Should Alcoholics Receive Liver Transplants?


 I am posting this topic because of the extreme interest other blogs on the subject have generated.   All I ask is that you not only objectively read the material, but also click on the referrences and read them, too.  Your comments are are not only invited, but encouraged.  Addiction is a deadly and cunning disease that can strike any person at any time with no respect for race, religion, social status, gender or age.  No one makes a conscious decision to become an addict, it just happens.  Yes, some bad choices are made that can lead you there, but chances are very good that you were born one and activation of the disease only needs the right trigger. 

This is a “think piece.”  I’m hoping this blog will challenge your thinking and cause you to comment.  Please open your minds and consider the total picture not just a narrow view of people involved in substance abuse.  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 25, 2009 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 on August 21, 2007.  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 in the space provided or email your thoughts to me at bob@baronson.org.  And – spread the word about the immediate need for more organ donors.  On-line registration can be done at http://www.donatelife.net/index.php  Whenever you can, help people formally register.  There is nothing you can do that is of greater importance.  If you convince one person to be a donor you may save or positively affect over 50 lives.  Some of those lives may be people you know and love.  

You are also invited to join Facebook’s Organ Transplantation Initiative (OTI) a group of well over 3,000 members that is dedicated to providing help and information to donors, donor families, transplant patients and families, caregivers and all other interested parties.  Your participation is important if we are to influence decision makers to support efforts to increase organ donation and support organ regeneration, replacement and research efforts. 

Posted on June 10, 2010, in alcohol and drugs. Bookmark the permalink. 19 Comments.

  1. Darla…because you didn’t elaborate I don’t know the details of your brother’s situation but if he has been sober for at least six months there are many transplant centers that would accept and list him if he meets all the other criteria. if you’d like to write to me personally please do bob@baronson.org

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  2. my brother 46 years old- WAS an acolholic because he was -he was told he could not have a transplant- my family is ready to be donors- no registry- WHY should they play God , they have to right to say who lives and who does not 1i am so upset over this- we all make mistakes and smokers get more chances – and so on and so on!!!!!!!!!!!!!!!

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  3. Update on my posting yesterday;

    I am very excited and pleased to say that the consultant at our hospital, has agreed to put C forward for an assessment for a liver transplant. You cannot possibly imagine the joy of hearing this news.

    To those who object to alcoholic’s being given this second chance, just remember that the alcoholic is a person, just like you and I. Alcohol addiction is so often misunderstood and it is so easy for people to glibly say, ‘they do it to themselves, they put the bottle to their lips’, Oh if only it was that simple, believe me there are many complexities to addiction and the inner turmoil that the addict has is immense. My heart goes out to anyone with addiction.

    As Bob very kindly replied to me, he told me that there is always hope, Bob, I slept the first nights sleep in 3 months last night……I just want to say ‘thank you so much Bob for your kindness and words’ it really helped me so much.

    To anyone reading this, please, when you meet a person with an addiction, please do not judge them, loneliness is often part of the illness too….please open your mind, your heart, your eyes…..Show some compassion….it’s goes a long way to helping someone more than you will ever know.

    Prayers go out to all the people who are needing a liver transplant or any organ donation.

    Lily.

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  4. Hello Bob,

    Thank you so much for your honesty, for your compassion and your kindness to other fellow human beings. If I lived near you I would want to meet you as you seem such a warm human being and you have battled against an addiction which is very misunderstood by outsiders. Being an alcoholic is not a choice, no one wants a dependency that controls their life. You value your life and I think that you always did dispite having an addiction. Clearly you are a very intellectual deep thinking man, I value that in you even though I don’t know you.

    I am not an addict, my partner is a recovering alcoholic. We have been together for 10 years. I have seen the daily struggle and pressure that C my partner has been through. C is a highly intelligent guy, he has a masters degree and is a very caring sensitive man. He has 3 children who are all under the ages of 17.

    Due to his job he travelled the world working long hours abroad as a consultant engineer. He is well known in the industry and held down a very responsible position until very recently.
    sadly, his marriage broke up and he lost the rights of his children, they were very young. He only got to see them every other weekend. I met him a year into his marriage breakup. I saw the ‘man, the spirit the intelligent bright minded warm caring person, not the addict’. I saw how the break- up affected him and the pain he went through each time he said ‘goodbye’ to his children at the end of a weekend visit. He would then sink into depression and drink, it was his way of coping, at the time he couldnt reach out emotionally and depression set in so drink began to feature heavily in his life as a coping mechanisuim.

    I am giving these details so that people who read this blog will understand that an addiction can affect anyone. As a couple, we are both professional people and we live in a nice area in the UK. we are very lucky in many ways, from the outside alot of people would probably have found it hard to believe what went on behind closed doors, he never appeared to be drunk, just happy and chilled out by the continuous input of alcohol.

    The addiction took a firm grip on C, and June 2009 C took seriously ill, and was diagnosed with Cirrhosis – he had varacies and nearly bled to death. After emergency surgery his life was saved, and he managed to stop drinking for six months. He later suffered another set back and this resulted in he using his crutch alcohol. So hence the addiction really took hold.

    Being his life partner has been painful to see this wonderful man deteriorating in front of my eyes.
    I am a very positive person and have always supported him to try to give up his drinking, whilst realising that it is not a simple act of ‘stopping drinking’ addiction is very complex and very lonely for the addict be it drugs or alcohol or substance misuse. Never think that people ‘want’ to be an addict, they don’t. The more pressure you put on an addict the worse the addiction becomes, specialist support is often needed. If you are giving up alcohol, please seek advice from your doctor about the implcations of stopping, this has to be done very carefully.

    Now diagnosed with End stage Liver disease and very poor prognosis, (he is not drinking) – we are now waiting to hear if a decision for C to be put forward for transplant or not, without it he could die very soon.

    Would I say an alcoholic should be offered a transplant? Hell YES I WOULD say that they should have the same chance as any other human being.

    My son died 27 years ago, his organs went for transplantation, would we as a family have objected or discriminated as to who the organs went to?…………………..I think you know the answer to this.

    Tomorrow, we will hear news if the decision is YES or NO – to an assessment to go onto the transplant list……I pray that god hears me and guides me tomorrow, we are all human beings, and I respect the viewpoint of the people who object, however, if it was your sister, your brother, your mother or anyone in your family – would YOU still object to them having a transplant because they had an alcohol addiction?……….Think about it, seriously, you do not know what lies ahead in life, one can never predict how life can suddenly change…..I hope that the objectors of this world never have to go through waiting for a transplant for the reasons of a member of their family having an addiction.

    To anyone who is also waiting to have the judgement decision like we are, good luck, be strong, there are people out here who care about you – take care my friends be strong.

    Lily

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  5. Hi Bob,

    You don’t punish a person by letting them die because they have an addiction. If they genuinely want help and get it by doing rehab then they deserve to live and be happy. God forgives us when we repent of our wrong doings. Who are we to not forgive others, especially if they have an addiction. Someday my daughter will get that call informing her that they have a liver for her. Until then, I pray that it won’t be long. Her MELD Score at one time was 17 and now down to 13. She has been on list for 1 year. She quit drinking 3yrs ago and it has been a hard battle for her and painful for me to see her going through this. Pray for her please.

    I appreciate it.

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  6. WHO IS ElIGIBLE?

    Addicted people are not suitable to receive organ transplants. This is a great discussion that is taking place because of organs lacking, medical community polices and more important, common people` paradimgs. First at all we have to take into consideration what Bob Barronson has said: “Addiction is a deadly and cunning disease that can strike any person at any time with no respect for race, religion, social status, gender or age. No one makes a conscious decision to become an addict, it just happens. Yes, some bad choices are made that can lead you there but chances are very good that you were born one and activation of the disease only needs the right trigger”. Secondly we have to consider that there are some associations that position some addictions as diseases and we should not blame nor punish people for having them. Also it is of worth to remember that we are children of God, we can make mistakes but we deserve an opportunity.
    Also we have to take into account the importance of a medical treatment in order to help addicted people to recover from their addictions and, relapse anymore. We surely know that there is a lot of good people who need an organ donation as well as there is a great necessity of donors, however what would happen if the hurt person is your aunt, or your mother, your wife, or your daughter? Could it change your viewpoint considering that they have an addiction?. We need a merciful heart and a pious soul. As someone said: “I strongly feel that people with addictions issues ar e people like every one else and they deserve as much right medical treatment as anyone else”.

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  7. Alcholic should not be allowed to have liver transplant. they cause this. they should join the line from back. sorry

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    • Joan…do you believe alcoholics should not have transplants even if they have not a drink for years? If that’s true then do you also believe that people who smoked should not be treated for cancer. True?

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      • Cancer treatment is plentiful, though, while donor organs are not. You cannot compare the two. If you treat a smoker for cancer, it’s not like someone else will go untreated and likely die. The alcohol/liver debate is completely different and comparing it to anything else is just biased. Nobody should have to die, and alcoholism is a disease that some people are genetically predisposed to, but nobody forced those people to drink. They knew it ran in the family and drank anyway. I agree with Joan; alcoholics who have ruined their own livers should be last in line for transplants and should only receive them after people with diseases they did not bring on to themselves.

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  8. Dianna, I cry with you. As a recovering alcoholic I know first hand the misery of living that way. I, too, know what it is like to have not low but NO self esteem. It is a horrible way to live. Alcoholism or any kind of chemical dependency is a disease that is officially recognized as such but always looked down upon. Many physicians, who should know better, are cruel and insensitive when it comes to people who struggle with the sickness. I only wish I had some words of comfort for you. My dad was an alcoholic, too. It and smoking killed him. I know your grief.

    I’m hoping that by sending you a hug, you will at least know there is someone here who cares. Please call on me any time you like if I can be of any help.

    bob

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  9. thank you for reposting this…..my heart needed it. I lost my mother on my daughters 12th birthday due to end stage liver disease. To have the doctors in there own words tell me that my mothers life isn’t worth trying to save because she did it to herself was heart breaking. The call themselves doctors but yet the have seemed to fail to see that this is indeed a disease that they have been fighting usually on their own that has brought them to the verge of death. You can google alcoholism and it will refer to alcoholism as a disease. Its states that it can be hereditary. So why then do the same rules not apply when an obese person who has family history of obesity caring on an unhealthy eating habit rejected due to the fact that they just may go back to the same poor eating habits. Same thing should also be applied to smokers, and those who have had let say numerous speeding tickets and then was in a car accident and then needed an organ to survive. Cancer patients who have lived and unhealthy lifestyle to increase their chances to develop cancer. Heck that would be every cancer patient. Darn near everything we eat, breath, touch puts us at some risk. I think what really breaks my heart it that usually alcoholics have feelings of little self worth. I can’t even begin to tell you the HARD life my mother lived yet she was the best mother I could ever ask for. She was able to teach me more then a mother who had the ability to give me everything my heart desired. She had the most giving heart even when she had every right to be bitter with a stone cold heart. Yet she never had the ability to feel worth much. Her whole life she never did wrong to any person she left this earth with not one single enemy. And I can’t help but to think how she would have felt if the doctors would have told her “we believe in you, that’s why we are giving you a second chance” finally some stranger would have believed in her. Yeah she had her family to tell her how much she meant but for a stranger to finally acknowledge her worth would have been life changing for her. As I think with many alcoholics. Their whole life they struggle to feel self worth usually because of depression and at their moments of death their feelings to them are confirmed because this doctor is telling them you are not worth saving because you did it to yourself and you just may do it again. That’s where my heart breaks. An alcoholic doesn’t want this disease no more then a cancer patient wants the cancer.

    don’t know if its possible request but if it is I would request that my liver be given to a patient that needs one due to drinking.

    p.s. sorry if my thoughts are scatter brained or errors are made. trying to type through m tears.

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  10. I THINK THAT EVERYONE DESERVES THE CHANCE TO LIVE. IM AN IRAQ VET AND YES I DO DRINK ALOT BUT IM ALSO AN ORGAN DONOR SO ARE MY OTHER ORGANS THAT ARE HEALTHY NOT GOOD ENOUGH FOR THE SICK CAUSE THEY SAY MY SICK LIVER CANT BE REPLACED DUE TO THE FACT THAT I DRINK DUE TO WAR AND OTHER THINGS?

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  11. Great post with Great stuff.That sounds pretty cool. Really helpful thanks for the post, Great job, hope we can expect more Drug and Alcohol Test articles.Take Florida DMV approved Drug and Alcohol test. Also known as Florida TLSAE course and 4 Hour Drug and Alcohol Test course. All the Best. For more info please visit Florida Drug and Alcohol Test

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  12. Ashley T Curran

    GREAT blog “re-post” Bob, as usual, right on time also!
    There is a man in Massachusetts who just got his 3rd GUI, and he had just gotten his 2nd liver transplant (from a deceased donor).
    At first I felt outrage, but then, as you said in your blog, (this is a “thinking piece”), I had to reflect on some of the horrific choices I made as an addict, as did my husband, we are now clean and sober (11 years, and he found out he was sick 2 years ago), but we know that “There but for the Grace of God go I”…
    The problem I am having with all of this is not the acceptance of alcoholism and drug addiction as a disease, not the treatment of any disease, but the fact that unlike a person who smokes and gets cancer, chemotherapy is NOT in short supply. Diabetes? Insulin is in every pharmacy..obesity? weight loss programs and even surgery await those people.
    But ORGANS? WHOLE OTHER BALL GAME!
    So, that said, I think that I can only speak to what my husband (on UNOS LIST waiting for a liver) and I have experienced at our Transplant Clinic.
    1. No blood screens for drugs and alcohol, just a paper given to you, that you then take to the lab, where they give you a cup and send you into the bathroom, unsupervised, you could carry a huge bag in there with you, and that amazes me. Part of the disease of addiction/alcoholism (same thing) is manipulation and finding “the ways and means to get more”. So an active alcoholic or addict would easily bring a fresh urine sample, and remain on the list.
    2. My husband, an admitted recovering drug addict, has not even received so much as one counseling session about how he feels about being on the transplant list and being an addict. He has not been told to go to any groups, not required to document his sobriety. (I will say that he DOES get regular drug SUPERVISED screens at another clinic, where he voluntarily gets drug counseling, but there are others on our Transplant Clinic who do not have that, and they are on the List, free and clear, with absolutely ZERO support or mandatory counseling or group thereapy!
    3. RELAPSE PREVENTION AFTER THE TRANSPPANT…ESSENTIAL in anyone who has a drug or alcohol problem, and frankly, the people I know who have received the “GIFT OF LIFE” would GLADLY go to ANY group they are asked to, and find it beneficial and useful. So what is the harm, and WHERE IS THE SUPPORT?
    As I said, I can only speak for our particular hospital (one of the best in the WORLD, in BOSTON, MA) and I feel like we are experiencing the “PINK ELEPHANT SYNDROME”.
    (the saying goes that there is a giant pink elephant in the room, but the disease of addiction/alcoholism is such that denial is so rampant, nobody talks about it)
    When I am in the Transplant Institute, I sometimes glimpse the pink Elephant. (he wears pink trousers too…very dapper fellow)
    NO, I am not making light of this issue, quite the contrary.
    We need more stringent guidelines in place, because we as addicts can EASILY come off the path to recovery, and the result? ORGANS DIE, PEOPLE DIE..pretty high cost.
    Thanks for letting me BLOG on your BLOG…lol

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  13. Hey,Bob, good discussion question!

    How can we tell which person will make the changes needed in order to take care of the gift of a transplanted organ?

    I had a living donor or else I would have waited another 5 years for a kidney. Not because of my lifestyle but because of my blood type being the most common.

    Another consideration is the mental aspect. Are they prone to depression? Are they suicidal? Getting an organ does add stress to one’s life simply because you are now accountable to someone more than yourself and God.

    I will be honest. I have been prone to depression and a divorce, a seven month hospital stay plus dialysis really
    tested me but I past the test to be put on the list.

    I do know that getting the kidney added a whole new dimension to my life. In the back of my mind, I feel like I need to live the best life I can just to show my appreciation to my donor. That is how I can thank him for what he has done for me.

    Now that I think of it, that is really how I am to show my appreciation to God for all that He has done for me. I live by Grace and Grace alone!

    To answer the question, I feel you can only evaluate a person on the past performance and present awareness. How they will react in the future is only a guess.

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  14. Gary Burlingame

    My blood is 100% donor, genetically speaking. I don’t know what I did to get multiple myeloma, a blood cancer, since a cause has not been found.

    I also have a genetic liver condition, for which some people need a liver and/or lung transplant for. I know what caused that, but obviously, I didn’t have a choice.

    Fortunately, I have taken good care of myself, or I probably would have made it this far. Choices can help, but aren’t everything.

    I’m not going to try to answer any of your questions. Since there are not enough organs, we must pull all our values together, and work towards maximum care for all. I feel that we should all work towards caring for each other, but often, we don’t even take care of extended or even close family members. When we can do that, and for instance stop genitally mutilating half the population, I’ll get back to you on these minor details.

    There’s a world of hurt out there that needs attention.

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    • Ashley T Curran

      this comment is in response to your comment, Gary, I found it extremely informative. A dear friend of mine, Sally, had Multiple Myeloma, and though she fought the good fight, and even was very healthy at one point after the chemo and radiation (she went hiking in Colorado)…she went in to the hospital for a Bone Marrow Transplant, walked in without assistance, and unfortunately, the transplant was rejected by her body immediately.
      I can only imagine the rough times you have had, such a dangerous and destructive disease…
      My husband is waiting for a liver on the UNOS list, and he made the wrong choices, as did I. We have both been clean for ten years, long before he got sick 2 yrs ago, but the past can come to the present at any time..I don’t know WHY good people get sick, but I know that there ARE no “bad” people who get sick, in so far as addiction, alcoholism, etc are considered. It is SO refreshing to hear someone who made all the RIGHT choices that has such a warm and loving human heart for ALL humanity. You are so right, we all need to pull together, and get something going…in my opinion, and I believe in Bob’s, the “Donor” method is a GREAT one, but it just is not working. On to a positive solution!!!!
      Thanks 4 yr comment.

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  15. Hi Bob,

    A great question, and I look forward to hearing others answers.

    First of all to let you know that I am a liver transplant patient (not because of alcohol, but a viral infection)

    I also feel that addictions are just as much of a disease as any other medical condition. Really no different from diabetes or heart disease. Addictions play havoc on the life of the person dealing with it, and their family and friends. Sadly there is still a huge stigma around this.

    I am not sure what the policies in transplant centers around North America are. I believe in center, they do not transplant people who are still actively abusing substances, but they do help these people find appropriate treatment. In most cases I would say I agree with this. But I do hate to see an across the board rule.

    I met a fellow at my clinic who was a rip roaring alcoholic and they were not going to transplant him. Somehow he convinced the team he would never touch a drop. He hasn’t, and did his rehab around his alcoholism after his transplant. He has done well and is now there for his family and children. I do recognize that not everyone could do this.

    So I think a general guide that a person still abusing substances is not a good recipient is in order, but each case needs to be individually assessed.

    But I strongly feel that people with addictions issues are people like every one else and deserve just as much right to medical treatment as anyone else. I am not seeing that we are refusing to provide medical treatment to smokers who have created their own health problems.

    Thanks for posting the question, and I will look forward to reading your new responses.

    D

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