Transplant row over organs for drinkers
Figures show that transplants for heavy drinkers have risen by more than 60% in the past decade, while waiting lists have lengthened. In December 1997, 180 people in the UK were awaiting a liver transplant, compared with 325 in the same month last year.
Dr Tony Calland, chairman of the British Medical Association’s medical ethics committee, said surgeons are within their rights to refuse transplants to anyone with alcohol-related liver disease if they do not demonstrate a genuine desire to stop drinking.
And the mother of a young woman whose organs helped to keep five people alive after she died said it was “offensive, terrible and unfair” that an increasing proportion of livers were going to people with serious alcohol problems.
Eunice Booker, whose 26-year-old daughter, Kirstie, died in a car crash in 2006, said: “I find it offensive that one in four of the livers donated go to alcoholics. If there are two people side by side wanting a liver, and both have the right tissue match, and one is an alcoholic and one isn’t, there’s no contest – you take the one who’s not an alcoholic, they are more entitled.”
Official figures that show in the year to 31 March 2008, 151 liver transplants, out of a total of 623 carried out across the UK, went to people with alcohol-related liver disease – 23% of the total. By contrast, in the year to March 2007, there were 94 liver transplants for people with alcohol-related liver disease, just 14% of the overall total.
Calland acknowledged that the trend was raising new questions for surgeons, who are within their rights to insist that anyone with alcohol-related liver disease demonstrates a genuine intention to address their problem before the operation is approved.
“Organs are precious resources and should be used where the clinical outcome – the patient’s health – justifies the use of something so scarce,” Calland said. “You have to have very definite evidence that the person is going to stop drinking. If someone won’t promise, you could refuse them the transplant on clinical rather than ethical grounds.”
Concerns about alcohol-related health problems in Britain are increasing. A report by the London School of Hygiene and Tropical Medicine two years ago suggested that deaths from cirrhosis of the liver were rising faster in Britain than anywhere else in Europe. The rise was especially sharp in men and women aged under 45, where death rates now exceed the European average.
Last month, Alison Rogers, chief executive of the British Liver Trust, warned that “the death toll from alcohol remains unacceptably high” and that twice as many people are dying from alcohol as 15 years ago.
Some have questioned whether livers are being allocated fairly. Professor Nigel Heaton, the surgeon who performed a liver transplant on alcoholic footballer George Best, said at the time that new measures were needed to identify patients likely to abuse alcohol after their operations so that medical staff could make an assessment as to whether there were more suitable candidates.
“If you knew someone was going to be recidivist, you wouldn’t take them on for a transplant,” he said.
A spokesman for NHS Blood and Transplant, the special health authority that oversees transplants, said the decision to allocate each organ was made on a case by case basis: “The patient’s surgeon assesses whether that person is fit physically and is able to cope with the rigours of living after a transplant.”
Liberal Democrat shadow culture, media and sport secretary Don Foster, who obtained the new transplant figures, said only by increasing the cost of alcohol could the nation’s health be saved from Britain’s binge-drinking culture.
“These figures are a stark warning about the impact alcohol is having on health services in this country,” he said. “Recent studies have proven that the cheaper alcohol is, the more we all drink. None of us wants to pay more for our alcohol, but with an alcohol crisis on our hands we have to look again at raising the price of the cheapest alcohol.”