The Sobering Truth

Man with alcohol liver diseased yellow eyes

The Sobering Truth: Drinking and Liver Transplants

Before I was diagnosed with end stage alcoholic cirrhosis, I naively thought that if my excessive drinking led to complications I could just have a liver transplant. Not even close. Getting a transplant isn’t like buying a new pair of shoes. And yes, size does matter! 


In recent years, there has been an alarming increase in alcohol consumption. Whether this escalation is due to stress, social pressure, or simply a desire to escape reality, the repercussions of excessive drinking extend far beyond the immediate effects of intoxication. Excessive and prolonged alcohol intake can cause severe damage to the liver, resulting in conditions such as alcoholic hepatitis, alcoholic cirrhosis, and liver cancer. As a consequence, individuals with advanced liver disease often require liver transplants to survive.

 

The Current Situation

The demand for liver transplants far exceeds the available supply of organs, creating significant challenges for healthcare systems. This scarcity of donor organs leads to long waiting lists and delays in receiving life-saving transplants.

Alcohol Use Disorder (AUD), in particular, contributes to the yearly demand for liver transplants. Alcohol-associated liver disease (ALD) is now the most common defined cause for both liver transplant (LT) (31%, 2584 transplants) and listing diagnosis (31%, 3861) in the US. (1)


Of the 100,530 liver disease deaths among people ages 12 and older in 2021, 47.4% involved alcohol. (2)


Available Livers for Transplant

The number of available livers for transplantation is primarily dependent on deceased organ donations. In recent years, there has been a steady increase in the number of deceased donors, resulting in a rise in the availability of livers. However, despite these efforts, the demand still outpaces the supply.

  1. Number of Liver Transplants: In 2022, there were approximately 8,000 liver transplants performed in the United States. While this number may seem substantial, it falls significantly short of the number of individuals in need of a transplant. (3)
  1. Transplant Rates: The transplant rate, which represents the number of liver transplants performed per 100 people on the waiting list, varies across different regions. On average, the national transplant rate stands at around 47 transplants per 100 waitlisted individuals. (4)
  1. Waiting List Mortality: Unfortunately, due to the limited availability of livers, some patients on the waiting list do not survive long enough to receive a transplant. On average, the waiting list mortality rate in the United States hovers around 15-20%. (5)
  1. Time on the Waiting List: The average time a patient spends on the liver transplant waiting list varies based on factors such as blood type, medical urgency, and regional disparities. In general, patients can expect to wait anywhere from several months to several years for a suitable liver.  (6)


    The average national liver transplant rate stands at around 47 transplants for 100 waitlisted individuals.
    On average, the waiting list mortality rate is 15-20%. 


Addressing the Issue

It is important to recognize that the rising demand for liver transplants due to increased alcohol intake is a complex issue that requires a multi-faceted approach. By addressing the root causes of excessive alcohol consumption, promoting early intervention and treatment, improving organ donation processes, providing mental health support, and implementing effective public policies, we can work toward reducing the burden on liver transplant programs and promoting healthier lifestyles. To address the concerning rise in alcohol-related liver diseases and the subsequent need for liver transplants, several steps can be taken:

  1. Education and Awareness: Increasing public awareness about the risks and consequences of excessive drinking is essential. Education campaigns can highlight the long-term impact on liver health, encouraging individuals to make informed choices about alcohol consumption. (7)
  1. Early Intervention and Treatment: Early identification and intervention in alcohol-related problems can help prevent severe liver damage. Accessible and effective treatment options, counseling services, and support groups should be readily available to individuals struggling with alcohol addiction. (8)
  1. Organ Donation and Transplantation: Efforts should be made to increase the availability of donor organs for liver transplantation. This includes improving organ donation processes, raising awareness about the importance of organ donation, and enhancing collaboration between healthcare systems and transplant centers. (9)
  1. Recovery Support: Positive abstinence-based recovery programs to support substance use challenges are crucial. Connecting with others improves mental health and promotes better lifestyle choices. (10) For those diagnosed with AUD-related medical conditions, these social connections are lifesaving. Connecting with others who are at various stages of their own recovery journeys is emotionally impactful and can build confidence and strength. Patients undergo treatment  with a better understanding of the road ahead and  improve their chances for success.
  1. Public Policy: Governments can play a significant role in reducing alcohol consumption and its associated harms. Implementing and enforcing policies that discourage excessive alcohol intake, such as stricter regulations on alcohol marketing, can help mitigate the demand for liver transplants.

Next Steps

The statistics surrounding the availability of livers for transplant versus the number of people in need highlight the urgent need for action. By raising awareness, expanding living donor programs, and refining organ allocation policies, we can work towards reducing the gap and providing timely liver transplants to those who need them most. Organ donation remains a powerful act of compassion, offering hope and a second chance at life for countless individuals.

 

LifeRing Resources

The Liver Spot | Wednesdays at 5:30pm Pacific

LifeRing hosts a focus meeting for people in recovery who are also diagnosed with health issues resulting from substance use disorders. The Liver Spot is the first of its kind:  built on the LifeRing “How Was Your Week” (HWYW) check-in  format, this special meeting offers an opportunity for open patient-to-patient knowledge exchange and supports an average of 50 people every week with a core group of 30.
Zoom Meeting Link  | Meeting ID:  856 0614 8917 | Passcode: 162086

 

References

  1. The Sobering Complexities of Alcoholic Liver Disease and Decisions for Transplant
    JAMA Network, August 11, 2021, Kenneth A. Andreoni, MD1,2Ali Zarrinpar, MD, PhD2
  1. Alcohol and the Human Body
    National Institute on Alcohol Abuse and Alcoholism (NIH), 2023
  1. UNOS National Liver Data (All Donors)
    United Network of Organ Sharing (UNOS)
  1. National Liver Waitlist Additions through October 27, 2023
    Organ Procurement & Transplant Network (OPTN)

  2. When alcohol abstinence criteria create ethical dilemmas for the liver transplant team
    National Institute on Alcohol Abuse and Alcoholism (NIH), May 2006, K A Bramstedt and N Jabbour
  1. The Liver Transplant Process
    National Institute on Alcohol Abuse and Alcoholism (NIH), 2017
  1. American Liver Foundation
  1. Alcohol Related Liver DiseaseNational Health Service
  1. Health Resources Services AdministrationOrgandonor .gov
  1. Recommend Evidence-Based Treatment: Know the Options
    National Institute on Alcohol Abuse and Alcoholism (NIH), May 2022

 


You can help LifeRing provide peer-to-peer resources like The Liver Spot with your one-time or sustaining donations.
Thank you!

 

2 Comments

  1. SocraticGadfly on November 2, 2023 at 3:29 pm

    Side note: Let us remember that within the addiction world, things like dirty needles causing hepatitis can also lead to transplant needs.



    • Bobbi on November 6, 2023 at 9:31 am

      True that, Steve, as can sharing straws or any other means of transmission where blood may be present (which is also why people shouldn’t really share razors for shaving, either). Hepatitis C is far more easily treatable than it used to be, but the problem is unless someone specifically checks for it it can go undetected for years until it starts to cause damage the liver. It’s definitely not a bad idea, if one has a history of IV or intranasal drug use where sharing occurred, to ask their physician to order a blood test to find out if they’ve been exposed without knowing it.