THE COMPLEXITY OF ALCOHOL
(continued from page 21)
disease was due to a patient’s voluntary actions—and, accordingly,
providing a deceased donor LT to patients with ALD means taking
a scarce resource away from patients who are purportedly “more
deserving.” As one ethicist posits, “what justifies giving them low-
er priority for a liver transplant is that they are not only causally
but also morally responsible for their liver failure.” 19
10.
11.
12.
CONCLUSION
At this time, liver transplant remains the only durable long-term
therapy for ALD. Appropriate patients with end-stage liver dis-
ease secondary to alcoholic cirrhosis should be considered for
liver transplantation, just as other patients with decompensated
liver disease, after careful evaluation of medical and psychosocial
candidacy. In addition, this evaluation should include a formal as-
sessment of the likelihood of long-term abstinence. Patient selec-
tion criteria is center dependent with most requiring six months
of sobriety. Return to harmful drinking after transplant remains a
unique challenge in this population and ethical issues surround-
ing liver transplant for ALD remain contentious. At the Trager
Transplant Center, we believe equity in access to transplantation
is an ethical requirement. Treating all liver patients the same way
eliminates the possibility that some patients gain quicker access to
transplantation than others because of a trait, such as demograph-
ics, experiences or behaviors.
Dr. Jones is the division director of the University of Louisville’s Department of
Surgery, Division of Transplantation.
Dr. Adamson is a practicing surgeon in UofL’s Department of Surgery, Division of
Transplantation. (non-member)
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