Transplantation for Alcoholic Hepatitis: Are We Achieving Justice and Utility?
Steven F. Solga
Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
These authors contributed equally to this work.Search for more papers by this authorCorresponding Author
Marina Serper
Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
These authors contributed equally to this work.Address Correspondence and Reprint Requests to:
Marina Serper, M.D., M.S.
3400 Spruce Street
2 Dulles
Philadelphia, PA 19104
E-mail: [email protected]
Tel.: +1 215 349 8222
Search for more papers by this authorRebecca A. Young
Hospital of the University of Pennsylvania, Philadelphia, PA
Search for more papers by this authorKimberly A. Forde
Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Search for more papers by this authorSteven F. Solga
Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
These authors contributed equally to this work.Search for more papers by this authorCorresponding Author
Marina Serper
Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
These authors contributed equally to this work.Address Correspondence and Reprint Requests to:
Marina Serper, M.D., M.S.
3400 Spruce Street
2 Dulles
Philadelphia, PA 19104
E-mail: [email protected]
Tel.: +1 215 349 8222
Search for more papers by this authorRebecca A. Young
Hospital of the University of Pennsylvania, Philadelphia, PA
Search for more papers by this authorKimberly A. Forde
Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Search for more papers by this authorAbstract
Early liver transplantation for alcoholic hepatitis is a potentially life-saving treatment. As this practice becomes increasingly common, however, the liver transplant community is taking a fresh look at a familiar challenge: best stewardship of donor organs. Herein, we examine a few basic, necessary ethical and practical concerns relevant to this indication.
References
- 1Tapper EB, Parikh ND. Mortality due to cirrhosis and liver cancer in the United States, 1999-2016: observational study. BMJ 2018; 362: k2817. 10.1136/bmj.k2817.https://www.bmj.com.
- 2Singal AK, Bataller R, Ahn J, Kamath PS, Shah VH. ACG Clinical Guideline: Alcoholic Liver Disease. Am J Gastroenterol 2018; 113: 175-194.
- 3Louvet A, Labreuche J, Artru F, Boursier J, Kim DJ, O’Grady J, et al. Combining data from liver disease scoring systems better predicts outcomes of patients with alcoholic hepatitis. Gastroenterology 2015; 149: 398-406.e8; quiz e16–7.
- 4Artru F, Louvet A, Mathurin P. Liver transplantation for patients with alcoholic hepatitis. Liver Int 2017; 37: 337-339.
- 5 United Network for Organ Sharing. https://unos.org. Accessed August 8, 2018.
- 6Snyder L; American College of Physicians Ethics, Professionalism, and Human Rights Committee. American College of Physicians Ethics Manual: sixth edition. Ann Intern Med 2012; 156(1, pt 2): 73-104.
- 7Mathur AK, Schaubel DE, Gong Q, Guidinger MK, Merion RM. Racial and ethnic disparities in access to liver transplantation. Liver Transpl 2010; 16: 1033-1040.
- 8Nephew LD, Goldberg DS, Lewis JD, Abt P, Bryan M, Forde KA. Exception points and body size contribute to gender disparity in liver transplantation. Clin Gastroenterol Hepatol 2017; 15: 1286-1293.e2.
- 9Yeh H, Smoot E, Schoenfeld DA, Markmann JF. Geographic inequity in access to livers for transplantation. Transplantation 2011; 91: 479-486.
- 10Ratcliffe J. Public preferences for the allocation of donor liver grafts for transplantation. Health Econ 2000; 9: 137-148.
10.1002/(SICI)1099-1050(200003)9:2<137::AID-HEC489>3.0.CO;2-1 CAS PubMed Web of Science® Google Scholar
- 11Albertsen A. Drinking in the last chance saloon: luck egalitarianism, alcohol consumption, and the organ transplant waiting list. Med Health Care Philos 2016; 19: 325-338.
- 12Marot A, Dubois M, Trepo E, Moreno C, Deltenre P. Liver transplantation for alcoholic hepatitis: a systematic review with meta-analysis. PLoS ONE 2018; 13: e0190823. 10.1371/journal.pone.0190823.http://www.plosone.org.
- 13Lee BP, Mehta N, Platt L, Gurakar A, Rice JP, Lucey MR, et al. Outcomes of early liver transplantation for patients with severe alcoholic hepatitis. Gastroenterology 2018; 155: 422-430.e1.
- 14Skaro AI, Hazen G, Ladner D, Kaplan B. Organ transplantation: an introduction to game theory. Transplantation 2015; 99: 1316-1320.
- 15Connor JP, Haber PS, Hall WD. Alcohol use disorders. Lancet 2016; 387: 988-998.
- 16Neuberger J, Adams D, MacMaster P, Maidment A, Speed M. Assessing priorities for allocation of donor liver grafts: survey of public and clinicians. BMJ 1998; 317: 172-175.
- 17Daugherty Biddison EL, Gwon H, Schoch-Spana M, Cavalier R, White DB, Dawson T, et al. The community speaks: understanding ethical values in allocation of scarce lifesaving resources during disasters. Ann Am Thorac Soc 2014; 11: 777-783.
- 18Wright L, Ross K, Daar AS. The roles of a bioethicist on an organ transplantation service. Am J Transplant 2005; 5(4, pt 1): 821-826.
