Some surgeons are rethinking the informal, yet widespread practice of requiring patients with alcoholic liver disease to be sober for six months before they can join a waitlist for a liver transplant, Kaiser Health News reported Oct. 12.
The rationale for the practice, which dates back to the 1980s, is that the waiting period gives a person's liver time to heal, potentially avoiding the need for a transplant. If the liver does not heal, the patient has at least proven he or she can stay sober after the transplant.
However, emerging research has poked holes in this premise and suggests that the six-month period is not a good predictor of long-term sobriety. Some surgeons and family members also argue the practice unfairly penalizes people with substance use disorder, which is now better understood as a disease rather than a personal failure of the patient's.
"We have to move beyond denying people lifesaving therapy because we think they don't deserve it," Andrew Cameron, MD, PhD, head of the liver transplant program at Johns Hopkins Medicine in Baltimore, told Kaiser Health News.
Transplant centers can set their own policies on the waiting period, as there is no national regulation. As of 2019, only about one-third of hospitals performing liver transplants had done the procedure without the waiting period, according to research cited by Kaiser Health News. Patients who cannot access these hospitals and are forced to wait may die without ever making it on a transplant waiting list, according to Dr. Cameron.
Some physicians have expressed concern that eliminating the policy could overwhelm an already limited supply of donor livers in the U.S. Scrutiny of the practice comes as many U.S. hospitals have reported an uptick in hospitalizations for alcoholic liver disease since 2020.
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