Who Should Receive Liver Transplants

There are three important facts to consider when thinking about liver transplants. Alcoholism is the leading cause of liver disease, donor livers are extremely scarce and liver transplants are very expensive to perform. These facts force us to ask the question, Should alcoholism be a factor in deciding who receives liver transplants? I propose that alcoholics who have done nothing to better their condition should be placed at the bottom of the waiting list for liver transplants. Not all alcoholics should be excluded from treatment. Alcoholics who have received treatment and improved their quality of life for a substantial period of time should be able to compete equally for liver transplants. I base my proposal on the considerations of fairness and distributive justice. Scarcity of donor livers forces us to make a decision in regards to who receives transplants and people who have liver damage due to no fault of their own should not be punished.

Based on principles of fairness, practicing alcoholics should be at the bottom of the list for receiving liver transplants. In society today people must be held accountable for their mistakes, therefore it is only fair that patients with ARESLD who are still drinking should be held responsible for their behavior. ARESLD patients who have been diagnosed with alcoholism and treated for their illness should receive equal opportunities for treatment. These patients have the disease of alcoholism. If they have taken the effort and struggled to make their life better, it is remarkably unfair to place them in the same category as practicing alcoholics. Alcoholism is recognized as a disease and patients who have overcome this disease should not be judged on their poor decisions in the past.

The system of distributive justice is often put to use when problems of allocating scarce resources, such as healthy livers, arise. The system can be used in this circumstance as well. Many things must be taken into account when deciding if the distribution of these scarce resources are just. Factors such as standard of living, standing in the community, and health of the patient must be taken into account. Using these factors as criteria for receiving liver transplants it is only logical that practicing alcoholics should not be allowed access to the healthy livers. Alcoholics as a whole are generally ( with some exceptions of course ) members of a lower social class, have a lowered standard of living, and have other medical illnesses. These facts force us to come to the realization that the likelihood of the patient living a long and fruitful life after the transplant are slim to none. Alcoholism is a chronic disease and if a grown adult has drank themselves to the point of destroying their liver it is highly unlikely that the person is capable of successfully receiving treatment for the disease. Giving a healthy liver to a practicing alcoholic is a very dangerous use of such as scarce and valuable resource.

There may be two objections to the argument I have presented. 1) Some may argue that patients have the ability to receive treatment and stop drinking after they have been diagnosed with ARESLD. 2) Not all alcoholics have been diagnosed and are unaware of the fact they are considered alcoholics. I will discuss these possible objections further.

What keeps alcoholics with ARESLD from flooding into rehab clinics after being diagnosed so they can receive new livers? ARESLD patients do have the ability to seek treatment after diagnosis but it will not help