When alcohol abstinence criteria create ethical dilemmas for the liver transplant team

Journal of Medical Ethics 32 (5):263-265 (2006)
  Copy   BIBTEX

Abstract

In the setting of transplant medicine, decision making needs to take into account the multiple clinical and psychosocial case variables, rather than turn to arbitrary rules that cannot be scientifically supportedThe yearly demand for liver transplants far exceeds the supply of available organs .1 Additionally, alcoholic cirrhosis has been a controversial indication for transplant as these recipients can be viewed as having caused their own illness—an illness that is preventable by abstaining from alcohol . While not categorically denying liver transplantation to those with alcoholic cirrhosis, many hospitals have incorporated a six month alcohol abstinence criterion 2 in an effort to select optimal candidates. The six month rule has two purposes; namely, allowing the liver a chance to recover in the absence of alcohol , and also observation of the patient to verify that he/she remains alcohol free, with the hope of reducing the risk of relapse. Everhart et al,3 determined that 85% of US liver transplant programmes and 43% of third party payers require a defined period of abstinence—for example, three or six months—as part of the waiting list process.Liver transplantation does not cure alcoholism, as evidenced by the fact that roughly 20% of these patients use alcohol following transplant, with one third exhibiting “repetitive or heavy drinking”.4 Arguments abound as to the scientific merit of a six month abstinence criterion in reducing the risk of alcohol relapse following transplant. Some propose that a minimum of six months abstinence itself predicts a lower relapse rate,5 while others argue that six months is not predictive or that other factors—for example, illicit drug use—in combination with a minimum number of months abstinent is predictive.6,7 Even the United …

Links

PhilArchive



    Upload a copy of this work     Papers currently archived: 93,745

External links

Setup an account with your affiliations in order to access resources via your University's proxy server

Through your library

Similar books and articles

Responsibility and Priority in Liver Transplantation.Walter Glannon - 2009 - Cambridge Quarterly of Healthcare Ethics 18 (1):23-35.
Responsibility, alcoholism, and liver transplantation.Walter Glannon - 1998 - Journal of Medicine and Philosophy 23 (1):31 – 49.
Case Vignettes in Transplant Psychiatry Ethics.H. Paul Chin - 2022 - Cambridge Quarterly of Healthcare Ethics 31 (3):386-394.

Analytics

Added to PP
2010-08-24

Downloads
39 (#115,291)

6 months
13 (#1,035,185)

Historical graph of downloads
How can I increase my downloads?