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Do Alcoholics Deserve Liver Transplants?

Do alcoholics deserve liver transplants?

This story is making the rounds again. It reveals a lot about how society thinks of alcoholics.

Here is an example from the latest incarnation of the story from the UK. Eunice Booker, whose 26-year-old daughter died in a car crash in 2006, is quoted by the UK's Observer newspaper as saying: "I find it offensive that one in four of the livers donated go to alcoholics. If there are two people side by side wanting a liver, and both have the right tissue match, and one is an alcoholic and one isn't, there's no contest - you take the one who's not an alcoholic, they are more entitled."

This "entitlement" issue is at the heart of the controversy. One of the previous occasions this story came up was when the soccer legend George Best was given a liver transplant in 2002 after battling with alcoholism for all his adult life. After receiving his liver transplant, he was seen out drinking more than once. He had been warned repeatedly that drinking would kill him, even after his transplant. He died three years later. Here is a quote about Best's transplant from a reader of the Daily Mail, a British tabloid newspaper.

"George Best's liver transplant was morally indefensible. A viable liver was wasted on him. There are not enough livers available for transplant to people with non-alcoholic related diseases, people who are ill through no fault of their own".

Here we have "fault" as well as entitlement. Somehow alcoholics are at fault for becoming alcoholics. Almost everyone drinks or smokes at some point in their lives, but the majority of people do not develop problems and this seems to make it harder for them to understand those that do. This issue is exacerbated by the heavy drinking culture of the UK (George Best once said "I spent a lot of money on booze, women and fast cars. The rest I just squandered").

Alcoholics, like all addicts, are usually diagnosed once their drug use has become a problem. It has become a problem because they are suffering from the defining symptom of addiction; loss of control. In fact the very definition of an addiction is "continued drug use in spite of adverse consequences". George Best is a classic example. Here is a man who has been told, like so many alcoholics, that his drinking has ruined his liver function to the point where he needs major surgery. If he carries on drinking, he will die. So what does he do? He goes drinking. I'd say death was an adverse consequence. Is there any more direct example of the loss of control that defines an addiction?

The public understanding of addiction lags behind that of other mental disorders. Telling an alcoholic to "stop drinking" is like telling a victim of depression to "cheer up" or an anxiety sufferer to "calm down". In the past few decades, great progress has been made in recognizing diseases like depression, anxiety and posttraumatic stress disorder for what they are; medical conditions deserving of sympathy and treatment. We still have a long way to go with addiction.

 

 

 

 

Philip M. Newton, Ph.D. is a Neuroscience Lecturer at Swansea University Medical School in the United Kingdom.

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