The Ethics of Organ Transplants: The Current Debate

By Arthur L. Caplan; Daniel H. Coelho | Go to book overview
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29. Alcoholics and
Liver Transplantation

Carl Cohen, Martin Benjamin, and the
Ethics and Social Impact Committee of the
Transplant and Health Policy Center,

Ann Arbor, Michigan

Alcoholic cirrhosis of the liver—severe scarring due to the heavy use of alcohol—is by far the major cause of end-stage liver disease. 1 For persons so afflicted, life may depend on receiving a new, transplanted liver. The number of alcoholics in the United States needing new livers is great, but the supply of available livers for transplantation is small. Should those whose end-stage liver disease was caused by alcohol abuse be categorically excluded from candidacy for liver transplantation? This question, partly medical and partly moral, must now be confronted forthrightly. Many lives are at stake.

Reasons of two kinds underlie a widespread unwillingness to transplant livers into alcoholics: First, there is a common conviction—explicit or tacit— that alcoholics are morally blameworthy, their condition the result of their own misconduct, and that such blameworthiness disqualifies alcoholics in unavoidable competition for organs with others equally sick but blameless. Second, there is a common belief that because of their habits, alcoholics will not exhibit satisfactory survival rates after transplantation, and that, therefore, good stewardship of a scarce lifesaving resource requires that alcoholics not be considered for liver transplantation. We examine both of these arguments.


A widespread condemnation of drunkenness and a revulsion for drunks lie at the heart of this public policy issue. Alcoholic cirrhosis—unlike other causes of end-stage liver disease—is brought on by a person's conduct, by heavy

Originally published in JAMA 265, no. 10 ( March 13, 1991): 1299-1301.


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