Who Gets a Liver?: Transplant Centers Differ on Substance Abuse Abstinence Rules

MD | AASLD Conference Coverage

Donor livers are scarce, donated organs are precious, and transplant surgeons make the final call on whether to transplant a particular patient. The severity of illness is easy enough to measure. When the patient has a history of using marijuana, drinking too much alcohol, or even smoking tobacco comes up, the issue of who gets a liver can become tricky.

"You don't want to waste a liver, but you don't want to deny a patient a life-saving therapy either, just because he's a smoker," said David Riech chief of multi-organ transplantation and hepato-pancreato-biliary surgery at Hahnemann University Hospital in Philadelphia, PA., "A lot of people who need liver transplants are smokers."

In a symposium presented at the Liver Meeting (AASLD) in San Francisco, panelists took up the questions of liver transplantation in patients with addictive disorders. The topic is complex, fraught with medical and ethical issues.

Even though the furor over "death panels" has died down in the national political arena, transplant committees are making such decisions, partly with rules, but too often with incomplete data on the impact of various addictions on transplant. The decision-makers are also prone to inserting personal bias into the process, panelists said. Continue reading



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