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Liver Transplants for Alcoholics: A Public Debate

If you're an alcoholic you many not get a liver transplant in some casesThe legitimacy and effectiveness of liver transplants for alcoholics has been publicly debated with some merit on both sides of the issue. Unfortunately this debate can lead to the denial or delay of liver transplants for some alcoholics. This is because medical requirements in most cases dictate that an alcoholic must be sober for a minimum of six months before they become eligible for a transplant. But in the case of liver failure or severe bouts of hepatitis, some alcoholics don’t live long enough to meet these criteria. It is especially important that alcoholics understand this troubling issue because a potentially fatal liver-related incident could happen to any active alcoholic.

Why would an Alcoholic need a Liver Transplant? Alcoholism has a crippling effect on the body over time – most notably on the liver and kidneys. This is because it is these organs that must process the toxins in the alcohol and remove them from the blood stream. The human liver is normally adept at handling moderate amounts of alcohol or other similar toxins, but because most alcoholics drink far too much for far too long, sensitive organs like the liver and kidney suffer. In the case of many alcoholics, cirrhosis of the liver and alcoholism-induced hepatitis are two common killers. In order to escape death from these and related conditions, some alcoholics will require liver transplants.

You’re an Alcoholic?  Nope – you can’t have a new Liver.

However, many medical facilities and most insurance carriers require that a patient be free from active alcoholism for six months before a transplant can occur. This is because viable livers are so difficult to come by and waiting lists are long – therefore anyone who could potentially damage their new liver through their own actions cannot be considered until they can demonstrate their ability to abstain. Nevertheless, in a study detailed in the New England Journal of Medicine, the number of patients in this condition are very few and would add only 3% to the total demand for liver transplants. Additionally, the study concluded that;

“Early liver transplantation can improve survival in patients with a first episode of severe alcoholic hepatitis not responding to medical therapy.” (1)

Detractors in this issue are often thought to believe that alcoholism is a matter of choice more than a clinical disease and are therefore against liver transplants for alcoholics because there are too many others who need new livers that don’t drink. But in an article for the Associated Press, Carla K. Johnson quotes the study’s lead author:

“… a strict application of the six-month rule may be unfair to such patients. He said they are just as deserving as other liver patients, many of whom have diseases caused by poor lifestyle choices such as drug use or obesity.” (2)

The only solution for alcoholics – regardless of liver disease – is to seek treatment and stop drinking.  In the event that livers are easily created one day in the lab, this public debate might be put to rest.  But until then, it makes sense that with the limited supply of healthy replacement livers available in the world, people who are at high risk of damaging those potential new livers are not ranked on waiting lists as favorably as people who would not damage them.

References:

(1) The New England Journal of Medicine Early Liver Transplantation for Severe Alcoholic Hepatitis
http://www.nejm.org/doi/full/10.1056/NEJMoa1105703
Accessed 12/29/2011

(2) Johnson, Carla K. Study Stirs Debate over Transplants for Alcoholics Associated Press
http://news.yahoo.com/study-stirs-debate-over-transplants-alcoholics-220225257.html
Accessed 12/29/2011

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