Interpreting the significance of drinking by alcohol-dependent liver transplant patients: Fostering candor is the key to recovery

Few studies have examined the value of treating alcohol addiction either be fore or after liver transplantation. Nevertheless, most liver transplant pr ograms and many insurance companies require 6 months to 1 year of abstinenc e from alcohol as a condition of eligibility for liver transplantation (the 6-month rule). We believe there are potentially harsh clinical consequence s to the implementation of this rule. For example, the natural history of a lcohol use disorders often involves brief fallbacks to drinking ("slips"), but when alcoholic liver transplant candidates slip, most are removed from consideration for transplantation or are required to accrue another 6 month s of sobriety. Because there is no alternative treatment to liver transplan tation for most patients with end-stage liver disease, the 6-month rule cou ld be lethal in some circumstances. In this review, we survey the literatur e concerning the ability of the 6-month rule to predict drinking by alcohol ic patients who undergo liver transplantation and examine its impact on the health consequences of drinking before and after liver transplantation. We believe that fostering candor between the alcoholic patient and the transp lant team is the key to recovery from alcoholism. We conclude that it is un ethical to force alcoholic liver patients who have resumed alcohol use whil e waiting for or after transplantation to choose between hiding their drink ing to remain suitable candidates for transplantation or risk death by aski ng for treatment of alcoholism. Consequently, we advocate a flexible approa ch to clinical decision making for the transplant professional caring for a n alcoholic patient who has resumed drinking and provide specific guideline s for patient management.