Article on whether alcholics need to abstain for six months to be considered for liver transplantation

I read this interesting article and wish to share it with you. A woman who wished to donate part of her liver to her alcoholic husband was denied from doing so despite being a possible match. He died two weeks later. Now she is fighting the restriction that resulted in the decision, namely that alcoholics are required to abstain from alcohol for six months in order to be eligible for liver transplantation.

The link is:

http://www.msn.com/en-ca/news/canada/widow-of-alcoholic-denied-liver-transplant-fights-%E2%80%98six-months-sober%E2%80%99-policy/ar-AA8uSNh?ocid=mailsignoutmd

Previous to this article, I have imagined how unfair it would be if I had to compete for a liver transplant with alcoholics and people with fatty livers from overeating. I've lived a sober life, exercised, and eaten properly. It would seem so unfair.

It makes me angry when I see people abusing their livers, whether they are alcoholics or not. Any thoughts?

Like you, I have thought about this a few times previously in relation to other forms of treatment like gastric by-pass surgery for the obese, liver transplants for alcoholics etc. and I have to say there positives and negatives on both sides that need consideration. I don't believe there can be a one size fits all type of rule applied here.

There are number of different points raised in the article that are worth thinking about...

1. The man was alcoholic, his Mrs. was a match and she was willing to be a living donor in this instance. We don't know if she was on the donor list otherwise. We don't know that, had she not donated her liver here then, she would definitely have donated her organs later in life. On the other hand, had she been given the option of saving her husband's life, the experience may have turned her into a strong advocate of organ donation. And we all know how important that is.

2. The man had already abstained from drinking for six weeks. How serious was his condition? Does this suggest he didn't have six months to prove himself? Isn't a blanket six month rule a little harsh without considering the overall picture. I feel that the Mayo Clinic style of assessment of the patients illness, their support structure, willingness to change is far better and fairer.

3. I've never suffered any form of addiction in my life so I don't really know how it feels. But I am sure that people who have would state that it's not easy to go from being addicted to teetotal overnight and maintain that without a relapse for six months. That takes some strong willpower and a lot of support. In an ideal world they wouldn't be there in the first place.. but we all know the world isn't ideal. How can we deny someone the right to help their 'own partner'.

In the UK we get free healthcare so I do agree with your comment somewhat. if there was a choice of giving a DDT to an individual who has knowingly abused their organ OR one who is a need of an organ donation due to no fault of their own then I would like to believe the organ would go to the latter. I wouldn't be comfortable for tax money and the gift to go to someone who is in that position due to their own actions. But I wouldn't have any problems if they found their own living donor and were willing to pay for the treatment. I think that choice should be left to the living donor.

As he died in November, 2010, the same year in which he was diagnosed, it would appear his condition was serious. The diagnosis must have seemed a surprise to them, but not to anybody who knows what drinking can do to a liver. It's a shame he wasn't diagnosed sooner.

In the article, a reasonable comparison is made to people with Hepatitis C who get new livers, and in whom the virus recurs. Arguably, PSC can also recur in a transplanted liver of a PSC patient. The moral distinction would seem to be that recurrence of PSC and Hepatitis C are beyond one's control. But drinking is within one's control. Hard as it may be, the motivation to abstain came for this man when he realized his death would otherwise ensue. He was able to abstain for six weeks. I don't believe alcoholism is a disease, because otherwise he couldn't have stopped the disease for six weeks. However, I agree that it would be as hard for me to stop scratching when I'm itchy, as it would be for him to stop drinking.

The trouble is that livers ARE precious organs and many people need those livers. There are better and worse donor livers. Perhaps, the worse ones (from older, overweight smokers etc.) could go to the alcoholics since they weren't too worried about liver quality when they were drinking their livers away. You can see the ethical challenges!

Or perhaps, alcoholics need to be screened early, and regularly for liver disease so they can be diverted from the transplantation route.

I think about it ALL the time! A friend of mine feels terrible knowing that “our group” will struggle to even get one when her uncle is on his 2nd transplant from being an alcoholic- tho I understand it is considered a “disease” I struggle with that label when it’s still by a “choice”! I know a few who drink heavily bragging on how their blood tests come back all in normal ranges so guess it’s ok to drink… :frowning:

Very interesting - I did not read the article you posted yet, but my first question would be how could somebody tell if you've had one drink in the last 6 months? I could see putting someone lower on the transplant totem pole, so to speak, if they are found to be creating or contributing to their issue by their own choosing on the basis of fairness. I have concerns about medical staff though. I've encountered some absolutely incompetent medical professionals who tell you to do whatever you want, you're going to die anyway (yes, that's what was said, I so wish I could have recorded that) and to see a patient suffer from their ignorance would be abhorrant. Not saying that's what happened here, but when we're talking life or death, I guess I just hope that there's more to the situation. Very thought provoking!

Interesting! I learned something new today! I do not drink heavily (glass of wine with dinner, maybe once a month) and was unaware of GGT levels. I centered on abstain, or completely refrain, not knowing how much damage this particular person had done to themselves. Considering the other restrictions we place on the consumption of alcohol, I can certainly see transplant considerations being within the reach. Again, great topic!

It is my understanding that partial liver transplants do not solve the problem of PSC..

If I am wrong I stand corrected.

Adrian

Living donor transplants from genetic family members tend to have a higher recurrence of PSC when compared to living donor transplants from spouses/friends or from cadaver livers. That said, this does not mean there is a guarantee that PSC will return, only that the chances are greater that it will recur in a genetically similar liver.