Should sufferers of alcohol addiction be eligible for liver transplants?

After meeting our ambassador, Russell Brand, Medical Ethics and Law student at King's College London, Raveena, 23, considers the implication of medical ethics on addiction.

by The Mix Staff

Friday 22nd September 2017

Russell Brand spent a day at The Mix to find out about all our incredible work

On 19th September 2017, I met Russell Brand at The Mix HQ as part of an addiction and
recovery Q&A. I asked him, ‘Does recovery end?’ He answered, ‘No’. That got me thinking
about the recent controversy which is being considered by healthcare policy makers, that
people dependent on alcohol should not be considered for a liver transplant. With more and
more young people suffering from alcohol addiction, is this even ethical? Would such a
policy not be detrimental to all our futures?

The general bias towards believing that people dependent on alcohol should not be
considered for liver transplants lies within the concept that they have essentially caused
their disease. Therefore, when allocating such a scarce resource, livers should be assigned to
those who have liver disease through no fault of their own. Some argue that alcohol
addiction is preventable, and so is the developed liver disease. Because of this element of
choice, some have also argued that alcoholism should not be classified as a disease at all.

Can refusing individuals liver transplants on the sole basis of their alcoholism be justified
strongly enough to result in a new healthcare policy which might deny them treatment?

One argument in favour of liver transplants being made available to sufferers of alcohol
addiction, could be the fact that alcoholism is widely accepted as a disease, and therefore
should be treated as one. Cancer Research UK states that smoking tobacco is one of the
largest causes of lung cancer, yet we would not refuse treatment if we were aware they
smoked. There is no denying that choice is a factor in alcoholism – without voluntary action,
the dependency may not have occurred. However, there has been a lot of research to
suggest that there are a variety of factors which can influence someone to drink –
these include environmental, genetic, and neurological.

Studies on child adoption have shown that it is possible for those who were raised away
from their alcoholic biological parents to still develop an alcohol addiction. This surely
indicates the presence of a genetic predisposition for addiction, and how sometimes this
can outweigh environmental factors?

Neuroimaging research has found that there are differences between the brains of addicted
and non-addicted people in regard to their responses to drug related spurs. This implies that
a person’s neurological build can affect their chances of developing addiction related
problems, which is a factor outside of their control.

There are evolutionary theories on alcoholism which explain that carrying out pleasurable
experiences was once a characteristic to ensure human survival. Theorists argue that this is
therefore why most people naturally find themselves giving in to pleasurable experiences.
However, since human survival is not quite the issue in the current world as it was many
years ago, acting on every pleasurable experience may not actually be as beneficial as it
once was. Unfortunately, there are now pleasurable experiences that have the ability to kill
us, and this can include alcohol.

It is these varying factors which can contribute to alcoholism being a disease and not simply
the free choice of the sufferer. To use choice as the main factor to blame an individual for
their disease, to the point where they should be denied lifesaving treatment, can be an
unfair assumption and an irrational method of allocating livers for transplantation. Doing so
would be immoral and it would be essentially condemning society to pay for their actions
through the type of medical care they receive.

Currently, to be considered for a liver transplant a patient would generally need to show
abstinence from alcohol for a least a few months. This is because without abstinence the
transplant would fail. If a sufferer of alcohol addiction does successfully abstain, this could
indicate that they are one step closer to overcoming it.

Although denying alcoholics liver transplants would shorten the waiting list, this does not
necessarily justify why they should be denied treatment. There is currently no alternative
therapy that can replicate the function of the liver. This means that for those with end-stage
liver disease, a transplant is their only hope of survival. Denying all liver transplants to
patients with alcohol-related liver disease, could potentially be the equivalent to condemning
them all to death – even those who can demonstrate that they can abstain from drinking. This
essentially deprives such patients from the opportunity to both recover and heal.

To deny alcoholics liver transplants could arguably be a step back for society. We would
essentially be ignoring a very real social and healthcare issue which needs more attention,
especially as alcohol dependency amongst individuals is increasing and becoming more
prevalent in young people.

If as Russell Brand says ‘recovery never ends’ but is manageable – can we have the denial of
liver transplants in sufferers of alcohol addiction on our conscience? Can we place value on
who is more deserving of treatment? Is a mother of two who has suffered at the hand of
partner and turns to drink less deserving than a 69-year-old who has never drunk? Isn’t it
more complicated than that? What about the effects of that person not being around
anymore – the effects on the lives of their family, friends, and society?

Perhaps when a strong enough argument arises to suggest that alcoholics are somewhat
less deserving of liver transplants – only at this point should a policy which refuses them
lifesaving treatment be considered.

Words by Raveena Theodore