Liver disease and hepatitis are the names of a few issues affecting the human liver, which result from poor human decision-making. In light of today’s medical advances, U.S. society is very well aware of the issues behind excessive drinking. These activities result in cirrhosis or scarring of the liver, which decreases its detoxing efficiency. This decreased efficiency results from fibrous tissue accumulating within the sinusoids of the liver in addition to increased oxidative stress caused from mitochondrial enzymes. This leads to inadequately filtering the blood within the liver complicating a variety of other bodily systems. A study recently published in the New England Journal of Medicine shows that individuals with severe alcoholic hepatitis have a better chance of surviving 6 months when transplantation occurs early rather than not at all (77±8% vs. 23±8%). The controversy mentioned in a recent USA Today articles addresses whether or not patients with previous documented alcohol or drug abuse ought to be considered for transplant without significant evidence of lifestyle change. According to online medical statistics, it is estimated that 50% of patients resume drinking after receiving a liver transplantation despite being forced to be abstinent 6 months prior to transplantation. This is clearly difficult to accept when the previous mentioned New England Journal of Medicine suggests that earlier liver transplants result in better statistics for survival after 6 months. This begs the question of whether or not people who abuse drugs and alcohol have a legitimate argument for receiving liver transplants when a majority return to harmful habits post surgery. In my opinion, because the news article states that nearly 1,400 people die each year while waiting for liver transplants (some drinkers and some non-drinkers) it is difficult to hear arguments for people who abuse their body to receive such a gift without showing the commitment to change. Counter arguments such as lack of awareness and socioeconomic status seem to be weak at best because the National Health Interview Survey suggests that the highest percent of adults who integrate alcohol into their lifestyle are 400% above the poverty level. This illustrates at least ample awareness and resources for proper treatment. Ultimately, it is difficult to rationalize enabling individuals who continue to make poor lifestyle choices with a gift as precious as a liver transplant when they will only continue to bog down a healthcare system by using their new chance on life so egregiously.
http://www.cdc.gov/nchs/data/hus/hus10.pdf#065
http://www.nejm.org/doi/full/10.1056/NEJMoa1105703?query=featured_home
I tend to agree that it is difficult to justify giving away a precious commodity to someone that is likely to abuse the privelege. However, I think more careful screening needs to take place before ruling out the possibility of donating a liver to a chronic drinker. My former roommate was faced with this situation through his brother-in-law, who had only began drinking heavily during the last 6-8 months of his life. He had not been a chronic alcoholic, nor was he given a huge timeframe to change his ways before alcoholic liver disease (or something similar) set in. He had a young wife and brand new baby when he was hospitalized, and passed away just a few short weeks later. Many people go through tough times and turn to unhealthy vices to ease the pain. I feel that cases such as these are warranted for granting a new chance at a healthier, happier life. Of course, this is very subjective. Clearly more wide-ranging and judicious screening measures are necessary to fully address this issue.
ReplyDeleteRegarding Ashley’s comment, I agree that there should be a series of screenings before a chronic alcoholic is ruled out from receiving a liver. There are many people who turn to alcohol due to a series of unfortunate events and difficulties, but it may not be chronic and/or last for the rest of their lives. There are people who may turn to drinking, but eventually come to their senses and resolve their problems-like Ashley’s case, but there are people who have been big drinkers all their lives and will continue to be chronic alcoholics. An example is a man I know who is close to me. He hasn’t had any liver problems (that we know of), but he is a big drinker and has been a heavy drinker for all the years that I have known him. At social events and gatherings, he is usually intoxicated to the point of being carried to bed. Although this man is dear to me, I know that even with a liver transplant, it would not be fully appreciated and he would most likely continue to drink and abuse the liver. In cases such as his I believe that liver transplants should not be granted. Again, there are many people who turn to alcohol, but some can break out of the habit and be helped.
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