Alcoholics and liver transplantation. The Ethics and Social Impact Committee of the Transplant and Health Policy Center

JAMA. 1991 Mar 13;265(10):1299-301. doi: 10.1001/jama.265.10.1299.


Two arguments underlie a widespread unwillingness to consider patients with alcoholic cirrhosis of the liver as candidates for transplantation. First, alcoholics are morally blameworthy, their condition the result of their own misconduct; such blameworthiness disqualifies alcoholics in unavoidable competition for organs with others who are equally sick but blameless. Second, because of their habits, alcoholics will not exhibit satisfactory rates of survival after transplantation; good stewardship of a scarce lifesaving resource therefore requires that alcoholics not be considered for liver transplantation. These arguments are carefully analyzed and shown to be defective. There is not good moral or medical reason for categorically precluding alcoholics as candidates for liver transplantation. It would, in addition, be unjust to implement such a preclusion simply because others might respond negatively if we do not.

KIE: There is widespread unwillingness to consider patients with alcoholic cirrhosis for liver transplantation. Cohen and Benjamin examine the two arguments that underlie the exclusion of alcoholics from a potentially life-saving procedure. The first, a moral argument, holds that alcoholics are to blame for their condition, and that this blame excludes them from competition for scarce donor livers with other patients with end-stage liver disease who are not to blame for their illness. The second argument, taken from a medical perspective, holds that alcoholics do not do well after liver transplantation, and that scarce donor livers should not be allocated to a group with a poor survival rate. Cohen and Benjamin reject as unfair and unacceptable both arguments for withholding liver transplantation from alcoholics. They also reject the argument that public support for transplantation will suffer if it becomes known that donated organs are going to alcoholics.

MeSH terms

  • Alcoholism*
  • Attitude to Health
  • Ethics, Medical
  • Health Behavior
  • Health Care Rationing*
  • Health Policy
  • Humans
  • Liver Cirrhosis, Alcoholic / surgery
  • Liver Transplantation / standards*
  • Morals
  • Patient Selection*
  • Resource Allocation*
  • Tissue and Organ Procurement / supply & distribution
  • United States