Liver Transplantation: Justifiable to deprioritize people with an alcohol use disorder?

Alcoholic liver cirrhosis, characterized by severe scarring of the liver due to excessive alcohol abuse, is one of the major causes of end-stage liver disease. Often the only possibility for survival is liver transplantation. 

However, the demand for liver transplants currently exceeds the supply of livers available. The result? A rather controversial moral dilemma in the medical community: is it ethically justifiable for people with an alcohol use disorder to be deprioritized for liver transplantation due to their alcoholism? 

It is important to address this issue with medical and moral considerations in mind. 

There are two medical assessments to consider: the likelihood of success and life expectancy. In other words, with all else being equal, we must consider whether transplants would be successful and whether people with an alcohol use disorder have shorter life expectancies than those without. Some say that if people with an alcohol use disorder “score poorly” on these criteria, their deprioritization for a liver transplant is justified. 

There is essentially no compelling reason to believe that a person who has or used to have an alcohol use disorder would have any less likelihood of a successful transplant than any other patient needing a liver. It is definitely possible for alcohol consumption to weaken immune systems or cause other health-related problems, but these cases must be investigated individually. 

It is inappropriate to simply assume that people with an alcohol use disorder would carry a lower likelihood of success as a sole result of their addiction. If they do have health issues that lower their likelihood of a successful procedure, those other health risks are more significant than their alcoholism. 

Additionally, regarding life expectancy, there is no compelling reason to think that people with an alcohol use disorder who receive liver transplants have a lower life expectancy than those without an alcohol use disorder. It is possible that people with an alcohol use disorder, on average, may have a shorter life expectancy than those who do not, but that is not a valid reason to discriminate against them for liver transplants.

In fact, in some cases, people with an alcohol use disorder may have a longer life expectancy than those who do not. For instance, someone without an alcohol use disorder may have a medical condition that shortens their life expectancy, meaning that a transplant candidate with an alcohol use disorder but without a life-shortening medical condition likely has a higher life expectancy.

 It is understandable and acceptable to deprioritize individual people with an alcohol use disorder because they have a lower life expectancy, but there is no reason to deprioritize them as a population. It is possible that the shortened life expectancy resulted from all use disorders; however, alcoholism itself remains irrelevant to the assessment. Thus, we cannot deprioritize those with an alcohol use disorder on their alcohol use alone.

However, a case for deprioritization can be made on moral grounds. The critical question is whether people with an alcohol use disorder should be deprioritized on the grounds that their own actions caused their illness whereas people without an alcohol use disorder might need a liver transplant for reasons beyond their control. 

However, are the former to be blamed for their condition? It all depends on how people perceive alcohol use disorders: does someone with an alcohol use disorder choose to drink? If we say that they do not choose it, it can be viewed as a disease wherein the addicts cannot control their actions. 

Yet, people may think that they are still making the conscious choice to drink on some small level. For this, they are blameworthy for cirrhosis. While this may or may not be accurate, a valid conclusion cannot be made before understanding the true workings of alcohol use disorders. 

In essence, medical considerations are not likely to be substantial on a population level to the extent that people with an alcohol use disorder are riskier transplant cases or have lower life expectancies than those who do not. While some people with an alcohol use disorder will “score” poorly in regards to these criteria, this does not justify deprioritizing them due to their alcohol use disorders, especially since they may already be deprioritized based on medical criteria alone. 

Moral dimensions are harder to evaluate, and the critical question is whether people with an alcohol use disorder are blameworthy for their cirrhosis. If alcohol use disorder is treated as a disease, then those with it are not blameworthy and should not be deprioritized; however, if it is not treated as a disease, perhaps it is acceptable to deprioritize them on moral grounds. 

There is no right answer in situations like these, and your opinion might change based events in your life. It is essential to take the time to understand such heavy and controversial topics so that you are equipped with enough information to understand certain outcomes if ever faced with such scenarios. 

~ Saathvika Diviti `25