There’s an article in the Observer today talking about a ‘furious’ row that has broken out concerning the number of transplant livers that are being provided to alcoholics with liver disease.
According to Associated Press, figures released by UK health minister Ann Keen showed that the number of liver transplant cases involving damage caused by alcohol has risen rose 94 in 1997/98 to 151 in 2007/08 – increasing from 14% to 23% of the number treated annually over that period. Overall 1,300 people suffering from alcoholic liver disease have received new livers since 1997/98 – 18% of the total number of patients benefiting from the transplants. The Observer quotes the an outraged mother whose unfortunate daughter died and donated her organs and who said how she finds it ‘offensive that one in four of the livers donated go to alcoholics’.
Feelings about this obviously run high in some quarters. The subtext is that people with alcohol problems are deserving of their fate and that by giving a transplant liver to an alcoholic doctors are depriving a much more worthy recipient; a small child whose mother has terminal cancer perhaps. There is certainly a risk that someone who is an alcohol will knacker the second the same way as they did the first, but it’s not evident from the figures reported if non-alcoholics have lost out, or indeed the underlying reason why more transplant operations have taken place on such patients, beyond the obvious possibilities that there are more alcoholic cirrhosis patients or that surgeons are more willing to give them the benefit of the doubt.
I don’t think as a doctors we can afford to be picky or judgemental about our patients. As a profession plenty of our patients have done things that have not turned out to be in their best interests, be it smoking, drinking, a sexual oversight, or climbing up a tree. Some of these society is more tolerant of than others but most pay their taxes and have families who care about them. An alcoholic’s situation is often framed as one of a lack of self control, and subsequent disapproval follows from this ‘failure’. However many factors* have been implicated in alcohol abuse only some of which can be shoehorned into this narrow view.
Rather than get exercised about the care being given to people with alcohol problems, who some presumably think should be let rot, what we need more is a frank discussion about the way alcohol pervades our lives, the forces that drive this and the ways we all collude into making this so. But kicking your local alcoholic on the way to work is like shooting the messenger.
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*The aetiology of alcohol dependence has biological, psychological and social factors. Birth trauma, abandonment by parents, death of parent, death of sibling, sexual or emotional abuse in childhood, broken families, genetics, personality traits of novelty seeking and impulsivity and biochemical factors have all been implicated.