HEALTHWISE: Alcohol and Liver Transplantation – Lucinda Porter, RN
April Alcohol Awareness & National Donate Life Month
Imagine that you have a thirty-something year-old daughter or son. Your adult child is the parent of your grandchild, who is the love of your life. Tragedy has struck. Your adult child is a heavy drinker, and is now in the intensive care unit, fighting to live. Your child needs a liver transplant, and will die without one, leaving your grandchild minus a parent.
The heartbreaking reality is that your son or daughter might not receive a liver. For as long as liver transplants have been performed, most U.S. transplant centers require people with alcohol-related liver injuries to be sober for 6 months before they are listed as a candidate. The rationale for this is to avoid risking scarce organs on alcoholics who might relapse and harm the transplanted liver.
It’s complicated from both a medical and ethical standpoint. Although alcoholism is a medical diagnosis, alcohol use is perceived as a behavioral problem. Heavy alcohol use doesn’t necessarily mean that one is an alcoholic. Let’s say in this fictitious case, the adult child is your daughter. She recently had a baby, and is battling postpartum depression. Although alcohol is a depressant, she uses it to cope. The situation is complicated because as a female, her body doesn’t metabolize alcohol as well as most men’s bodies do. She binges, and is now in a hospital with acute alcoholic hepatitis.
There is no doubt in my mind about what I’d hope for: I’d want a transplant for my child, even if he or she isn’t sober. I believe in mercy.
Now imagine the same scenario, except this time your adult child was the victim of a motor vehicle accident. Life support will be stopped after all vital organs are removed. Your child is technically dead, but his or her organs will give life to others. One of the potential recipients may be dying of alcoholic hepatitis. How do you feel about that? How would you feel about it if your child’s death was caused by a drunk driver?
In this situation, my belief in mercy is tested. Fortunately, decisions about cadaver organ allocations are not left up to donors or recipients. Decisions are based on evidence and ethical standards.
It is essential that we have a fair system for the sharing of organs. The Organ Procurement and Transplantation Network (OPTN) brings together medical professionals, transplant recipients and donor families to develop our national policy. The U.S. organ transplant system is managed by the United Network for Organ Sharing (UNOS).
Years ago, UNOS opted not to recommend an exact timeframe for alcohol abstinence before liver transplantation. Although specific guidelines determine who will be eligible for the next liver, the actual eligibility requirements differ among transplant centers. Some centers in the U.S. are now considering transplanting people with acute alcoholic hepatitis, and are relaxing their six-month abstinence from alcohol requirement.
Second Chances I said I wasn’t sure about how I’d feel if my child was the donor for someone in alcohol-related liver failure. I hope I’d feel generous, especially since I was once in a similar situation. In 1988, beaten by 20 years of severe clinical depression and post-traumatic stress syndrome, I attempted suicide. I was abusing alcohol and added a near lethal overdose of pills to the mix. The initial result was multi-organ failure. My liver failed, with enzymes above 18,000. My kidneys failed, and my heart was following. The transplant team was not keen about giving me a liver, and quite frankly, they were justified. I was 35 years old and had a 3-year-old daughter. I was told to say my good-byes, as I would not live another 24 hours.
In the end, I didn’t need the transplant. However, I did need multiple blood transfusions. That beautiful donated blood saved my life and gave me hepatitis C. I am grateful to those who donated the blood that gave me a second chance. I hope our organ allocation system continues to give second chances to others, despite the challenging situations they may find themselves in.
Some Facts About Liver Transplantation The liver transplant waitlist in the U.S. is increasing annually, growing by 7.6 percent in 2016. There are nearly 14,000 people waiting for a liver; roughly half will receive one.
For nearly two decades, hepatitis C-related complications were the leading indication for liver transplantation. Hepatitis C treatment using direct-acting antivirals (DAAs) is changing this. In 2016, alcoholic liver disease (ALD) took the lead, with non-alcoholic steaotohepatitis (NASH) following closely behind. Transplant for hepatitis C declined 18 percent in 2016.
Ways You Can Make a Difference Two awareness events that occur in April are Alcohol Awareness Month and National Donate Life Month. Learn the signs of alcohol abuse and how to help others. Increase the organ donor pool by being an organ donor. Urge families and friends to participate. If you can, donate blood as often as you are eligible to.
References and Resources
Lucinda Porter, RN, is a long-time contributor to the HCV Advocate and author of “Free from Hepatitis C” and “Hepatitis C One Step at a Time.” She blogs at www.LucindaPorterRN.com and HepMag.com
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