Transplantation in alcoholics: separating prognosis and responsibility from social biases

The general public does not favor transplanting livers into patients with alcoholic cirrhosis. This opinion may reflect a sense that we should not distribute scarce resources to people who are personally responsible for their illness. It may also reflect a sense that alcoholism is socially undesirable, and therefore alcoholics should not receive transplants. This article argues that these positions do not hold up under scrutiny. The only reason to give alcoholic patients lower priority for transplantation is if subgroups of alcoholics can be shown to have unacceptably poor transplant prognoses. However, giving these alcoholics lower priority is justifiable only if it is part of a larger policy that distributes livers on the basis of prognosis. In the meantime, there is no justification for giving lower priority to alcoholics for available livers.