Should Alcoholics Get Liver Transplants?
This is a “think piece.” I’m hoping this blog will challenge your thinking and cause you to comment. I am taking no position on this issue, I am simply asking some very important questions.
Heavy drinking or alcoholism can severely damage our organs and the liver seems to be the most susceptible to such damage. So – if you were to ask the average person if alcoholics should be eligible for liver transplants the answer would likely be a resounding, “NO!”
As with most things in life, though, nothing is that simple. If transplant eligibility depended on us living healthy lifestyles then there would be no organ shortage because few people would qualify for the life-saving procedure.
According to a study, published in the April 25th edition of the Archives of Internal Medicine, led by Mathew J. Reeves who is the lead researcher and epidemiologist at Michigan State University, only 3% of Americans lead a healthy lifestyle. Reeves says a healthy lifestyle that includes not smoking, maintaining a healthy weight, regular exercise and a diet containing lots of fruits and vegetables lessens the risk of developing diabetes, cardiovascular disease and cancer. http://www.qualityeldercare.com/healthy.html
Back to the question on heavy drinking and liver transplants. Just what is heavy drinking? You may be surprised to learn that population-based surveys indicate that 68 percent of adult Americans drink at least one alcoholic beverage per month. About 10 percent consume more than two drinks per day, which is a commonly used definition of “heavy drinking”. Two drinks a day! http://www.enotalone.com/article/11240.html
Let’s ask the question again, “Should alcoholics or heavy drinkers be eligible for liver transplants?” Well, I am an alcoholic and had a heart transplant eighteen months ago. It Is likely that my alcoholism contributed to the disease that destroyed my original heart. I quit drinking in 1982 and have had no relapses but I am an alcoholic and always will be. Should I have been denied a transplant?
Should the obese person suffering from diabetes be denied treatment? Driving too fast is one of the top killers of American men, should the person with a speeding record be denied a transplant because they are likely to kill themselves? What about people who have anorexia, bulimia and other lifestyles that could be considered self destructive? Should prisoners be denied transplants even though they might someday be released? I fear that once we go down this road it is unlikely we would treat or transplant anyone.
I am not trying to justify transplanting livers into practicing alcoholics, but if you accept the American Medical Association (AMA) position that alcoholism is a disease, should the patient be punished because of it? Do we punish cancer patients because they have cancer? There is a school of thought based on limited research that suggests a liver-transplant recipient was statistically more likely to reject a new liver than to destroy it from continued drinking. The fact is that most transplant programs around the world require at least six months of alcohol abstinence before they will consider a transplant. But if two drinks a day is heavy drinking, the average person may be only a few drinks a week away from being a member of that group.
I began by saying that this is a “think piece.” I wrote it because I want to hear from you. Where do we draw the line on who is and who is not eligible for a transplant? The medical community has some solid guidelines, for example cocaine use in most cases will automatically eliminate a person from being considered for a transplant. The public however, as was evidenced in the Mickey Mantle case, may not agree with the medical professionals. What do you think? Being as there is a shortage of organs and thousands die each year because of it, should we more severely limit who is eligible for a transplant?
Please comment here or email your comments to me at bob@baronson.org.
Please read and comment on my World Wide Issues blogs on http://blogsbybob.wordpress.com. Also…visit and join my Facebook site, Organ Transplant Patients, Friends and You at http://tinyurl.com/225cfh OR — my Facebook home page http://www.facebook.com/home.php
Posted on March 1, 2009, in Alcohol. Bookmark the permalink. 62 Comments.
Bob's NewHeart 
My older brother is an alcoholic who has just been diagnosed with cirrhosis. This is his 4th time in the hospital for his alcoholism. He also has pancreatitis. I don’t know if he will live long enough and stay sobber, to get any transplants, or is even eligible? does he deserve one as an alcoholic? Let me begin with a little of his history. His alcoholism began when he was a police officer, he came across an accident where the mother, (driving while drunk) killed 2 of the children and herself in the car, while looking in the car he heard a baby crying barely alive, he took it in his patrol car, to the nearest hospital where it soon after died. My brother didn’t come out of his room for a week and from then on his attempts to drowned out the pain began. His drinking destroyed his 20 year marriage, he lost his job, is losing all he owns.
Does he deserve a second chance if possible?
In a heartbeat, I would donate a partial liver to him but I am adopted and don’t know if I can….
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I am so sorry to hear about your brother.Having suffered as an alcoholic I can identify with his pain and his disease. If he is still using and needs an organ he likely will be turned down. Most transplant centers will only consider a transplant if an addicted person has been drug and alcohol free for at least six months and can prove it. Please encourage him to quit..help is available and he can quit using. If you think it would do any good I would be most pleased to talk with him about my alcoholism, how I quit drinking 31 years ago, how I stayed sober and how much my life has changed for the better. I can be reached at bob@baronson.org.
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I’m a nurse and read all the comments. I have alcoholics on both sides of my family. I drank heavily and often in my 20’s. I knew what would happen, so I stopped. I stopped gambling too. While I may be predisposed to addictive behavior I was able to stop it. It was a choice for me, just like taking that first drink. Had I not stopped I’m sure I’d have some sad story about how sorry I was an how I’ll treat a new organ better, how it wasn’t really my fault. There are certain activities or choices that are worse than others. In my opinion 6 months doesn’t show a lifestyle change. Is it hard? Yes, but I don’t think it shows dedication. We all make choices in life and need to deal with the consequences.
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I think you put it perfectly. Only 3% of the population are really health conscious. My mom hadn’t had a drink in 4 years, had alcoholic hepatitis which turned into cirrhosis. She received a new liver within a year at U of M and died of liver cancer 9 months later. She lived only 10 days after finding out she had the cancer. I am still grateful she got that liver & I am an advocate for 2nd chances but I do have to say that if it is clearly evident that a patient will not quit drinking I’m not so sure it shouldn’t be saved for another patient. This is a good thinking question.
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I am a 58 year old female and have just been diagnosed with cirrhosis by a gastro doctor at a major HMO, using ultrasound, CT scan and clinical presentation. A second opinion at the HMO provided me with a similar diagnosis. The last doctor said I have a 30% chance of dying within the year. I had been previously diagnosed with fatty liver, since year 2000. I have a spotty past with alcohol, consuming more during most of my 20’s and 30’s – (average 2 drinks/day) . I did not drink in my 40’s and went back to having an average of 1 drink a day during my 50’s. I have had no alcohol for at least the last 4 months.
My doctor has decided that I am an alcohol abuser and says I must go to AA or a certified substance abuse counselor for six months before being considered for a liver transplant – NO discussion. He says he does not have to prove that I am an alcoholic, but that I have to prove that I am not or I will not be considered for a liver transplant.
Neither my friends or myself ever thought of me as an alcohol abuser and I feel quite deflated that my doctors simply think that I am a liar. I am wondering what gives these doctors the right to make a judgment call as to what constitutes an alcohol abuser or an alcoholic? Should people like me be eligible for liver transplant and who should play god on the matter?
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I know how you feel. I was turned down after 2 years of being sober because I “might” drink again. I also felt like they thought they were God. Another hospital said they would consider me if I went to counseling for 6 months so I did.
It wasn’t bad and mostly we talked about my life in general and the problems I was facing. He knew I was not drinking, tests also proved it, so mostly we talked about other things. I really enjoyed our talks. Just do it their way, it’s worth it in the end.
A note to all those people who have been waiting a long, long time to get a liver. Get up and move close to a hospital with a short waiting list. Not possible you think? Think again, it’s a matter of life and death . Just do it. I did and I have a new liver.
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I found this blog while looking for someplace to talk to other people like, the lowest of the low. People that have had a liver transplant yet still struggle with the craving for alcohol.
I was diagnosed with ESLD in early 2003. I had already quit drinking 3 months prior but the HCV marched on. I had my ups and downs until I had to cancel Thanksgiving because I was in the hospital for peritonitis. I got another present in March 2010; hepatocellular carcinoma. I had been sober the entire time to this point but as time dragged on my strength ran out. The 1 year mortality for HCC is 90%. I said screw it, the parties on. If I’m going to die, I’ll die kickin’ it. Finally in March 2011 I got the call and yes, I’d been drinking. I’m back in AA and glad of it. So I ask the question, does a short period of drinking after 8 years of waiting make me undeserving of a transplant?
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Thanks for your comments Kristin ! My husband had a liver transplant 4 years ago . Everything you shared is exactly as we experienced !! He is a a shining example of the miracles of transplantation ! Thank you again for helping people understand the process .
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I must say, when i first saw the actual question…the first thought was “no” then after i read on, i understood all points of view. that is Americans number one flaw. we look at it from our own shoes with one point of view, not others. Now im more prone to say yes, but with restrictions, like the alcohol abstinence. And to reply to ANON, Thats like saying mothers who smoke during pregnancy cant recieve treatment for complications. everyones different, everyones body reacts to everything in different ways. or punish the depressed for bringing down peoples moods from being sad. people arent perfect. dont treat them like they should be.
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Thank you for your comments and your honesty
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Bob,
I found all these answers interesting. I’ve had a transplant and it was hard to get one. First many centers don’t take people over age 60, others won’t take you if alcohol was the cause. I fit both catagories. I gave up drinking as soon as I found out I was sick. I had no signs of illness , no yellowing, no fatigue until I was in end stage cirrhosis. I was not like a lot of drinkers. I didn’t start until age 35. Then I was single, working and attending night school. I’d go out for a drink on the weekend. Just one or two glasses of wine. After I remarried and then retired at 55 I started drinking Vodka at home . Then I got addicted to it and tried many times to quit. I never got a DUI, never hurt anyone, just couldn’t make myself quit. My body and mind would just beg for it. It’s not just a bad choice it’s more like getting caught in a rip tide you can’t swim against . Anyway, first I was told I was too old, but then I found hospitals that don’t have that rule. Then I was turned down because I might drink again. Then because I was too far from the hospital, so I moved closer. Finally I got on a waiting list and after 7 months got a new liver. The liver had to be the right size and blood type so no adult is taking one a child could have used. There is also a way to have a donor give you half their liver and in only 6 weeks both livers will regenerate to full size. The donor must be in good health and willing to go through a difficult operation. So in conclusion, I am very in favor of allowing transplants to those drinkers who are really willing to get help and change. I also think everyone should donate to the cause. You don’t need a liver after you’re dead, why not put it to good use.
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No. Cancer is not a disease you bring upon yourself; alcoholism is. If you’ve destroyed organs because of bad habits, too bad. Pay the price. There are people who need new organs, and they didn’t do things that knowingly caused their organs to fail. You only have yourself to blame. I have no sympathy for alcoholics and drug addicts.
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You have no sympathy because you are not affected. Judge not people with afflictions for you, too, could be judged wrongly for yours.
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I humbly disagree with half of your statement. My own Dad is now facing his 4th cancer, brought on entirely from his inability to quit smoking. While smoking in and of itself IS an addiction, and therefore a disease, this is not a disease that has been inherited. I believe that he DESERVES his 4th aggressive chemo , surgery, and whatever else these doctors have to cure him. Alcoholism IS addiction, and both are defined by the American Medical Association as a disorder of the Brain. The insanity of the disease is proof enough that it is a disease that TELLS you that you do not have a disease, while your whole world comes crashing down around you. No “sane” person would allow that to happen, or “bring it on themselves”.
While some cancers are clearly NOT linked to the patient’ s addictions or unhealthy habits, especially in chidren, most are. How can you claim you have no sympathy for alcoholics and drug addicts? Do you not have one friend or family member who suffers from gambling, anorexia, addiction to cigarettes, ..I find that hard to believe! I DO agree with the fact that a stigma has been put on such people, which you have clearly endorsed. I am a recovering drug addict of 14 years. I watched my 24 yr old best friend die from an overdose. She tried like hell to quit drugs, more so than anyone I have ever met. Until you have been in a person’s shoes, you might want to hold off on the blame, Thank you very much, may God give you vision to see clearly, as He would, that EVERYONE deserves a second chance, yourself included.
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Hello all,
What I find much more disturbing than the “blacklisting” due to alcohol use, is denying needy people a transplant due to marijuana use. This practice is just as prevalent as that for alcohol use and at almost all centers the same rules and procedures apply.
There have been several noted cases of people dying while on the transplant list because they had not had time to abstain from marijuana use for the required six months.
AND, these were people who had been prescribed the use of medical marijuana BY THEIR DOCTORS.
This, in light of the fact that the use of Marijuana has never been linked to damaging the liver and has many properties have been scientifically proven to be medically beneficial.
THIS MUST STOP !
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My name is Jon and I have been waiting for a liver transplant for 15 months now. I’ve been aware I’ve definitely needed a transplant for 4 years now. It’s been 4 long, hard years and it is destroying me. I have had liver problems all my life. It is not something I asked for or bought on myself. I never asked for it, it just happened to me. I am of the opinion alcoholics should not get a new liver. I have been to many meetings for people who have had liver transplants or are awaiting liver transplants. Each time I go I meet at least one person there who needed a new liver because of alcohol abuse. What is more annoying is that these people have not had to wait as long as I have for one and they bought it on themselves. I don’t think alcoholics should usurp people who find themselves on the organ donor list through no fault of their own and if you live in a country that provides free health care (like Britain) they definitely shouldn’t get it for free. The tax payer should not be left with the bill to clean up someone else’s mess. What is so frustrating is that I am a young man (in my 20s) and my friends are all establishing themselves in careers, buying homes, marrying, etc and I can’t do any of that. My life is on hold simply because I need a working liver. I can’t go to university, can’t find a job, can’t buy a home, can’t leave home (to sick to live on my own), can’t get a bank loan, can’t even go on holiday. Just you try getting a girlfriend in my position. Alcoholic liver disease does not happen over night. It takes years of high level abuse to get to the stage where you need a new organ. In the western world you can not claim ignorance these days. Everyone knows that alcohol abuse causes serious health problems. Indeed, even the drinks manufacturers themselves put warnings on their bottles and adverts saying ‘drink responsibly’ or smiliar. If you are drinking to that level for that amount of time, sorry, you don’t deserve one. Alcoholism, a disease? I don’t think so. You have a choice. You could choose to drink or not to. Addicted I grant and it is hard to say no but disease implies you have no choice in the matter. No one forces you to have a drink. Alcoholics have had their life and they blew it. You can call me insensitive if you wants but consider this; they are asking for their second chance. I am asking for my first.
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I thought it’s was a bunch of crap too. Until I became an alcoholic. And nobody around me believed I was. Even after almost dying in the hospital, turning yellow and my funeral all but planned. I would cry and almost check myself into rehab, but was told I was being overly dramatic. I could feel myself dying. I wanted nothing more than to stop. But you can die if you just stop. I went thru a week of the dt’s. I was utterly out of my mind and confused and terrified. I wanted to stop more than I had words for. Withdrawal is hell and knowing a few swigs can make you feel normal is irresistible. And it’s as legal as taking Tylenol for a migraine. And it works. For one more day. And one more day, until your body shuts down. It’s not about having a hard life or using that as an excuse. It just happens. It can sneak ip on you. No- it’s not the complete same as cancer. Maybe it’s more like being poor. Do you hate the poor? They made bad choices. Do it’s all their fault they are not wealthy. Sometimes it is, sometimes it’s not. It’s a choice until it no longer is a choice, and by then it’s too late. I agree- if somebody is willing to really want to live a full life and fight to get better, they should not be handed a death sentence.
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For everyone here going on about how alcoholism is a “disease”: no one forced them to drink! Deciding to put a glass of alcohol to your lips is YOUR choice and YOUR responsibility. I don’t buy the peer pressure bull**** or “due to a difficult childhood/family issues/etc”. You’re responsible for your own decisions and the consequences are no one’s fault but your own.
Comparing alcoholics to patients suffering from real diseases perhaps caused by genetics or some other cause out of their control doesn’t sound fair to me. If liver cancer is sometime that runs in someone’s family I think they deserve to get the transplant rather than the person who, even so indirectly, intentionally and consciously poisoned their body by uncontrolled drinking.
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Spoken like a true ignorant. Congrats. I only hope that someday you can find peace and shed your hatred of those you deem to be “below” you. I would recommend some scripture readings, but I can already tell you are not a person of faith.
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Oh my God I cannot believe you even said such a thing, hey what about 5yrs who get into the cleaning supplies and snort them and become addicted later in life, shall we have public hangings for their parents because they didn’t take care in securing there home?? I think you had a bad experience in your life with someone who was an alcoholic and so you feel “they” all should die. My brother in law died from alcholism and I watched the anger, anguish, and hatred that developed in the family. It is a DISEASE and God help you if you ever get a disease that can’t be cured. Perhaps you should go to a rehab center and volunteer under suspervision of course and see what a person goes thru during detox, I watched it 3 times with my brother in law and let me tell you NO ONE wants to go thru that. It can’t just be put the bottle down, it is a way of life.
God help you if you ever get sick. It is not a way of life that anyone chooses.
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Nancy, I agree with what you said, and I replied to this person, praying that God gives her the spiritual vision to have the same Mercy on people as she would want for herself. WE ALL DESERVE A SECOND CHANCE…if we begin playing “GOD”, and condemm those who are Hep C pos, or alcoholics to rejection for transplants, (as they DID IN ARIZONA UNDER GOV JAN BREWER, killing at least 3 people , and taking at least 98 people OFF of the APPROVED TRANSPLANT WAITING LIST , under Medicaid, simply because they were alcoholics in recovery, or addicts with Hep C)..then this country will be in even bigger trouble than it already is. God Bless, I am so sorry about your brother. My husband is on his 4th year waiting for a liver Transplant, and I watch him suffer every day. It is people like yourself that give me , and him, hope. Compassion Is the key to a cure, for almost everything!!!
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I am truly sorry to hear about your brother in law. I must say this is not about disease. This is about the low supply verse the high need. For this reason criteria needs to be in place.
Your brother in law was an active alcoholic when he died. Lets say you need a liver transplant due to natural causes and your brother in law accelerated his disease by drinking. He got the transplant first because he was in greater need and you died due to not having that transplant. Would you still feel the same way? I doubt your brother in law would feel proud to tell others his survival was based on someone elses death that was not a result of self destructive behavior.
Criteria states that alcoholics can be put on a waiting list for a liver transplant as long as they are not using for atleast 6 months. This does not exclude alcholics from this gift of life. It is to ensure that an organ is not wasted because they are limited in the first place. Why waste a precious, valuable gift of someone’s organ to turn around and destroy it. I know I wouldn’t be able to live with myself nor would I be proud of it. That would be completely unethical on my part.
God help you one day if you get sick. Would you feel the same way if the liver you needed to survive was going to an active alcholic? What if that someone turned around and abused the liver that could of saved your life? Did I mention this person died from their disease and destroyed their new liver. The precious liver that could of saved your life. What a waste! Aren’t you nice to sacrifice your only chance at life for someone elses disease. You deserve an award for that.
I am sorry, it just doesn’t go down that way.
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I have just been referred to a transplant center for evaluation for a new liver. I know that drinking landed me in this spot – no excuses! – but everyone has a different story. I nursed my husband through 15 years of autoimmune hepatitis, resulting in a liver transplant in 1993. Afterwards, he decided he had a “new lease on life” and no longer needed a wife and severely handicapped daughter. I picked up my life, met a great guy, and was going to get married again, when he had a freak stroke at 49, leaving him paralyzed on his left side and with real brain problems. I took him in and have spent the last eight years being the sole caregiver for two disabled people. He has alienated all friends, and my nearest relatives live 1000 miles away, and I was always lonely. Somewhere in there, I started “self-medicating”. I never missed work, never got drunk, never had a DUI, absolutely no one knows that I was spending my nights and weekends sipping away. I haven’t had a drink in two months, and don’t even think about it. I dread becoming the pariah when friends and family find out. I hope people will feel I deserve a second chance. Somewhere I read that most people think all alcoholics are barflies or on skid row, but we all have different stories. I have really appreciated reading all the comments…
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If everyone that could donate thier organs than this would not be an issue. I think an alcoholic deserves a transplant if there is one availabe and he is up on the list. No one has the right to judge this person. You could be donating an organ to someone who takes care of themselves and never don drugs or alcohole, but perhaps they do something else that is not considered good behavior that we are not aware of. I am a donor and if my liver goes to an alcoholic or drug addict so what, someone out there love the person that is recieving the organ and they will be grateful that thier alcoholic son or daughter is getting a new liver.
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Hello
My sweet kind funny precious brother needs a liver transplant…yes he is a recovering alcoholic.Started using at 12 and was in and out of rehabs many times.Destoyed my parents with worry and guilt. I dont wish this pain on anyone. He
has been married over 20 years. He is 43
and very sick.thank you for your compassion.we love and need him very much
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I am a 24 year old man with a both a masters and bachelors degree. I have been a manager at a well known Retail Company since the age of 18 and on graduating from my masters degree got a job at one of the top 20 companies in the country. I have a supportive family and a great set of close friends…on top of this I am an alcoholic!
Six months ago I received a liver transplant due to paracetamol induced liver failure which must have been obtained and taken when I was completely out of my mind with alcohol. Now this may shock and/or disgust a number of people out there with loved ones who are in critical situations through no fault of their own.
If I was of sound and sober mind would I have taken the overdose? Certainly not! Did I try to stop drinking over and over again? Absolutely! Even though my liver was in a reasonably healthy state prior transplant did I cry myself to sleep many nights concerned with how I’d lost my job, dignity, respect of friends and colleagues not to mention my poor parents going crazy and out of their minds? All the time. Did I ever see myself as a youngster growing up and being a failure, an embarrassment and choose to be an alcoholic? Never in a million years! Am I a mental depressive recluse that doesn’t get on with people nor has a likeability factor? No again
All I can say is that before I came to the realisation that I had this very real problem was that I was of the very same disposition of many others of the scorners on this page of alcoholics and the illness of alcoholism. All I can say is for you, thank God that you’re not cause that’s what I tried and prayed for every night. The key fact of the matter here is when I awoke from my coma and was told I had received a transplant I was confused and unsure of what had happened prior to this. Of all the things I had tried prior to kick this physical and mental addiction nothing had worked. Post transplant, in some respects this is the best thing that has happened in my life! It has provided me with a new appreciation for life. A clear set goal to keep myself alive for as long as possible and to enjoy it. To find new interests that don’t involve drink or being in drink involved situations. Therefore was it totally wrong for me to get the transplant? My mum, dad and anyone else close to me would certainly disagree.
As someone said to me, wherever an individual goes after death they have no use for their liver anymore so why should it be above anyone to offer their organs to another who can make use of it and be so thankful for a second shot at life? I was on the donor list long before I ever came to the realization that I was an alcoholic but nonetheless if we are bothered in life about helping third world countries, the homeless, etc why should we not help others in death when it is of no relevance to us anymore.
Also on a controversial point if we are to suggest that alcoholics are bad people that are self harming but then could it not be argued that an incorrect decision has been made for the ‘innocent’ children that receive the transplants and then end up growing into adulthood and become pedophiles, murderers and thieves(I’ve never seen statistical studies on this)? You may think this is ludicrous and irrelevant but surely it is a matter to contemplate nonetheless.
I shall stop myself now as very muddy water ensues which can only lead to vehement argument that truthfully can bring no definitive or accurate answer.
All I can say is that I thank my donor, thank God and am so thankful for my 2nd chance in life.
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Further to the above should we only consider a patient on their medical grounds or again consider their criminal records and so forth and possibly add in a “good person test” into the equation? Remember in all cases a transplant is a matter of life or death so should any of us have the right to play judge and jury in any one situation. I was not me when my liver failure happened, I was a character I knew and hated but couldn’t get rid of!
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Good for you… I do hope you continue a LONG and healthy life… IT sounds like you have a great life and have a good family support system…that is SOO important. YOU hang on to that..
AND I wish you all the luck in the world, and I am so grateful you were give a second chance. You were meant to stay here for a reason, find that reason and use it. Maybe be an advocate for young people…share your story.
You are an inspiration!!!!
Thanks for sharing your story!!
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My dad has cirrosis through alcohol consumption over his life time as a social drinker, I feel llet down and powerless as I don’t want to lose my dad due to this horrible disease. He takes his medications but he is really struggling staying t total.
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I have been vegetarian for 16 years and a marathon runner for 4 years.
I considered being an organ donor but don’t see why my organs can’t go to someone who needs it due to no fault of their own (like Camille’s daughter above my comment).
Alcoholism is a disease like cancer? I think NOT. I watched my ENTIRE family drink, beat each other up, force alcohol down my throat when I was a kid, etc, and you don’t see me boozing it up every night because I have a “genetic disposition”. Alcoholism is a CHOICE just like smoking, overeating, etc, and these people don’t deserve my organs, sorry!
Maybe someday organ donation centers will change their policy so we can donate to people who are the most deserving (like innocent children).
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Hi Camille:
I agree, people who are in the greatest need of an organ should get them first unfortunately the problem isn’t that simple. The United Network for Organ Sharing (UNOS) is a Government contractor that coordinates and tracks organ donors and those who need organs. The process is done in a manner that determines the following:
• blood type (some are rarer than others)
• tissue type
• height and weight of transplant candidate
• size of donated organ
• medical urgency
• time on the waiting list
• the distance between the donor’s hospital and the potential donor organ
• how many donors there are in the local area over a period of time and
• the transplant center’s criteria for accepting organ offers
To learn more please go to http://optn.transplant.hrsa.gov/about/transplantation/transplantProcess.asp
I hope it is easy to see that while an organ may be available that doesn’t mean that it will be a match for a child, nor does it mean it will be a match for a recovering addict.
Transplant centers have rules about alcoholics and other addicts pertaining to transplants. I don’t know of one that doesn’t require sobriety for at least six months before you can even be considered. I am a recovering alcoholic and have been for 28 years. I got a new heart and am ever so grateful. At the time I wondered how I got a heart when there were so many other sicker people including children. It bothered me for a long time but I was assured that the heart that was transplanted in my chest was a match for me and only me at that particular time. A day later…who knows?
I am not nor will I ever advocate that practicing addicts be eligible for organ transplants. They should not be. But if an addict has the required amount of sobriety and has shown his commitment to staying that way, why should they be treated any differently than someone who needs a transplant but had earlier been cured of a certain type of cancer?
I don’t know about your family situation and it certainly sounded terrible. Some people survive those situations and others don’t. You were lucky but don’t let your bitterness condemn those who have changed their lives. Every major medical organization accepts addiction as a disease. I know that for myself I could not quit without help. 28 years ago I went into treatment and haven’t had a drink since. It’s not a question of will power. As a counselor said to me once, “If you think will power will work, try it the next time you have diarrhea, there is no difference.
During my time as a practicing alcoholic I knew I had a problem and I resolved to quit drinking scores of times. It never worked. Once you become an addict all you live for is your next “hit” even though you know it’s wrong. It isn’t as though an addict uses to get high, at some point they use to try to feel normal. The only high they ever get is the first time they try the substance, after that is the unending quest to feel normal, a goal that is never realized. No one would purposely choose to live a life where you can lose your job, your family, your self respect, your friends and your freedom (jail). It is an awful disease.
I; hope this is of some help to you. If you have questions or want to further discuss the matter please contact me at bob@baronson.org.
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My daughter is 6 months old and was born with a rare liver disease called Biliary Atresia. She will most likely need a liver transplant in the next couple of years. I understand that alcoholism, obesity, anorexia, etc. are diseases but they all started with a choice and they only turned into a disease when those same bad choices were repeated over and over. My daughter has never had a choice. It would be very wrong for her to be denied a chance at life because the liver that could have been hers went to an alcoholic who already had their chance at life and threw it away.
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My father is a heavy drinker. I say heavy drinker and not alcoholic because he has stopped drinking when it is beneficial to him several times throughout his life. He is now in end stage liver disease and has been referred to a liver specialist for a transplant. I honestly don’t think he deserves a new liver. He is a selfish man who chose alcohol over his family many many times. He quit drinking for a month in order to undergo back surgery. I know he is able to do it, he just didn’t want to. He has been sober for three months now, but has said that he can’t wait til this is all over so he can have a beer again. I was disgusted when I heard him say that. The thought that some child could be in need of a liver, and he might get it instead is horrifying to me.
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yes that is what i thought,now they are saying that mum has no chance of living because her liver has completly gone and her other organs are slowly shutting down too they said that if they bring her back then it will only be for her to die again.she really wants to live and she has so much to live for.we are all so worried and dont know what to do, we are wondering if she would be better off in a private hospital and if there is anything a private hospital could do for her if we pay.The nhs hospital whare she is now dont seem to be very good at all, it seems as though she is being left on her own and the staff took 25 minutes or so to take her to the loo when we had told them she was desperate twice and also rang the bell, The staff seem to go to everyone acle first.also The feeding tube that mum had put in was found to be put into her lungs instead of whare it should have been so it must have been drowning her lungs.
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my mother is an alcoholic and she is currently in hospital for the third time,she has cirrhosis, she is very poorly this time and she has been told that if her heart fails then they wont concider reviving her as there is not much alce they can do for her, this has really scared her and she says if she makes it this time she will never drink again,the whole family are really worried for her and non of us know what to say or do.she started drinking heavely when she lost her partner through drink, and it has been her life for many years now,she lives on her own and dont go out very much, what kind of help can we get for her? i just dont know,she is being fed via a tube and has to have her stomach drained, her skin is very yellow and so is her eyes,she has so much to live for and she is only 54. It is an illness, she didnt ask to end up like this.I only wish we could do something to help her, we feel like there is nothing we can do but to sit back and basically watch her die, its horrible
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I’m not a physician but I don’t think it is up to the physician to decide if they will attempt to revive her, it is their duty. Now, if she has a living will that directs physicians not to revive her or use “heroic” measures to save her life that’s a different story. If she has no living will and is unconscious or in a coma then the decision is up to the family. As I said, I am not a physician and I’m not a lawyer either but that’s been my experience.
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I am so concerned. My brother has cirrhosis from alcohol, I am so worried about him. I also, worry about my mother who is obese. I know their past, and what has brought these problems about. I actually understand what has brought it about. My best friend is type 1 diabetic. She has so much going on in her life, a child whom she adores, and a husband, that is trying so hard to find work, however financial troubles are consuming their lives. She does not have money for co-pays to go to the Dr. to get the treatment she needs. These are 3 people in my life, that I can not imagine my life without. They are as important to me, as the sun. If anyone one of them asked/ or if I even knew I could, I would without question, give or do whatever necessary to keep them in my life. My brother is trying, I know how much he wants his life back, and how much he doesnt want to be this person. He deserves every chance at happiness. It is not his fault he comes from a long line of alcoholics. My mother, after my father left for another woman, gained weight, yes, she was depressed after her 35 year marriage walked out the door with another woman, leaving 4 children, and alot of heartache. My best friend didnt ask for this, as did my mom and brother. No one asks to be sick. No one asks to come from a family that has a history of alcoholism, no one asks to be depressed, as no one asks for diabetes. For the people, who believe it is a “choice” “life-style behavior” etc….. read, educate yourself on the judgment you make. Everything is not as cut and dry as it seems. As for donors, I would be pleased to donate my organs to anyone of these people or anyone else. Most importantly.. Please Don”t Judge.
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Everybody deserves a second chance to live but I think that we have to prioritize people who has pathological diseases to get the transplant first than alcoholics. I think it is a choice to become alcoholic. I used to drink alcohol when I was younger (heavy consumption of alcohol) but I was able to stop. It was my choice to stop drinking and it’s been 5 years and I still don’t drink alcohol. It is not fair to give the organ to a person that never took care of him/herself because a lot of people out there that are more deserving.
For cancer patients, depending on how they got it. Again for liver cancer, if they are a chronic smoker then they should be the last one on the list and give it to person who took care of him/herself.
I was gonna donate my organs before but I changed my mind when I asked the Organ donation center if I have a choice to not to give it to alcoholics but she said “no and it is given to people who matched my organ wether they are alcoholic or not.”
sorry Bob but that’s just my opinion.
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Many people have a misunderstanding of the difference between heavy drinking and alcoholism. Many heavy drinkers use will power and quit. Alcoholics, however, have a genetic predisposition to addiction. They crave alcohol the way you crave air. I know, I’ve been in recovery for 28 years and every day is a struggle. If you think will power will help an alcoholic or other substance abuser quit using then you also believe that will power will stop diarrhea.
Your choice to not become an organ donor may have doomed many others to death. Did you know that one organ donor can affect or save the lives of up to 60 people? Had others made the same decision as you did then I would have died a little over two years ago. Please rethink your decision.
bob
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Hello Bob your article is amazing! My step father recently discovered that he has stage 4 Cirrhosis and he has 6 months to a year to live. I really just need your advice to be honest. He hasn’t had a drink in 8 months and I believe he will never touch one again. our next step is to see if we can get him on a transplant list. However, I am just terrified that he won’t be a candidate. What do you recommend? Do you know any good sites? Or do you know any good transplant places we could go to? I just really don’t know what to do? Do you think there is any way of saving him?
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Texas liver center in Houston ! My husband had a transplant 3 yrs ago .He had been sober for 3 month they put him in AA and walked us thru the process ,6 mo sobriety and he was put at top of list !Call them asap as u dont want to wait he will turn green (really) and recovery is harder ! Best of luck
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My brother has alcoholic cirrhosis. He is a hard-working father and husband who, by his daughters admission “has always been there”. He only recently understood/admitted his drinking problem, and only about a month ago learned he had end stage cirrhosis. Two and a half years ago he successfully completed a 30 treatment program. He was sober for about a year and a half. He then fell off of the wagon only about 3 months ago to go back into a treatment program. Unfortunately, he had to be rushed to emergency with pancreatitis. He recover pancreatitis, only to remain very sick until his diagnosis of cirrhosis. He has worked at sobriety. He will get the hang of it given the chance. The challenge is that he only has 3 months soriety, and no recent 30 treatment program. His MELD score is somewhere over 20 and he is decompensating rapidly. What I am hearing often is that he did this all to himself and is really not worthy of giving a chance. He certainly does not fit the typically perception of an alcoholic, but I have yet to uncover a transplant team who would even consider him without 6 months and a 30 day treament program. My brother wants a chance to continue his growth in mastering his sobriety. He wants to satify the requirements and in fact hit a homerun iwth sobriety, but he may not live long enough. How does he do a 30 day treament program when he has hardly been able to walk for the last month? I am a breast cancer researcher and I have yet to uncover any primary research indicating any disparity between survival rates of alcoholics to non-alcoholics post-transplantation. I have spoken to friends on other kind of transplant teams and they feel the strong sense of morality in allowing someone onto the waiting list. Minus the alcohol, I know few more moral people than my brother. I am clearly frustrated on how I may fascilitate a truely good person to have the chance they deserve.
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Unfortunately people who are chemically dependant are beyond your personal control. They must come to the realization that they are powerless over their drug of choice and it is killing them, Furthermore they must have a very strong desire to live. Usually this cannot be done alone, a treatment program or regular AA attendance are the only medically accxeptable methods for helping addicts whether the drug is alcohol or heroin. The best you can do is urge him to get help or arrange with a professional for an “intervention” which may be the difference between life or death.
bob
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My twin sister just received a portion of her daughters liver. Her transplant center was very clear-NO DRINKING. They have a one strike policy. She has been sober for 10 months. I may have agreed before watching my sister almost die from cirrhosis that alcoholics should not be given a liver. However, until you watch someone that you love suffer from this dreadful disease you can’t judge. My sister has shown incredible strength, humility and courage through this entire process. The one word that comes to my mind is gratitude. I’m so thankful to have my sister in my life.
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This is the one comment I can reply to because I think you can empathize with me.. NO ONE GETS THAT ALCOHOLISM “IS” a disease. Everyone looks at them (my sister), including my own family, as if they did this to themselves. THEY CANNOT HELP IT..IT IS AN EVERY DAY STRUGGLE!!
I am dying here watching my sister in ICU, the doctors are telling me she will die without a liver transplant, and have told me she she is not eligible because she is an alcoholic.
She is only 45 and has a 12 and 19 year… her oldest is fighting in Afghanistan but is on his way home to watch his mother die.
So for all of you judging the alcoholics, please remember, they are someone’s mother, father, brother, and in this case MY BABY SISTER….
I am going to loose her because no one gets that she has a disease. Her last words before she went into whatever state she is right now is “I am so sorry, I slipped up, I am having a hard time.” It was heart wrenching. We just wait… watching her get sicker and sicker.
So for everyone out there. Don’t judge.. You have no idea how hard this is for the families that have alcoholics who have got themselves here, and I am sorry it is NO DIFFERENT than any other disease listed above. Alcoholism is a disease…it is just a shame it is not recognized as one.. and because of that I will be burying my sister really soon.
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I am so sorry to hear about your sister, and her suffering. I am outraged that anyone would say that an alcoholic does not deserve the same treatment and a cure that , say, a cancer patient would receive from years and years of smoking. (I agree that SOME cancers are genetic, and are NOT linked to a person’s “habits” (addiction IS a disease), but most of them are, and to say that ANYONE does not deserve a second chance is tantamount to playing God. (HE would give anyone a second chance, I might add). I hope you have availed yourself of the patient ADVOCACY, or the OMBUDSMEN of the hospital, to discuss the issue of the refusal of a transplant due to your sister’s alcoholism. I know a man personally who received not one, but TWO LIVING donations of liver, and then died from his inability to get into recovery. While some might say that is a perfect argument for NOT giving him a transplant, I say look at the case of my own Dad, who is facing his 4th treatment and hopefully a cure for the cancer that has been caused by his inability to stop chain smoking. He would not even cut down, yet the doctors went ahead and gave him the most aggressive treatment they could. We cannot play the judge, jury, and executioner. GOD BLESS YOU FOR BEING SUCH A GOOD CAREGIVER TO YOUR SISTER, I AM PRAYING FOR HER. My husband is facing his 4th year on the transplant list due to Hep C.
Ashley T. Curran
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I didn’t know drinkers had a choice in the matter, I thought they had to quit drinking even to be considered for the transplant. A friend of mine has Chronic Hep C, cirrhosis, primary liver cancer… and he still came over here with a beer in his hand. He’s only 50. What is that? Why is he drinking? Should he get a transplant? I don’t know. He said they are putting him at the top of the list, but I don’t know if that is true, they still have to check and see if the cancer has spread. I’m really upset. I read that people in this condition who do get a transplant don’t last very long anyway, and if he’s drinking…. ????
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I also work at a transplant center and have seen many different people get transplants. Some were recovering alcoholics/drug abusers who truly changed their lives for the better and it showed. And then there are those who slip thru the cracks and continue drinking up until and after the transplant. I have seen patients who reported doing drugs 1-2 days prior to transplant, still receive a transplant. I have seen patients receive transplants after intentional overdoses. I have also gone into patient’s rooms and found empty vodka bottles. I feel that the six months of soberity should be longer, and that pre-transplant recipients should go thru rehab as part of the listing process. I also think they should been regularly seen by psych, as you said, alcohol is an illness, to help them change their behaviors and thinking related to alcohol as well as offer support.
I have seen patients with long histories of alcohol and drug abuse, most of which with hep b and c receive transplants, when patients with liver cancer or some strange disease die waiting, only to have the hep resurface and destroy the new liver. I try my best to objectively care for my patients, but sometimes it can be difficult and your mind starts wandering and thinking “is it fair?”
As far as not drinking for fear of being taken off the list. I have seen this as well. Patients have been hospitalized for non-liver related instances, and immediately upon admission, alcohol and tox screen. I have seen patients wait-listed from this. In fact, I have seen patients die as a result of not getting a new organ soon enough, because they did not adhere to the 6 month rule.
The point you made against diabetes and alcoholism, I do not feel is the same. How would you then explain type 1 diabetes? Many people with it are very young and it is not a result of eating behaviors/habits. If you are going to compare it to diabetetes, then is would be more along the line of a patient with diabetes and is NOT taking their insulin and as a result has damage to other parts of their body (usually amputations/altered healing).
But before we go down this very grey road, I think what is most important is.. has this person changed their ways, and are they capable of now taking care of their new organ?
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I am still pondering over this…when Mickey Mantle got his liver I do remember being angry about it I feel the same about obese people that do not even try to change their life habits, I know women that have diabetes and are what is considered very over weight, but they don’t seem to change their eating habits, I think a recovering alcoholic should be given a new chance if they have changed their life style…I guess I feel there are so many that need transplants, just because you are a movie star, baseball hero etc. the mechanic or the factory worker should have the same opportunity, I think Kristin’s reply was very good, but I wonder sometimes how some people get there transplants and others don’t, I admit I am suspicious about it…..
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Just passing by.Btw, you website have great content!
______________________________
Don’t pay for your electricity any longer…
Instead, the power company will pay YOU!
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So many thoughtful, interesting comments. but — I’m not hearing anyone address the larger issue of destructive behavior. what about the obese person who has diabetes that destroys his/her kidneys? What about the anorexic who through her behavior is destroying her entire body? Should these people be denied transplants, too? I’d sure like to hear comments on this broader issue.
bob
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Depends on whether or not this is a serious recovering alcoholic. And those perimenters are simple…time in recovery. I truly hate to be that way. I do. But TOO MANY PEOPLE need these organs. People who did not willingly and purposefully poison themselves over time. I would need to see that a candidate is serious. That they take their recovery seriously. They make bipolars who are poisoned by lithium go thru the these tests, what makes an alcoholic so SPECIAL. In fact, they are not. They are just a little more socially acceptable.
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I worked at a busy transplant center 17 years ago. I worked the night shift, and that is when people would come in after getting the call that they were getting a liver transplant. We had people come in to the hospital for their transplant that were drunk. Yes, drunk, and it happened more than a few times.
The first time it happened, we took a blood alcohol test of the patient. The next morning, the surgical staff gathered the night shift nurses together, and told us to never do that again, that the patient would be transplanted regardless. The Residents called it TUI- “transplanted under the influence”.
We had a mother and son that were both alcoholics get transplanted (liver) within a few months of each other. They lived together and had little other support- I don’t know what happened to them.
Another lady that was an alcoholic did not go back to drinking, but got addicted to Benadryl. She had numerous long stays at the hospital. I remember one of the Doctors ripping through her belongings looking for her stash of Benadryl.
We also had a young man get a liver transplant- he went back to drinking and destroyed his liver. He got a second transplant, went back to drinking, and then died.
After this happened, the transplant team made it a policy that all those with drinking problems go to rehab after their transplant. I’m not sure what they required before the transplant.
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When a anyone wants to donate a kidney, they do so based upon how it will be used. My brother, who was very helpful and became my Power Of Attorney, did not want to donate a kidney to me. Why? I did not want to ask. I felt it was a private matter and sometimes it is just better off not knowing why.
If a potenial recepient shows no desire or attempt to better their life before a transplant, chances are good they will be the same after the transplant.
Instead, if there is an attitude of thankfulness and a willingness to change, they should be considered.
I would like to see a “lease” agreement signed with each organ transplanted. It would state that if the transplanted organ is abused or put at risk, the agreement can be revoked and the organ taken out and given to someone else. Harsh? Perhaps but just signing something like that would indeed give them incentive to take care of themselves!
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Silly
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Bob:
That is a very hard question to answer. I had a liver transplant 2 1/2 years ago and was told not to drink any alcohol at all several years before translant and again after transplant. Basicly I was given the idea that if I drank before, it would show up in my blood tests and I would be backed up on the list and after transplant, if I was to go into rejection because of drinking, I would probably not get another chance. Mind you this was not in writing but kind of insunated.
There are not enough organs to go around now and they should be given to the person that takes care of themselves before and after.
Thats the opinion I have.
Thank you, Bob for all the work you do.
Jim
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Kristin:
Thank you for your comments they are especially appreciated because of your obvious expertise and concern. I hope everyone who reads this blog also reads your comments. At some future date I may want to publish them in their entirety as a separate blog.
thanks again
bob
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Hi Bob,
I work for the busiest liver transplant program in the nation. I think your blogs are insightful and your efforts to increase organ donation are wonderful. As for the question, should alcoholics get liver transplants, yes, under the right circumstances. The liver transplant evaluation process is incredibly extensive. No stone is left unturned from a medical or a social standpoint. Most centers have strict guidelines not only on absinence but also formal treatment and ongoing aftercare such as AA. If someone is willing to go through this very difficult process to better their lives, then they deserve a second chance.
Transplant centers struggle with the charge to save as many people as possible. Never is a decision made lightly and without hours of discussion involving a huge multidisciplinary team. I think people need to know this…if they make the decision to be a donor or to donate a family members organs, they need to know that as a center, we make every effort to use that organ in the most responsible way possible. If many people could see this process from the inside, I think their decision to donate would be an easy one.
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I am very naive in this area. Can you donate a portion of your liver or do you have to wait for a person to pass (die) to get a liver?
My sister is dying as I write this and I think I am compatible with her blood type and would give her part of my liver if that is even possible.
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Kirstin….please contact me by email at bob@baronson.org
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You are so right ! I watched the process with my husband ! It’s been 4 yrs since his liver transplant . He is doing great and God Bless the Drs who gave him a second chance !!you must be willing to endure the process to prove you are not going to waste a precious organ !!!!!
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