Patients with severe alcohol-related liver disease will receive transplants for first time under pilot scheme
People with a severe drink-related liver disease are to be considered for transplant for the first time, reopening the debate over whether people who are thought to bring ill health on themselves deserve expensive treatment.
The decision by the NHS's blood and transplant service (NHSBT) comes at a time when there is a national shortage of suitable organs, and amid concerns that donors would be reluctant to support schemes of this nature.
Health officials concede they are acutely aware of the sensitivities surrounding their decision, but argue that a pilot scheme is worthwhile. "We transplant humans, not angels," NHSBT's associate medical director James Neuberger told the Guardian.
The new scheme concerns those with severe alcohol associated hepatitis (SAAH) who have been excluded from consideration because the prognosis was so poor. There is sometimes not sufficient time to judge the prospects of them giving up alcohol and they often suffer infection and bleeding as well as having deep jaundice and mental confusion.
The patients the doctors are looking to treat in the pilot scheme must be relatively young – between 18 and 40 – seeing a doctor for the first time with liver disease, and being diagnosed with a drink problem for the first time.
There has been some concern among transplant specialists over the number of candidates they may have to assess, including for post-transplant abstinence, and the impact on other patients awaiting transplants.
Research suggesting that such patients may escape a rapid death through such intervention persuaded the NHS to set up a trial involve 20 patients who may take up to two years to recruit – a small proportion of those with the disease.
Alcohol use was a "very complex and emotive area", said Neuberger. "We need to retain public confidence that organs donated are used properly. That trust has to be earned; it can be lost very quickly. We have to work hard to ensure we are fair and that organs are used in the right way."
The move comes amid mounting concern over rises in deaths from alcohol-related liver disease. The Office for National Statistics revealed in February that in England and Wales these had gone up from 3,269 in 2002 to 4,265 in 2012, a rise of 18%. The biggest increase – a third – was seen in people over 60. Liver disease of all kinds is going up steadily, the only major disease category in which premature mortality is increasing in Britain while falling elsewhere in Europe, a trend that will mean steeply increased demand for replacement organs.
Already about a fifth of liver transplants involve patients whose liver condition has been linked to their drinking, including the late footballer George Best.
The latest rethink was prompted by a study by a French and Belgian team published in the New England Journal of Medicine in November 2011 which reported encouraging results among SAAH patients. It found early transplantation worked in some targeted patients, with six-month survival rates of 77% among 26 who had transplantation compared with 23% among patients who did not.
The transplant service usually lists people for transplant if they are expected to have a more-than-50% chance of being alive with a good quality of life after five years. Its guidelines for those with drink-linked disease say prospective recipients should abstain from alcohol before transplant, and be required to remain abstinent for the rest of their lives.
Andrew Langford, chief executive of the British Liver Trust, said some people said they would not donate organs because of the George Best case or wanted to be sure the organ would go to someone who would look after it.
Instead of looking at the cause of a potential recipient's disease, "we should be looking at what their healthcare needs are and not be judgmental", Langford said. Most liver disease was caused "one way or another" by personal choices.
"The vast majority of people who have transplanted organs do look after them and lead a far healthier life," he said.
By James Meikle
Photograph Kieran Doherty Reuters; The late George Best
April 3 2014
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