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.