1. Running Head: LIVER TRANSPLANT DEBATE 1
Liver Transplants for Alcoholics Debate
Codi Leggett and Kelsey Martin
Texas A&M University College of Nursing
NURS 305-500

2. LIVER TRANSPLANT DEBATE 2
Liver Transplant Debate
If you need a liver transplant, you get put on the liver transplant list … or do you?
Questions have risen debating whether or not alcoholics should have priority to receive liver
transplants. Some argue that all people should have the equal right to a transplant and to
healthcare equality, but others argue that transplants should not be given to people who choose to
damage their livers and take a spot on a very long transplant list. While both views have ground
to back them, nurses and health care providers must interact with patients from both spectrums.
So the question arises then that, why not everyone receive the organ they need? “Organ
transplantation has increased worldwide while the number of organ donors have not increased
similarly”, which create the dilemma of who gets the next available organ and how is order
decided on a transplant list.
When looking at a transplant list, it is clear that helping one person could potentially hurt
another because one gets a liver and one does not (Brudney, 2007). Just because someone made
choices that causes health problems, does not mean they should be denied their right to the same
healthcare as someone else. This can be argued for many aspects of health, for example, should
smokers with lung cancer be denied treatment? Currently, to receive a liver transplant, the patient
must be abstinent from alcohol use for six months, which would seem to create a problem for
alcoholics and their availability to receive a transplant (Fullwood, 2014). While this makes it
much harder, these patients are still given the same right to a liver transplant. It is the nurse and
providers job to help the patient achieve the abstinence goals so they can receive the best
possible care and be given a liver transplant (Fullwood, 2014). The main argument against
allowing alcoholics to receive liver transplants is the potential of relapse after transplantation due
to continued habits of alcoholism. However, present studies show that “the presence of an AAU

3. LIVER TRANSPLANT DEBATE 3
[alcohol addiction unit] within a liver transplant center reduces alcohol recidivism in alcoholic
patients after OLT [orthotopic liver transplantation]” (Addolorato et al., 2013) Also, alcohol-
related liver disease can be caused by “comorbid mental health conditions, such as depression”,
so there are other factors contributing to their liver disease, and they should not be denied a
transplant from an aspect of their health that they could not control (Bailey, Pathak, & Ahmad,
2013). Lastly, “we cannot use the allocation of liver transplants for punishment of lifestyle
choices” (Bailey, Pathak, & Ahmad, 2013). A person’s lifestyle should not decide the quality of
care that they receive.
Livers available for transplant are very scarce and this valuable resource should be
distributed in the most effective manner. In Europe, 30-50% of liver transplants are done for
alcohol-related liver disease, and “20-25% of those lapse or relapse into heavy alcohol use”
(Dom et al., 2015). The problem with giving livers to alcoholics is the high risk of relapse which
will damage a brand new healthy liver that could have gone to someone that would not damage
the new liver. Even if the alcoholism is caused by comorbidities, after the 6 month abstinence
from alcohol prior to the transplant, there is still a risk of habitual drinking post-transplant,
especially if the patient’s environment encourages their drinking habits. Many people feel that if
you make the lifestyle choice to be an alcoholic that they must live with the consequences that
follow this behavior (Brudney, 2007). This is a tough love explanation for this very complicated
process. Along with this, helping a voluntary alcoholic will hurt the person not receiving the
liver who may have chosen a healthy lifestyle.
The ethical implications are not black and white for this issue. However, as nurses, we
are first and foremost the patient advocate and should be unbiased in every aspect of our
practice. It is not up to us to assume how a patient will react after a transplant so we need to be

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impartial to the potential behavioral choices post-transplant. As nurses, it is our job to educate
our patients about the risks returning to alcoholic behaviors and to support them in choosing
healthy lifestyle behaviors. According to the International Council of Nurses Code of Ethics,
“Nursing care is respectful or and unrestricted by considerations of age, color, creed, culture,
disability or illness, gender, sexual orientation, nationality, politics, race, or social status”
(Taylor, Lillis, & Lynn, 2015). As nurses, we will have to give pain medications to drug addicts,
give care to people who have different beliefs then us, not give blood transfusions because of
patient religion, and give liver transplants to alcoholics because they should all be treated equally
and given the same options as everyone else with the same conditions.
Currently, there is no settlement, but there is hope for the future to educate patient earlier
to prevent this problem. A future solution could be to have more extensive warnings put on the
alcohol containers that educate people on the risks of their behaviors. Personally, we believe that
“there is a duty to the donor and his/her family for the liver to be given the best chance of
survival” (Bailey, Pathak, Ahmad, 2013). We believe in equal right to care, but when it comes
down to making this hard decision, there has to be the most amount of hope for the healthy liver
to survive. This implication extends beyond the scope of alcoholic liver transplants to other
comorbidities that can affect the liver survival. There are so many factors that go in to placement
on a donor list that a history of alcoholism alone cannot be the defining factor of level of priority.
In conclusion, there is still ongoing debate over the ethical issue of liver transplants for
alcoholics. There is no black or white answer for this issue, but we as nurses are required to
provide equal, unbiased care. Alcoholism is not explicitly a conscious decision of a patient, so it
is not a factor that can single-handedly affect this decision. Someone’s past should not define

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their present; no matter what causes a disease, nurses need to remain a patient advocate and help
every patient achieve their optimal health.

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References
Addolorato, G., Mirijello, A., Leggio, L., Ferrulli, A., D’Angelo, C., Vassallo, G., & …
Gasbarrini, A. (2013). Liver transplantation in alcoholic patients: Impact of an alcohol
addiction unit within a liver transplant center. Alcoholism: Clinical & Experimental
Research, 37(9), 1601-1608. doi: 10.1111/acer.12117
Bailey, D., Pathak, S., & Ahmad, N. (2013). Is liver transplant for alcohol-related end-stage liver
disease appropriate?. British journal of hospital medicine (London, England:
2005), 74(8), 439-442. Retrieved from http://magonlinelibrary.com/toc/hmed/current
Brudney, D. (2007). Are alcoholics less deserving of liver transplants?. Hastings Center Report,
37(1), 41-47.
Dom, G., Wojnar, M., Crunelle, C. L., Thon, N., Bobes, J., Preuss, U. W., ... & Wurst, F. M.
(2015). Assessing and Treating Alcohol Relapse Risk in Liver Transplantation
Candidates. Alcohol and Alcoholism, 96. doi: 10.1093/alcalc/agu096
Fullwood, D. (2014). Alcohol-related liver disease. Nursing Standard, 28(46), 42-47. doi:
10.7748/ns.28.46.42.e8998
Taylor, C., Lillis, C., & Lynn, P. (2015). Fundamentals of nursing: The art and science of
person-centered nursing care (pp.99) Wolters Kluwer.