What determines eligibility for liver transplantation in patients with alcohol use disorder?

Abstract: Transplantation in those with alcohol-associated liver disease presents an ethical dilemma. The stigma associated with alcohol use disorder used to preclude people from receiving a transplantation, as it was believed that patients with alcohol-associated liver disease were to blame for their condition. Recently, alcohol use disorder is being recognized as a biological illness, rather than a moral failing. However, there are limited livers available to be transplanted, meaning providers must practice good stewardship. Continued alcohol abuse post-transplant can result in graft failure and recurrence of liver disease. The “six-month rule” was created to allow liver transplantation in those with alcohol-associated liver disease after they have achieved six months of abstinence. However, waiting six months for a transplant is not an option for many patients, as their liver disease carries significant mortality. When should potential organ recipients whose livers have failed as a result of alcohol use receive a donated liver?
This presentation will explore the history of the stigma associated with alcohol use disorder, the history of liver transplantation in alcohol-associated liver disease, tensions that arise between the ethical principles in play for both living and deceased donation scenarios in cases of liver failure as a result of alcohol use, and the model that some transplant centers use for determinizing eligibility for transplantation for patients with alcohol associated liver disease prior to achieving six months of abstinence. This panel will provide interdisciplinary discourse from different perspectives, including medicine, law, philosophy, patient advocacy, as well as lived experience with transplant.

Keywords: Addiction, Organ Transplantation, Hepatology