Should alcoholics get liver transplants?

BBC ^ | Last Updated: Monday, 14 July, 2003, 11:14 GMT 12:14 UK | By Richard Warry

[Cinnamon Girl]

The failure of footballer of George Best to refrain from drinking alcohol despite a life-saving liver transplant just 12 months ago has prompted questions about the merits of offering transplant surgery to alcoholics.

Some say it is a waste of a precious and scarce resource, but others say there is no reason why people suffering from such a debilitating disease should be discriminated against.

The George Best case may give the impression that people suffering from alcoholism take their place in the transplant queue like any other person with severe liver disease.

In fact, this is not the case. Many units operate a vigorous screening policy to determine whether there is a good chance that a patient will give up dangerous drinking following surgery.

If the signs are bad, then they may very well be denied a transplant.

The Scottish Liver Transplant Unit in Edinburgh is one which takes this line.

It is headed by Mr John Forsythe, vice president of the British Transplantation Society.

He told BBC News Online: "You could say no patient with alcoholic liver disease should receive a transplant, but that would be pretty harsh on the truly reformed alcoholic who would do very well.

"Alternatively, you could say that that these patients should always be considered for a transplant, but that is plainly ridiculous.

"In cases where the likelihood of recidivism is high that would mean a vital resource given after a lot of thought by a donor family is likely to be wasted.

"That leaves us with something in between. We have a robust procedure to assess whether there is a good chance that a patient will not return to harmful drinking.

"If there is, then we will consider surgery. After all we have a duty of care to the recipient which is obvious, but we also feel we have a duty of care to the donor family."

Mr Forsythe said the chances of a patient returning to dangerous levels of drinking following surgery were low. Around 15-20% of patients do drink following surgery, but only about 2% of these do so at levels which could damage their new liver.

Long-term commitment

Dr Robert Lefever, who runs the Promis Recovery Centre for addicts in Kent, believes that patients with alcoholic liver disease should only be offered surgery if they have made a tangible commitment to staying off drink.

"People need to go to Alcoholics Anonymous and demonstrate that they understanding that they have to make a long-term commitment to tackling their problems," he said.

"Just simply saying 'I'm never going to drink again' is not good enough - anybody could say that."

Many would question whether George Best was a suitable candidate for surgery.

But his surgeon is not one of them. Professor Roger Williams said Best's weekend drinking session - which included a scuffle with a photographer, was a temporary lapse.

"Up to about a week ago he had been in extraordinarily good form," he said.

"He was at a House of Commons reception to launch a joint parliamentary group on liver disease and I had never seen him look so well, or talk so well. He was altogether a transformed person."

Sympathy required

Eric Appleby, of the charity Alcohol Concern, agreed. He stressed that Best needed sympathy - not criticism.

He said: "This isn't like swapping over a component in your car. If you get a new liver, it doesn't stop the problems you had which got you into trouble in the first place.

"I'm sure George Best was absolutely sincere in his wish to stop drinking.

"But drinking in this country is almost how you define yourself, and sitting at home with a glass of orange juice is not what a guy like him has been used to.

"How he leads his life, where his mates are, what he does is down the pub, and it's a tough call to cut that out of your life."

Mr Appleby rejected the idea that alcoholics should be made a low priority for a liver transplant.

"Whatever aspect of health you look at there is always some contributory factor.

"What we need to ensure is that those people who do get transplants actually get the help and support they need to make the most of it."

Deepak Mahtani is from the organisation Transplants in Mind, which works to increase public awareness of the benefits of organ donation.

He said everybody deserved equal treatment from the NHS - including George Best.

"When he received the liver transplant a year ago he made a resolution to stop drinking, and I do believe he was sincere in that.

"Nevertheless, drinking is part of the society in which we live, and he is only human with human frailties."

Mr Mahtani accepted that the negative publicity surrounding Best might put some people off donating their organs.

"I have heard people saying 'why should we register on the organ donor register if our organs are going to be wasted in this way'. But I don't think this is the rule, this is an exception."

Media criticism

Best also won support from Labour MP Helen Clark, a member of the all-party hepatology group, which the footballer helped to launch last week.

She criticised the media for adding to the pressure on Best by camping outside the pub in which he was seen drinking.

"George hadn't touched a drop of alcohol for three years, and nobody knows what caused this blip.

"He is not an evil, wicked person behaving in a terrible, bad way, he is ill, and he does need help."

[Cinnamon Girl]

There does seem to be serious problems that sometimes arise with the various systems of organ transplant. And the more any hospital or country removes the guidance of religious ethics to help with moral decisions, the more there will be amoral actions taken.

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[ken5050]

See: Mickey Mantle..

[ALASKA]

Should alcoholics get liver transplants?

NO

[Mr. Bird]

I've always been of the opinion that there shouldn't be an automatic disqualification for alcoholics. The article pretty well addresses the factors that should be weighed, i.e. evidence of commitment, etc. If we start disqualifying alcoholics automatically, when do we start disqualifying fat people for hearts or reckless drivers for anything?

We'd be asking physicians to start making value judgements, and I think their focus should be on making their patients better.

[bigfootbob]

Don't forget about "Papa" John Phillips and Larry Hagman too. As a person who's possibly going to need a liver transplant in 5 years from Hepatitis C contracted from a blood transfusion 30 years ago, I would prefer non-reformed alcoholics not be allowed a transplant unless it's donated by a family member. Alcohol is extremely bad for damaged livers, I stay away from all forms including mouthwashes that contain alcohol.

[randog]

I have a good friend that had a serious drug problem in his youth and contracted hepatitis. He has since found God, got a college degree, got married, had a child and is living a decent, moral life. He is not eligible for a liver transplant because of the circumstances surrounding his disease, but he's OK with that and acknowledges that he made mistakes in his life and must pay for them.

[Dr Warmoose]

This is the beauty of socialized medicine. Under the old rules, if a person had the money and could afford it then little was denied to them. With Socialized Medicine, it appears that icarcerated criminals have a chance at the head of the line before the "alcoholic" with the financial means, just because it is "unfair" that someone who abused their liver getting drunk should have one when this miserable looking person over there, by our means of reckoning, is more deserving.

Under the new rules, one needs to sign up with advocacy groups. Those who are obese and are heart attack candidates, should ban together and lobby the Powers That Be to remove any stigma that may prohibit them from getting that rationed care.

Homosexuals and drug addicts should ban together and plead the case that AIDS and hepatitis knows no demographic boundaries, and everyone should just ignore those lying statistics and fork over the free/subsidized health care.

I guess money still talks, just not at the hospital. If you want a particular medical treatment your money is much better spent on a politician.

[ken5050]

Good luck to you, my friend...I wasn't aware of the two other cases you mentioned..

[Dr Warmoose]

Who are you, and by what authority do you claim to have any say over another person's healthcare?

When you say that alcoholics should be denied liver transplants, then you are setting up a precedent that any private transaction needs to be approved by the Life Style Police - and it seems that you are bucking for the job as Chief.

[Protagoras]

Why is it any of your (or anyone else's) business?

[Protagoras]

When you say that alcoholics should be denied liver transplants, then you are setting up a precedent that any private transaction needs to be approved by the Life Style Police

Bingo! But don't think you will get much support for small unintrusive government around here.

[Cinnamon Girl]

Since the families of organ donors don't get money for their love one's organ DONATION how is it a business transaction? Also, the families have no say in who gets the organ as far as I know.

[misterrob]

Some people just like to live in judgement of others.

weighing my two cents on the matter, as a recovering alcoholic (14 years plus sober....thank God) I have seen people go out and make make major transformations in their lives by learning to live sober. It isn't easy and some people just never get it regardless of how much they try. Regardless though everyone is responsible for their own life and as such for those who continue to drink, they shouldn't be eligible for transplants until they have demonstrated the ability to stay off booze.

It's not a judgement issue rather a resource decision. Do we put an organ into someone who wants to live or put it into someone who's actions show that they don't respect their own life?

[Protagoras]

Since the families of organ donors don't get money for their love one's organ DONATION how is it a business transaction?

Who said it was?

Also, the families have no say in who gets the organ as far as I know.

They should. And they should get paid if they want to.

[Protagoras]

they shouldn't be eligible for transplants until they have demonstrated the ability to stay off booze.

Who says? Who should be making the decision?

It's not a judgement issue rather a resource decision.

If I want to give my organs to someone who's business is it other than mine?

Do we put an organ into someone who wants to live or put it into someone who's actions show that they don't respect their own life?

WE?

[Cinnamon Girl]

I like what you said. An alcoholic I know was only able to stop drinking when he was put on medication. I wonder if this guy could be helped in that way. Also, the comments in the article about "drinking is a social thing" may be part of the problem in this case. If he doesn't recognize his addiction, how can he commit to stop?

[MEGoody]

Should alcoholics get liver transplants? Not if they are still drinking.

[Cinnamon Girl]

You are basing your comments on a theoretical practice. The way it is now, donors don't choose the recipients, and people who need a transplant are put on a waiting list.

[Sabertooth]

Alcoholics should get liver transplants if they can afford them, and they've got a willing seller.The donor's estate should make the decision, and be compensated.