Should alcoholics compete equally for liver transplantation?

Abstract

The circumstances of liver transplantation are unique among organ transplantation because of the dire, absolute scarcity of donor livers and the predominance of one disease--alcohol-related end-stage liver disease--as the principal cause of liver failure. We propose that patients who develop end-stage liver disease through no fault of their own should have higher priority for receiving a liver transplant than those whose end-stage liver disease results from failure to obtain treatment for alcoholism. We base our proposal on considerations of fairness and on whether public support for liver transplantation can be maintained if, as a result of a first-come, first-served approach, patients with alcohol-related end-stage liver disease receive more than half the available donor livers. We conclude that since not all can live, priorities must be established for the use of scarce health care resources.

KIE: In 1990, the Health Care Financing Administration recommended that Medicare coverage for liver transplantation be offered to patients with alcoholic cirrhosis who are abstinent, and that the same eligibility criteria be used for patients with alcohol-related end-stage liver disease (ARESLD) as for patients with other causes of end-stage liver disease (ESLD). Moss and Siegler argue against this policy, proposing that patients who develop ESLD through no fault of their own have a higher priority for receiving a transplant than patients whose ESLD results from a failure to obtain treatment for alcoholism. They base their proposal on considerations of fairness and on whether public support for liver transplantation can be maintained if over half the available donor livers, which are in scarce supply, go to patients with ARESLD.