Ethical Insights from the Social Model of Disability Regarding Early Liver Transplantation for Alcohol-Related Liver Disease

Janetta Brundage – PhD Student, Bioethics, Case Western Reserve University

Abstract: Alcohol-related liver disease (ALD) is the leading indication for liver transplantation (LT) in the US. Historical practice for LT for ALD includes a mandated alcohol abstinence period of 6 months. But, given the extremely high 6-month mortality rate for a subset of patients who do not respond to treatment, some transplant centers have started to perform LT for ALD before 6 months of abstinence, a practice known as early liver transplantation (ELT). Frameworks for ethical considerations of ELT are needed. ‘Alcoholism’ has had several names historically, and has been viewed through multiple lenses: from a personal and moral failing, to a medical illness model. We want to consider how utilizing the social model of disability can provide further insight into this complex ethical issue and offer useful guidance on providing just, nuanced care to ALD patients seeing ELT. By utilizing an existing model from disability scholarship and activism, we aim to answer the following questions: is the social model of disability a helpful framework for conceptualizing ELT? How does categorizing ALD as a disability through the lens of a non-medical model benefit, harm, or complicate the treatment of patients with ALD? What insight can be gleaned from the social model of disability for consideration of the ethical implications of ELT, especially as it relates to the principle of justice? We will explore these issues in the hopes of offering guidance on the utilization of this model as it applies to this complex population.

Keywords: Alcohol-related liver disease, Liver transplant, Social model of disability