Liver Transplant and Alcohol Related Liver Disease: Time to Move the Goal Posts for Alcoholics?

I spent the day in Minnesota today giving a lecture on the ethics of transplanting patients with alcoholic liver disease. This is one of the more debated issues in medicine as well as in the field of transplantation.

Historically, patients with alcoholic liver disease need to wait six months before being considered a candidate for liver transplant. This so-called “six-month rule” generally requires patients to be abstinent for six months prior to that being seriously considered for transplant. One problem with the six-month rule is that there is no meaningful research indicating that being abstinent for six months reduces the chance of alcohol consumption after a successful transplant.

One of the major concern is the resumption of damaging alcohol use after transplant. Here again, the research is lacking, with no firm evidence that patients transplanted for alcoholic liver disease resume alcohol abuse to the point of damaging the newly transplanted liver.

Patients that are transplant for alcoholic liver disease have some of the best outcome and highest survival, compared to those transplanted for autoimmune or viral hepatitis.

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There is a growing sentiment amongst transplant programs around the country that the six-month rule needs to be phased out. From an ethical standpoint, considering patients with alcoholic liver disease have equal or better survival compared to other forms of liver disease that are transplanted, there is no ethical reason to deny patients this opportunity.

Patients with alcohol induced liver disease need a comprehensive evaluation prior to transplant, and will need to participate in rehabilitation before and after successful transplant.

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It will take time to implement this type of change in the transplant community. I firmly believe that patients with alcoholic liver disease deserve a second look, and that eventually phasing out the six month rule is the first step.

Public opinion in this area needs work, reassuring the public, and potential organ donors, that these donated organs will be transplanted into worthy candidates that will have excellent outcomes and survival.

For more information or to be evaluated for a liver transplant, contact us at 713-794-0700 or visit us at www.texasLiver.com.
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