. While this is true, it may not be realistic. Only 13% of waitlisted individuals have liver disease as a result of non-alcoholic circumstances. While this fraction is still much larger than the livers available, ALD patients should still be given a chance, even if it is small.

With increased donations, the hopes for even ALD cases will increase. Some may argue that the number of donor livers will decrease if ALD cases are allowed onto the waitlist. It is claimed that people will see it as a waste, because their liver will just go to someone who will destroy it anyways. Thus, it would seem, the number of donors will decrease, negatively impacting non-ALD patients waiting for transplants.

This claim seems very wrong, however. Firstly, we cannot know for sure how the public would react. Since the only other option, besides donation, would be for the liver to remain in the original individual’s dead body, it would seem odd for that person to claim that they wouldn’t give it up because it would be “wasted”. It is doubtful that that would be a cause for their concern. Rather, the situation might illicit an increase in the number of donors, for similar reasons. The public may see the fact that ALD cases are getting livers as a cause for alarm, in that there is a shortage of available livers, and feel compelled to become organ donors, thus increasing the hopes for non-ALD as well as ALD cases. It may even be feasible to allow donors to decide ahead of time whether they want ALD patients to have their livers, provided that a non-ALD patient is also waiting for one. In this way, the most control will be given to the public, calming possible fears about donating, and increasing the number of available livers.

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