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Toronto ON  Canada

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Liver transplantation was declared a clinical service at a consensus conference organized by the U.S. Surgeon General in 1983. By 1988, liver transplant pioneer surgeon Dr. Thomas Starzl said "...the imposition of an arbitrary period of abstinence before going forward with transplantation would seem medically unsound or even inhumane." In the same article, he confirmed the survival and long-term prognosis of patients transplanted for alcohol-associated liver disease was as good as, or better than, patients transplanted for other diseases.

Books sit on a shelf.

6-Month Wait

                  Despite the fame and available expertise of Dr. Starzl, the University of Alberta, along with the rest of Canada's liver 

                  transplant centres, chose to ignore his published research in the area of transplantation in patients with alcohol use

                 disorder. Yet 25% of the references of their waitlist criteria, (at left) written around 1989, used Starzl's work as reference

                 for other types of liver disease. The treatment of alcohol patients was backed by a phone call to a professor at the         

                 University of Alberta with no published research on transplantation patients. 

Although subsequent research papers continued to echo Dr. Starzl’s position, international liver transplant centers refused to  accept ALD patients who were not alcohol-free for 6 months. In 2008, the University of Pittsburgh published a meta data analysis, summarizing the results of 52 studies over a 22-year period in 3,600 patients. The research team observed that rates of return to heavy drinking in any given year was 2.2%.

 

The policy, based primarily on moral judgment of patients with alcohol use disorder, is also supported by an acute fear that poor public perception of alcohol use disorder will negatively impact donation rates.

 

But neither return to drinking or public reticence to donate have ever been supported by medical research or data.  Patients rarely return to heavy drinking and waste the organ.

In recent years, individual transplant centres in Europe and the U.S. have slowly started to conduct trials and transition to a more modern and compassionate approach to liver transplantation in patients whose liver disease is caused by alcohol use disorder.

 

You can find the status of the 6-month wait in Canada, and its application at U.S. liver transplant centres here 

The Reasons Given for the 6-Month Wait

[ Reason #1: International Standard ]
[ Reason #2: Liver Regeneration ]
[ Reason #3: Best Use of a Scarce Resource ]
[ Reason #4: Likely Return to Drinking ]
[ Reason #5: Public Perception ]

Research papers and transplant centres’ responses to media queries include many explanations of why the 6-month wait exists. If carefully analyzed, all comments on its validity are variations of these five standard reasons: