A survey estimate of academic liver transplant teams' selection practices for alcohol-dependent applicants

Alcoholism itself is not a contraindication to liver transplantation. However, certain individual alcoholic applicants may pose an unacceptably high psychosocial risk of poor outcome. Transplant psychiatrists or psychologists at 14 academic liver transplant centers were asked to estimate their centers' selection practices with regard to specific problems in the more difficult alcohol-dependent applicant and with regard to hypothetical problem cases. There was impressive variability in estimated selection practice between the centers. However, the centers consistently appeared to prefer to require rehabilitation or observation in difficult situations rather than to reject applicants outright. The results provide an initial estimate of current thinking and practice with regard to the more difficult alcoholic applicant and suggest directions for further study.