Let's just say Penny is a 60ish female with alcoholic cirrhosis. She had been a patient of mine for years. We first met when she had, what I thought would be, he last battle with the bottle. Back then, she presented with acute alcoholic hepatitis. Once she recovered from this acute event, we had a long talk and I told her that her ticket to like would have to be free of alcohol. Over time, she recovered from he liver insult from her heavy drinking ways, and for a few years, did well.
I saw her once or twice yearly when she flew into Houston to see me. She was happy in retirement, playing golf and relaxing. Every time we encountered, I was obligated to ask about alcohol. Every answer from her was NO!
Penny was evaluated for liver transplantation during her first bout with liver disease, and remained on the "list", even though her MELD score was relatively low (reflecting good liver function). Before listing for transplant, she was required, and completed, six months of Alcoholics Anonymous, with continued attendance.
This past spring, problems developed.
She was showing signs of worsening liver function, complicated by infections and gastrointestinal bleeding. One thing lead to another and she was eventually transferred to Houston for more intensive care. Upon question of the family and Penny herself, he had returned to active drinking for the past two years. Considering the clinical deterioration, this made sense.
I felt betrayed by this revelation. Time after time I questioned her sobriety. Nurses did the same. There were denials from everyone. I always told her that if she resumed destructive alcohol abuse, she would never be transplanted and have a miserable death. In the end, all of this came true. She died a terrible death, without any mention of a transplant.
Nationally, those of us in liver transplantation adopted the "six-month rule", mandating this time frame of active relapse prevention. Once completed and documented, formal listing for transplant could be discussed. Any break in this, and transplant is out.
The lesson here to learn is that if you have alcoholic liver disease and suffer from alcoholism, abstinence must be life-long. In many cases, the liver can recover and you dodge the transplant bullet. Feeling wonderful once your liver recovers could be a signal to start drinking again. Refrain from this. This is a scenario I see too often, and it does happen. Trust me.
Death by end-stage liver disease is dramatic. Transplantation is a wonderful gift and tool we have. It's use will always be reserved for the best candidates. We are not selecting against alcoholics. There's a system in place to deal with them. Falling off the wagon ends the discussion.
Penny is a fictitious name change to protect patient identity.
