Alcoholics and liver transplantation

Article Abstract:

Should alcoholics, who are liable to develop end-stage liver disease caused by alcoholic cirrhosis of the liver, be categorically denied the right to be candidates for liver transplantation? The single greatest cause of end-stage liver disease is alcoholic cirrhosis; the moral and medical questions regarding alcoholics' rights to compete for this very scarce resource are discussed. The moral argument in favor of excluding these patients from candidacy rests on the condemnation of drunkards and excessive drinking; this behavior, it is said, could be avoided in the interests of health. But society does not condemn other groups who neglect their health (those who do not use seat belts, cardiac patients who continue to smoke), but their treatments do not demand such scarce resources as donated livers. The authors do not agree with these attitudes. Moral virtue is not and cannot be a requirement for receiving a donated organ; if it were, we would have to reach agreement on the meaning of virtue and vice. The reasons why patient morality is not investigated prior to medical treatment are reviewed. Medical arguments against providing livers to alcoholics have been based on predictions of a poor outcome. This is no longer believed to be the case for carefully selected alcoholic patients. Moreover, if outcome criteria are to be applied, they should include other groups with equally poor prognoses. Decisions concerning liver transplantation that take into account only survival data would not exclude alcoholics as candidates. The most important screening criteria should be based on the probability that the patient will benefit from this extremely limited resource. Alcoholics need particularly rigorous screening, since transplant success requires the ability to maintain complex drug regimens and psychological stability. The negative public attitudes toward alcoholics cannot be used to justify excluding them from transplant programs; rather, efforts must be made to separate alcoholism from the deplorable acts of some alcoholics, such as drunken driving. One family in every three has a member at risk for alcoholic cirrhosis. Several other articles and editorials in the March 13, 1991 issue of The Journal of the American Medical Association address the issue of liver transplantation and alcoholism. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Liver diseases, Alcoholics, Liver cirrhosis

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Medical applications of fetal transplantation tissue

Article Abstract:

The ability of fetal tissue to grow, multiply and differentiate into numerous cell types make it attractive as a potential candidate for transplantation. Fetal tissue transplantation has been attempted in a number of human disorders, albeit with little evidence of long-term success. The future possibilities, however, raise important legal and ethical questions, which the American Medical Association's Council on Scientific Affairs and Council on Ethical and Judicial Affairs try to address. One important distinction is between the use of fetal tissues for research and their use for treatment or therapy. At least one state, Arizona, has laws specifically forbidding the use of fetal tissue for research. Fetal tissues have been experimentally transplanted in cases of Parkinson's disease, severe combined immunodeficiency, aplastic anemia and diabetes mellitus, and other diseases. Although success has so far been limited, possible future successes may result in clinical procedures which create a demand for fetal tissues, creating at the same time ethical concerns. These concerns will require that fetal tissue not be donated to designated recipients, that it not be sold, and that the consent to donate such tissue be given only after the final decision for abortion has been made. Legally, the donation of fetal tissue is governed by the Uniform Anatomical Gift Act, but it is considered by the Councils to be ethically imperative that the maintenance of a supply of fetal tissues cannot become the primary focus of abortion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Abortion, Fetal tissue transplantation, American Medical Association. Council on Scientific Affairs, American Medical Association. Council on Ethical and Judicial Affairs

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Successful liver transplantation in older patients raises new hopes, challenges, ethics questions

Article Abstract:

Elderly patients are usually considered poor surgical candidates due to age-related risk factors for complications and death. Patients in their seventh or eighth decade of life have successfully survived liver transplantation. In one study, 67 percent of patients over 60 years survived at least three years, compared with 75 percent of patients between 18 and 59; both groups had similar incidences of organ rejection and infection after transplant. With an organ donor shortage and an increased number of elderly patients on a waiting list for transplantation, the ethical question that must be addressed is, who are the most appropriate recipients? Researchers feel that a patient's physiological age is more important than chronological age when discussing survival, and since transplants have been successfully performed in the elderly, these patients should not be denied a transplant solely because of their age. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects

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