Thursday, April 2, 2015

Transplantation for Alcoholic Cirrhosis: is it justified?

All over the world, alcoholism is responsible for 40 to 50% of chronic liver failure and similar percentage is represented in transplant centers.  This presents a big dilemma for doctors, the family and health policy makers.  The fact remains that transplantation does not come cheap and when living donation is involved as it is in Asia there are moral questions to be answered.  After practicing as a liver transplant specialist for nearly 2 decades the answer is quite apparent to me.  Alcoholics by and large are serial offenders and nearly 70% of those who are transplanted resume alcohol consumption even as far as 4-5 years after liver transplant.  This underlines the fact that addiction is the problem that requires attention and treatment and not the liver disease.  So what about patients who pass with flying colors in AA programs and abstain form drinking for minimum period of 6 months before their transplant? Well the story is no different! In India there are social pressures that drive families to find a transplant solution. But they are making a mistake.  When a family is forced to make an emotional decision, invest their family fortune and risk of a living donor (usually the wife) surgery thrown in, common sense and rationale takes a toss.  Well why not ban live donor transplants for them and allow cadaver organ transplant? In my opinion this is  a bigger blunder.  A scarce national resource and a gift of life should find a more deserving home.  What then is the solution? They should be managed conservatively keeping a strict vigilance on abstinence. With better understanding of the biology of regeneration, it is possible to provide reasonable quality of life to those with alcoholic cirrhosis. Once stem cell based therapies, extrahepatic organogenesis and even Gene editing comes into standard medical practice many more solutions will evolve.

AA = Alcohol Anonymous
Cadaver organ = organ donated by a brain dead donor
Cirrhosis = scarring and shrinkage of the liver
Gene editing = technology used to alter the human genetic sequence
extrahepatic organogenesis = growing liver cells outside the liver in human body

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