When good organs go to bad people

Bioethics

Volumn 22, Issue 2, 2008, Pages 77-83

  Ho, Dien ^a  

^a MASSACHUSETTS COLLEGE OF PHARMACY AND HEALTH SCIENCES   (United States)

Author keywords

Alcoholism; ARESLD; Liver transplantation; Moral responsibility

Indexed keywords

ALCOHOL LIVER DISEASE; ARTICLE; DECISION MAKING; DOCTOR PATIENT RELATION; ETHICS; HEALTH CARE ORGANIZATION; HUMAN; LIFESTYLE; LIVER TRANSPLANTATION; MEDICAL ETHICS; MORALITY; PATIENT SELECTION; SOCIAL PSYCHOLOGY;

ETHICS, CLINICAL; HEALTH CARE RATIONING; HUMANS; JUDGMENT; LIFE STYLE; LIVER DISEASES, ALCOHOLIC; LIVER TRANSPLANTATION; MORAL OBLIGATIONS; PATIENT SELECTION; PHYSICIAN-PATIENT RELATIONS; SOCIAL VALUES;

EID: 41449099734     PISSN: 02699702     EISSN: 14678519     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2007.00606.x     Document Type: Article

References (22)

1. Indeed, the sentiment that alcoholics should receive lower priority for liver transplantation is prevalent among the population-at-large. J. Ratcliffe's Public Preferences for the Allocation of Donor Liver Grafts. Health Econ 1999; 9: 137-148, notes that 71% of the 303 respondents would prefer allocating livers to those who have naturally occurring liver disease over those whose conditions were brought about by prolong alcohol consumption.
2. W. Glannon. Responsibility, Alcoholism, and Responsibility. J Med Philos 1998 23 : 31 49.
3. Ibid. p. 44.
4. P. Burra M. Lucey. Liver Transplantation in Alcoholic Patients. Transpl Int 2005 18 : 491 498
5. A. Anand et al. Liver Transplantation for Alcohol Liver Disease: Evaluation of a Selection Protocol. Hepatology 1997 25 : 1478 1487
6. T. Gerhardt et al. Alcohol Use Following Liver Transplantation for Alcoholic Cirrhosis. Transplantation 1996 62 : 1060 1063
7. A. Cuadrado et al. Alcohol Recidivism Impairs Long-Term Patient Survival after Orthotopic Liver Transplantation for Alcohol Liver Disease. Liver Transpl 2005 11 : 420 426
8. A. Anantharaju & D. Van Thiel, op. cit. note 5.
9. L. Krahn A. DiMartini. Psychiatric and Psychosocial Aspects of Liver Transplantation. Liver Transpl 2005 11 : 1157 1168.
10. Cuadrado, et al, op. cit. note 5, p. 420.
11. D. Campbell, Jr. & M. Lucey. 1996. Liver Transplantation for Alcoholic Cirrhosis. In Transplantation of the Liver. R. Busuttil and G. Klintmalm, ed. Philadelphia, PA: W.B. Saunders: 145-150.
12. Center for Disease Control and Prevention. 2005. Available at http://www.cdc.gov/alcohol/faqs.htm. [Accessed 8-31-2006].
13. American Medical Association. 1999. H-95.983. Drug Dependencies as Diseases.
14. R. Veatch. 2005. Transplantation Ethics. Georgetown University Press: 314.
15. A. Moss M. Siegler. Should Alcoholics Compete Equally for Liver Transplantation? JAMA 1991 265 : 1296 1298.
16. Ibid: 1297.
17. Moss and Siegler consider AA an effective form of treatment for alcoholism.
18. C. Cohen, M. Benjamin the Ethics and Social Impact Committee of Transplant and Health Policy Center, Ann Arbor Michigan. Alcoholics and Liver Transplantation. JAMA 1991 265 : 1299 1301
19. This is true even when all liver transplantation candidates are required to have a biopsy to determine the cause of their ESLD. The results of liver biopsies do not determine definitively if the conditions are caused by prolonged alcohol consumption. The diagnosis of ARESLD is often a matter of taking into consideration multiple sources of information including frank discussions with one's patients.
20. I thank Dan Brock for bringing my attention to this objection.
21. S. Wilkinson. Smokers' Rights to Health Care: Why the 'Restoration Argument' is a Moralising Wolf in a Liberal Sheep's Clothing. J Appl Philos 1999 16 : 255 269.
22. I am not suggesting that we should treat all lifestyle choices equally. Some choices are clearly more valued or valuable than other. The burden of proof, however, rests with those who appeal to value preferences. In light of the non-factive nature of values, tolerance becomes the default position.