Patients with alcohol-related disease wait longer for crucial liver transplants : Shots - Health News Many transplant centers require people with alcohol-related liver disease to remain sober for half a year, before becoming eligible for the waiting list for a liver. But this thinking may be changing.

In the quest for a liver transplant, patients are segregated by prior alcohol use

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Americans have been drinking more alcohol during the pandemic - a lot more - and that means more hospitalizations for alcohol-related liver disease, which are on the rise, with more people with failing livers likely needing transplants to survive. Aneri Pattani of Kaiser Health News took a look at the gatekeeping process for liver transplants and found different rules for different patients. And some say that's unfair.

ANERI PATTANI: When Cameron Gorzney's dad suddenly became ill last year, she rushed home from college. Doctors at the hospital, just outside Kansas City, Mo., told her that his liver was failing. He had less than six months to live. The doctor said a transplant could save her dad, Brian, but there was a catch.

CAMERON GORZNEY: They're like, well, yeah, your dad's a different story because he's an addict.

PATTANI: What they meant was his liver damage came from years of alcohol use.

C GORZNEY: And he hasn't been six months sober.

PATTANI: For patients with alcohol-related disease, it can be hard to even get on the waitlist for a new liver. Since the '80s, many transplant centers and some health insurance companies have required these patients to be sober for six months first. That's because sometimes the person's liver will heal on its own. Dr. Alan Gunderson leads the liver transplant team at the University of Iowa Hospital.

ALAN GUNDERSON: So the six-month rule started as a buffer time to see if someone would really need liver transplant or not.

PATTANI: And for the patients whose livers didn't heal, it became a test to prove they could stay sober for six months.

GUNDERSON: And of course, if they could not, that was a marker that they probably wouldn't achieve lasting success with the new liver because they may lose it to alcohol as well.

PATTANI: On any given day, there are nearly 12,000 people waiting for a liver. Doctors who support the six-month wait say it's crucial anyone who gets an organ is ready to care for that gift. But here's the problem. Research actually shows about 80% of all people with alcoholic liver disease stay sober after a liver transplant, even those who didn't have to wait the six months.

GUNDERSON: Their rates of return to alcohol are no different than the people that we make wait six months.

PATTANI: Without the data to support it, Gunderson says...

GUNDERSON: The six-month rule is really problematic.

PATTANI: He says medical care shouldn't involve judging someone for how they got sick. That's not how doctors treat patients with diabetes or STDs. And in the case of liver failure, lots of patients die during the six-month wait. That's what Cameron worried about with her dad.

C GORZNEY: It's a trauma, really, when somebody is dying in front of you and there's things that can be done and nobody wants to do them for you.

PATTANI: Some doctors say more long-term research is needed to see if patients without a six-month wait stay healthy and sober 10 or 15 years down the line. But Gunderson says it's possible now to carefully choose patients who can forgo the waiting period and still care for an organ.

GUNDERSON: On the rare occasions where it seems like you're set up for success and you seem like you would have a young person who otherwise would have a lot of life in front of them, it seems like the right use of a scarce resource.

PATTANI: The doctors in Missouri told Cameron her dad, Brian, was dying and suggested hospice care. But Cameron refused. Her dad had stopped drinking and had actually been set to check into rehab just before his health crisis. So the family took Brian across state lines to Kansas for a second opinion. But a hospital there turned them down too.

C GORZNEY: At this point, we're desperate. Like, it's who can do this for us, you know? Who can see the value in my dad? Who can see the value in his family?

PATTANI: So they researched other transplant centers and got on the road fast.

C GORZNEY: I mean, we were just throwing stuff in a bag. I've got people trying to watch my animals at home 'cause we're just - we're going. And we left. I mean, we packed up, and we left immediately - headed up to Iowa.

PATTANI: At the transplant center in Iowa City, they met the team led by Dr. Gunderson and made their pitch. Brian would stay sober, they said. He had a steady job and strong family to help him care for a new organ. When the transplant committee responded, the family group text exploded with relief.

C GORZNEY: He's been approved for a liver. He's been approved for a liver. You know, he's on the list. He's on the list. And it was - we all - I mean, we cried, like, tears of joy.

PATTANI: Within 24 hours, Brian Gorzney had a new liver. That was 18 months ago. Since then, he got to see Cameron graduate college and his other daughter, Carson, finish high school. Brian says he's lucky his family found a transplant center that looked beyond the six-month rule, but he worries about other patients.

BRIAN GORZNEY: It happens every day. People are unfortunately passing away, not knowing that there may be other options for them because they don't have a support group that I had that was aggressive enough and strong enough to reach out and not accept no on the first response they got.

PATTANI: But only about one-third of all transplant hospitals have performed a surgery without the six-month delay. So no is still the most common answer for patients like Brian.

GARCIA-NAVARRO: That was reporter Aneri Pattani with our partner, Kaiser Health News.


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