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Alcohol & Liver Transplant Rejection

For many patients with end-stage liver disease, cirrhosis and liver cancer, a liver transplant is the only option. Alcohol use, however, may compromise a patient's ability to receive a liver transplant. A liver transplant rejection may occur for an active alcoholic patient, and candidacy for the transplant presents a controversy.

  1. Significance

    • The American Medical Association confirms that, as of 2010, there is still a significant shortage of organ donors, and a substantial difference between the number of patients waiting for transplants and the number of organs available for surgery. This is why a waiting list exists for patients in need of a liver transplant.

    Alcohol and the Liver

    • The liver is the organ responsible for metabolizing alcohol, hence its fragile vulnerability to alcohol abuse. While some liver conditions are hereditary and unrelated to alcohol or drug abuse, alcohol abuse is strongly associated with liver disease, as it causes hepatitis, cirrhosis, chronic alcoholic and end-stage liver disease, and liver failure.

    Qualifications

    • Patients in need of a liver transplant must be prioritized on the waiting list, and while the basic criteria (urgency, chance of success and future health) are universal, each medical organization may apply its own screening method for "numbering" patients. Active alcohol abuse or abstinence from alcohol affects a patient's qualifications for a transplant.

    Considerations and Controversy

    • Even with a more immediate need during disease progression, patients with a history of alcohol abuse and who demonstrate active alcoholism are considered transplant risks or are rejected alongside patients with no history of alcohol abuse, because the alcoholic patient is seen as being the cause of his condition, continuing to contribute to it, and, thus, will likely damage the new, transplanted liver. The controversy lies in deciding who "deserves" the new liver.

    Argument

    • The Council on Ethical and Judicial Affairs (CEJA) released a report published by the American Medical Association that points out there is no way to pinpoint the exact contributing factors for dangerous liver disease (i.e., a heavy drinker of 12 years may have developed cirrhosis because of hereditary factors).

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