Some people have views about alcoholics and whether they should receive liver transplants or not. Many of these views are based on little knowledge on the real facts of alcoholism and liver transplants.
On a case by case basis, it’s hard to deny anyone lifesaving surgery. The reality is, that’s what the decision makers for liver transplants have been doing. Alcoholics have been denied their right to receiving liver transplants for years.
The liver transplant waiting list by state will demonstrate why the guidelines are so strict on who should receive the procedure. The problem is, there isn’t a lot of logic behind why alcoholics are denied this much needed treatment.
Pros and Cons of Alcoholics Receiving Liver Transplants
Liver transplants for alcoholic’s pros and cons have long been debated. For many years, alcoholics have been denied the surgery but things are starting to change.
The arguments against liver transplants for alcoholics makes very little sense when dissected. This is exactly what one women from Canada did. She raised questions and has created the potential for change.
Principal Reasons Behind Liver Transplant Exclusion Criteria
Liver transplants are in extremely high demand. The supply of available organs doesn’t meet the demand. This is a major factor on why people think alcoholics should not receive liver transplants.
Alcoholic cirrhosis and the denial of liver transplants are based on the view that these patients caused their own illness. The moral dilemma is a challenge for liver transplant teams because if untreated, often a person with ALS complications will die. Their only hope is this surgery.
The area is grey as these patients aren’t technically denied for having ALS or alcoholic cirrhosis.
Why is There a 6 Month Rule for Alcohol Abstinence?
How long do you have to be sober to get a liver transplant? There is often a six month absence of alcohol that a patient needs to comply with to be eligible.
Liver transplant requirements state that a person must have abstained from alcohol for six months. This is to select optimal candidates. The six month rule is said to give a patients’ liver the opportunity to heal on its’ own.
This rule is also in place to observe the patient, ensuring that they have stopped drinking. It’s to determine the risk of relapse. Getting a liver is essentially a gift and the powers that be treat it as such.
Who is Responsible for the Liver Transplant Qualifications?
These liver transplant qualifications are determined mainly by the US liver transplant programs. A percentage is also determined by third party payers who require a period of abstinence. These third party payers, which are usually a person’s insurance company, may require a patient to go to rehabilitation for alcohol.
The argument about liver transplants for alcoholics is that liver transplants don’t cure alcoholism. In fact, 20% of patients will continue drinking alcohol after they receive a transplant. They are given the gift of a new liver and abuse it.
Death Due to Denial of Liver Transplants
There are more than 21,000 Americans who die from ALD complications every year, based on a CDC report. There is a potential that a liver transplant could have saved their lives.
Transplant programs include selection committees who monitor liver transplant requirements. They make sure each patient put on the national registry for an organ donation is a practical choice. These panel of decision makers include surgeons, pharmacists, nutritionists, social workers and psychologists.
The liver transplant exclusion criteria includes a weigh in of psychosocial and family health characteristics, how serious their health issue is, and substance abuse history.
A Widow’s Legal Challenge Creating Change for Liver Transplants in Addicts
Alcoholic liver diseases don’t respond to medical therapy. Diseases like alcoholic hepatitis and acute-on chronic liver failure have up to a 90% mortality rate within a year.
Most of the transplant centers include the six month stipulation in their liver transplant for alcoholic’s rules. This rule has no scientific evidence but more based on opinion. This is why a widow’s challenge has prompted a Canadian province in Canada to transplant livers into up to 100 alcoholics who need it.
Debra Selkirk’s husband died and she challenged the liver transplants for alcoholic’s rules. Although she was willing to donate her liver and seemed to be a match, the Toronto’s University Health Network denied his operation. He needed to be sober for six months to receive the surgery but died 2 weeks later.
The Pilot Project for Alcoholics and Liver Transplants
This has prompted a pilot project, making alcoholics with liver disease eligible for transplants. They don’t have to be sober for six months to become eligible through the project.
Over the next three years, there are going to be transplants provided to nearly 100 patients who would otherwise not be eligible.
Increase of Wait Times for Liver Transplants are a Concern
There is a concern that if alcoholics aren’t denied an organ donation, the wait times for liver transplants will increase. Due to longer waiting times, the public may not support the pilot program that is run by Trillium agency.
The Trillium agency has said that the goal of the project is merely to find evidence to determine whether criteria should be changed for liver transplants in alcoholics. This isn’t a “set in stone” policy by any means. The liver transplant exclusion criteria has not been changed.
How Did Selkirk Win the Fight?
Selkirk had no experience in the medical field and she had no lawyer. Despite these obstacles, she has caused the opportunity for change that is now in motion. This shows that the ideals were on faulty ground in the first place.
She launched the challenge for this constitution in 2015. Her argument was based on violation of constitutional rights to equal treatment. Furthermore, she argued that there’s no evidence to prove the six-month rule is effective.
Initially, there was a fight against the challenge but in 2016, provincial lawyers approached Selkirk. They agreed to hire a lawyer for Selkirk and take care of the fees. They asked that she put the case on hold while the liver transplant exclusion criteria was being reviewed.
Contrary Evidence to the Constitution with Liver Transplants for Addicts
While there is no conclusive evidence on the efficacy of the six-month rule, there is proof of alcoholics recovering after an organ transplant.
The chief of transplant surgery at the University of Chicago cited a series of studies in an affidavit. There was an indication that alcohol-liver disease patients recover well with transplanted organs. They were also found to rarely go back to heavy drinking.
Part of the research includes 4,000 liver transplants. The results showed that just as many patients with ALD were still alive five years after the transplant as others who received a liver transplant.
The conclusion of the American Association for the Study of Liver Disease and American College of Gastroenterology is that all patients with liver problems should be treated equally. When it comes to the US, it is centers that drive the liver transplant policy. Also public perception sees alcohol addiction as a form of self-destruction.
Why Liver Transplant Exclusion Criteria is a Contradiction
Should alcoholics be eligible for liver transplants has been debatable. One of the arguments is that they caused their own illness.
Ironically, the largest groups of patients eligible for transplants without restrictions are those with non-alcoholic fatty liver disease. This type of liver disease is most often caused by a poor diet and lifestyle.
These people are also hurting themselves knowingly but will receive approval for a liver transplant. The abuse is similar in that it takes a lot of lifestyle mismanagement to destroy the liver.
Hypothetically, if they were denied based on hurting themselves intentionally, that wouldn’t be acceptable. Why is it acceptable then when we deny treatment to alcoholics?
The Unknown Future of Liver Transplant for Alcoholics
Awareness is growing so instead of just screening patients, organizations are connecting patients to addiction recovery treatment. By helping patients maintain their abstinence, they are being given the chance to recover fully. This can help the liver heal itself so the transplant may not be necessary. This is giving addiction specialists the opportunity to help the transplant procedure.
In knowing the alcoholics story, a therapist can determine many things about the potential of full recovery. Otherwise, experts are playing a guessing game on who is willing to recover fully to save their own lives.
Current Change in Liver Transplant and Alcoholics
There are currently more liver transplants being done for those with end-stage alcoholic liver disease. The topic is still controversial and more focus will need to be taken on studies that produce real answers.
The six-month rule has been accepted but there’s no hard facts to prove it’s more effective in proper liver transplant management. Having a study that focuses on this outcome should help truly determine what the right answer is for this debate.
The Trillium plan in the province of Ontario will incorporate addiction treatment, specialized psychiatrists, and nurses to reduce chances of drinking relapses. Selkirk believes that part of the plan should be to educate the public to counteract the prejudice against those with ALD.