Liver transplants are a politically super-charged issue, as who gets on the list, who gets to the top of the list and who gets the benefits of a liver transplant are questions people ask, and sometimes the answers to those questions are infuriating.

The CBS news magazine show 60 Minutes ran a story about Japanese mobsters coming to the U.S. for liver transplants at UCLA Medical Center. The fact that these criminal gang leaders could put $1 million in cash down on the table might have had something to do with it.

Gee, do you think? Even the iconic baseball hero, Mickey Mantle, got some bad press when he went to the top of the list. Money, invariably in America, plays are greater role in determining care than any other issue. It’s political more than medical.

One of the reasons there is so much political argument is because 75% of liver disease is entirely avoidable. There are three alcohol-related liver conditions. The first is a fatty liver, which can be completely reversed if the person doesn’t drink anymore.

Fatty liver is not necessarily a trigger for disease. However, if the person insists on drinking, the fatty liver can progress into alcoholic hepatitis, a chronic inflammation of the liver.

People develop a fever, jaundice and abdominal pain. This is not to be confused with other abdominal conditions, such as cholecystitis, which is gall bladder inflammation. Alcoholic hepatitis can also be confused with pancreatitis or even appendicitis.

The reason it is important to diagnose the situation properly is due to the fact that persons with alcoholic hepatitis do not do well following surgery. Appendicitis and pancreatitis call for surgical intervention. Alcoholic hepatitis can be reversed with abstinence, but it can also be fatal.

Cirrhosis is the most serious form of alcoholic liver disease and occurs when scare tissue on the liver develops to the point where blood no longer flows through the vessels. The liver actually shrinks and becomes hard. It’s function is destroyed. Transplant is the only treatment for this condition.

While it is understood that there might be a progression, from the fatty liver to alcoholic hepatitis to cirrhosis, the end condition, cirrhosis, can occur without going through the other stages. Alcoholic hepatitis and cirrhosis are common causes of death in severe alcoholics.

The alcohol and drug addiction-related liver diseases can also be a step to the development of liver cancer. In alcoholics, the sheer amount of alcohol can contribute to the development of cancer. Hepititis B Virus (HBV) and Hepititis C Virus (HCV) are the two leading causes of liver cancer worldwide. Hepatitis C is a serious concern for drug users who inject their substance of choice. This disease is often caused by dirty needles, and infection rates are very high.

Again, this is avoidable. Some communities have a needle exchange program, just to attempt to prevent the spread of Hepatitis C. Once the liver has failed, patients must have a transplant or they will die. Human nature goes both ways on this issue. People will say “too bad, but you did it to yourself,” while others look at the same situation with compassion and a desire to help. This is an emotionally-charged issue.

Of the people who receive transplants, nearly 50% of them use some alcohol, and as many as 10% of the transplant recipients are addictive drinkers. If this is the case, those who screen applicants for liver transplants understandably have the difficult task of sorting through the candidates and determining who is likely to receive the greatest benefit from the procedure.

If one is to continue drinking heavily, regardless of the consequences, the transplant will only delay the inevitable. The best candidate is the one who does not have that issue. Again, the other 50% of transplant patients are not drug and alcohol abusers.

Once an alcoholic has been selected to receive a liver, there really is not a standard therapy to follow, other than abstinence. Drug users, who are on methadone treatments and can avoid using, are likely to do well. Aside from the liver issues, there are other factors that can be used to determine success rates, such as use of tobacco and dietary habits.

When a liver transplant is necessary, Science Daily reported that only 6% of former alcoholics and 4% of former drug addicts will relapse following a transplant. This is an encouraging statistic, but it depends on the individual’s willingness to abstain from alcohol and drugs.

There are those who will view that as an injustice and argue that it is not fair. However, the numbers tell a compelling story. Drug and alcohol liver disease can be reversed, with abstinence, if diagnosed early enough. In those cases, the only injustice is what we do to ourselves.

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