Liver Transplants for Patients with History of Alcohol Abuse
Position Statement
Whether patients with a history of alcohol abuse are deserving of liver transplants has long been a contented issue. Often, in discussion of this issue, a hypothetical situation is created where two patients, one an alcoholic and the other alcohol-free, are both in need of a liver. The question as to who is more entitled to a liver transplant is then raised. Other than entitlement, two factors aggravate the situation even further: the scarcity of donor livers and the lead cause of liver failure being alcohol-related liver disease (Thornton, 2009). A number of positions have been taken by various parties in relation to this topic. In spite of this, patients with a history of alcohol abuse should be considered for liver transplants so long as they show an effort of recovery from alcoholism.
Perspective One: Alcoholic Patients should be considered for Liver Transplants
Patients with a history of alcohol abuse who have made an effort to recover from their addiction should be given a chance at recovery from liver disease. This is because alcoholism is itself a disease for which patients of liver failure should not be punished. In addition, according to Sharkey & Gillam, the argument that liver recipients with a history of alcohol abuse will waste the organ is refutable (2009). First, the recipient’s body has a higher chance of rejecting the liver than it does of destroying if from continued alcohol use. Secondly, most liver recipients with a history of alcoholism often show signs of recovery before the transplant, and minimize or completely stop alcohol use after a transplant. Finally, as long as there is a shown effort to recover from alcoholism on the patient’s part, it can be morally argued that man has no right to deny his fellow man a fundamental right.
Perspective Two: Alcoholic Patients should not be eligible for Liver Transplants
However, other people hold a different opinion. This is because they tend to think that an illness caused by poor lifestyle choices has a morally weaker claim to treatment than that which occurs ‘naturally’ (Brudney, 2007). In addition, supporters of this perspective argue that people with a history of alcohol abuse who get a second liver will waste it when they revert to their alcoholic lifestyle. Moral responsibility is the main basis of those who support this perspective. Expense and scarcity are also used to support this argument. According Thornton, the American Liver Foundation reported more than 16,000 patients in need of a liver in 2009 (2009). Of these, about 38 percent received a new liver while about 13 percent died on the waiting list. In addition, cirrhosis, which is partly caused by alcohol abuse, was seen to be one of the most common diseases requiring transplantation. These statistics show that the demand for donor livers is high and effort should indeed be taken to ensure that wastage is minimal if not non-existent.
Possible Solution
A possible solution to the debate is requiring that all patients with a history of alcohol abuse provide proof that they have made an effort to recover. This can further be aided by input from multidisciplinary sources. For instance, psychologists can help in the understanding of alcoholism as an addiction that like any disease requires attention (Sharkey & Gillam, 2009). Moreover, education of the public on the consequences of heavy drinking – which include cost, health risks and repercussions on society – should be carried out. Finally, stakeholders, such as medical practitioners, should ensure that ethical procedures of the transplantation process are carried out to the letter, and that discrimination or personal bias does not feature in the process.
Potential Solution Impact
If taken into effect, the solution would ensure that patients who have had a history of alcohol abuse are considered for liver transplants and are not discriminated. Further, it would aid in recovery from alcohol addiction, as patients would be motivated to seek help and avoid alcohol use and abuse. Finally, involvement of other disciplines in addressing this ethical issue would ensure that it is considered from all possible perspectives and solved using the best means possible.
References
Brudney, D. (2007). Are alcoholics less deserving of liver transplants? The Hastings Center Report, 37(1), 41-47.
Sharkey, K., & Gillam, L. (2009). Should patients with self-inflicted illness receive lower priority in access to healthcare resources? Mapping out the debate. Journal of Medical Ethics, 36(11), 661-665.
Thornton, V. (2009). Who gets the liver transplant? The use of responsibility as the tiebreaker. Journal of Medical Ethics, 35(13), 739-742.
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