FRESH TAKE

For years, doctors used bad science to choose who could get a new liver

Saving lives.
Saving lives.
Image: Reuters/Fabrizio Bensch
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The share of total liver transplants going to people who suffer from alcohol-related health issues is on the rise in America—but don’t blame it on the bottle.

In 2002, alcohol-related liver disease was the cause for about a quarter of total liver transplants in the US. By 2016, the disease accounted for 37% of total liver transplants. And new research shows that increase of the share that are for alcohol-related illness is broadly attributable to the fact that, for many years, the medical community adopted and employed an unscientific policy that stifled the number of people who were able to qualify for a new liver.

As detailed in a new study published this week in JAMA Internal Medicine, the scientific community for decades had debated whether people with alcoholic liver disease should be sober for at least six months before being considered for transplants. In 1997, that debate virtually ended when the US surgeon general released a paper saying as much.

The idea seemed simple enough: If a person was able to stay sober for six months, it reduced the chance they’d fall back into addiction and damage their new organ. The idea wasn’t backed up with any real science, though. That means a lot of people who could have benefited from a transplant were never able to do so.

Medical opinion began to shift in 2010 and 2011, when scientific papers out of Pittsburgh and France showed little evidence that a mandated benchmark of six months of abstinence before a transplant made much of a difference at all, aside from creating a stigma toward the people who needed help to begin with. Changes in policies followed in some regions of the US, but not all. Without a national policy, a broader change in approach will take time, requiring physicians all over the country to shift their attitudes on their own time.

Still, already the overall share of liver transplants for alcohol problems has grown thanks largely to changing perceptions. That number is also boosted by medical advances for treating hepatitis C, which used to be the top reason that transplants were requested. Doctors can now treat that condition with drugs.

That’s good news for the more than 17,000 Americans on the waiting list for a new liver, a number of whom are likely there for a reason relating to alcohol.