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I have cirrhosis of the liver. Is that reversible?

More than 2 million Americans suffer from alcohol- related liver disease. The most common condition is alcoholic hepatitis, or inflammation of the liver (the root "hepa" refers to liver, and the root "itis" refers to a generalized inflammatory process) as a result of heavy drinking over a long period of time. The symptoms of hepatitis may include fever; abnormal yellowing of the skin, eyeballs, and urine known medically as jaundice; and abdominal pain. These more commonly go unnoticed until a lab test reveals elevated liver enzymes. Alcoholic hepatitis can cause death if drinking continues. If drinking stops, the condition may be reversible. About 10% to 20% of alcoholics develop alcoholic cirrhosis, or scarring of the liver, which is the result of chronic hepatitis. People with cirrhosis should not drink alcohol.

More than 2 million Americans suffer from alcohol- related liver disease.

Hepatitis a liver disease due to a viral infection.

Cirrhosis a liver disease where there is widespread disruption of normal liver functions. It is a chronic progressive condition that can eventually lead to death.

Although treatment for the complications of cirrhosis is available, a liver transplant may be needed for someone with life-threatening cirrhosis. Alcoholic cirrhosis can cause death if drinking continues. Cirrhosis is not reversible, but if a person with cirrhosis stops drinking, the chances of survival improve over time. People with cirrhosis can feel better, and liver function can improve after they stop drinking. An added complication is the fact that drug and alcohol abusers are prone to developing viral hepatitis as a result of their high-risk behavior (e.g., unprotected sex, intravenous drug use). These viruses include hepatitis B and hepatitis C. About 4 million Americans are infected with the hepatitis C virus, which can cause liver cirrhosis and liver cancer. Some alcoholics also have either the hepatitis B or C virus infection. As a result, their livers may be damaged not only by alcohol but also by the hepatitis virus. People with either hepatitis B or C virus infection are more susceptible to alcohol-related liver damage and should think carefully about the risks when considering whether to drink alcohol.

Am I eligible for a liver transplant if my liver failure is from my alcoholism?

One of the biggest stories that came in the 1990s was Mickey Mantle's liver transplant. Mantle, a famous baseball player, was 63 years old in 1995 when his liver failed, and he was placed on the list to receive a transplant. The average waiting time was 3 to 4 months. Mantle, however, received a liver transplant in a day. Unfortunately, the underside of his liver had cancerous cells. The transplant went ahead as planned; however, the cancer then spread to his lungs, and Mantle died 3 months later from the cancer. Critics charged that Mantle was given a liver quickly because of his public prominence. Others charged that he should not have been given a liver because of either his history of alcoholism or his cancer, both of which are reasons not to place someone on the list at some transplant centers.

Mickey Mantle had been an alcoholic since the age of 20 years. He had been abstinent a year and a half, but his liver was by then failing because of his alcoholism and the contraction of hepatitis C. Hepatitis C may have been contracted from a blood transfusion he received during surgery or may have been contracted as a result of his alcoholic high-risk behavior. He also had a tumor in his liver, called a hepatoma, that had not been discovered prior to the time of his transplant.

Should people who are alcoholics receive transplants? Increasingly, transplant centers are not using a history of alcoholism as a reason to deny patients a transplant. When liver transplants first became available in the 1970s and 1980s, centers generally excluded alcoholics because it was thought that they would have worse survival rates because of their inability to maintain abstinence. Since then, multiple studies have been conducted comparing alcoholics with nonalcoholic patients who received transplants. They have found that alcoholics do as well as or better than those whose livers have failed from other causes. Because the outcomes are the same or better, the only reason to deny an alcoholic a transplant would be either the fact that he or she continues to drink or for some other nonmedical reason. Most centers therefore require that alcoholics be abstinent for at least 6 months and to be actively engaged in a recovery program to maintain abstinence.

If we were going to reject a person with alcoholism from receiving a liver transplant because it was due to their own behavior, then we would have to reject equally the sedentary, type A, overweight cigarette smoker from receiving a heart transplant. If someone needed a liver transplant due to hepatitis C, we would have to explore the way in which that person contracted hepatitis C to see whether some form of "irresponsible" behavior was involved as well. This could go on and on until one could foresee denying all kinds of medical care to individuals simply because of the choices they made in their lives that did not accord with our conception of a "healthy lifestyle."

The first principle of organ allocation is making the best use of the organ in order to save a life that is in immediate danger, but also a life that has the best chance for long-term survival. In this regard, alcoholism is no different from any other disease of lifestyle.

 
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