NCADD, ASAM Express Concerns over Proposed Liver Transplant Criteria

The Alcoholism Report, August 1990 | Go to article overview

NCADD, ASAM Express Concerns over Proposed Liver Transplant Criteria


NCADD, ASAM Express Concerns Over Proposed Liver Transplant Criteria

The National Council on Alcoholism and Drug Dependence (NCADD) and the American Society of Addiction Medicine opposed any arbitrary abstinence requirements for alcoholics in need of liver transplants. The abstinence requirement was one of several concerns expressed by the two organizations in response to a proposed notice of Medicare Program Criteria for coverage of adult liver transplants issued by the Health Care Financing Administration (HCFA) in March. On the basis of a finding that adult liver transplantation is "safe and effective," HCFA proposed inclusion of alcoholic cirrhosis as one of the liver diseases for which transplants could be reimbursed by Medicare under certain conditions.

In NCADD's letter to HCFA, Medical/Scientific Director Daniel K. Flavin, MD, said his organization was pleased that alcoholic cirrhosis was included in the list of liver diseases for which transplants are deemed appropriate, noting that NCADD's board passed resolutions in 1987 and 1989 in support of such inclusion.

But Flavin said NCADD had a number of concerns about the HCFA proposal. Among them: * NCADD strongly recommended that funding

guidelines require professionals trained in the field of

alcoholism and other drug dependence to be members

of transplant teams developing guidelines for patient

selection, with these individuals serving as active

participants in the selection process. * The HCFA notice stated that in the case of alcoholic

cirrhosis, the agency would require that the patient

meet "the hospital's requirement for abstinence." The

NCADD official said his organization is opposed to

"arbitrary abstinence requirements for alcoholics

requiring organ transplantion," and decisions in this

area should be "clinical in nature resting with the

transplant team alone," as opposed to the hospital and

transplant team as proposed in the notice. * HCFA proposed that alcoholic candidates for

transplants have "documented social support

important to assure both recovery from alcoholism

and compliance with immunosuppressive therapy."

Flavin said, "It is unclear as to why such a

requirement would not be applied to other potential

recipients of liver transplants. In addition, the term

`sufficient social support' is vague and may be subject

to misinterpretation." NCADD urged the term be

refined to "reflect, in the case of individuals suffering

from alcoholism, the importance of ongoing

involvement in a recovery program as evaluated by an

expert in alcoholism on the transplant team." * Regarding HCFA's proposed requirement that a

facility have adequate patient management plans and

protocols, NCADD urged that alcoholic transplant

candidates be evaluated by a professional trained in

the field of alcoholism and other drug dependence,

and, if appropriate, enrolled in a formal alcoholism

treatment program matched to the patient's needs.

"NCADD believes that the value of formalized

alcoholism treatment has been underemphasizedd to

date in the consideration of alcoholic patients for liver

transplantation and in their overall management. …

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