Session: Clinical Ethics: Organ Donation/Procurement
Transplant Providers’ Perceptions of the 6-Month Alcohol Abstinence “Rule” for Liver Transplantation
Friday, September 20, 2024
3:45 PM – 4:45 PM CT
Location: Midway 3-4 (First Floor)
Abstract:
Purpose: Recent research has provided evidence challenging the long-standing “6-month rule” requiring patients with alcohol-related liver disease (ALD) to have 6 months of alcohol abstinence before liver transplantation. However, early liver transplantation performed without the 6 months abstinence requirement remains controversial. Additionally, the extent to which providers’ perceptions should guide transplant policymaking is an understudied ethical issue in this context.
Methods: We conducted in-depth semi-structured interviews about the “6 months rule” and transplant evaluation processes for patients with ALD (11/2021-4/2022), purposively sampling providers who treated patients with ALD (n=26; e.g., transplant hepatologists, social workers, intensivists) and performed inductive thematic analysis.
Results: Many viewed the “6-month rule” as “arbitrary” and unhelpful in predicting post-transplant sobriety. Some viewed 6 months of alcohol abstinence as a good benchmark but stated that providers should be able to “make exceptions.” A few providers said 6 months is a “low bar” that does not ensure post-transplant sobriety. Chiefly, providers expressed a desire for a guideline taking into account “nuance[s]” of a patient’s situation as opposed to a strict rule, though some expressed concern about flexible guidelines being “enforced evenly.” Providers emphasized that an alcohol relapse prediction tool would be helpful in selecting candidates who were not likely to relapse post-transplant.
Conclusions: Providers’ perceptions of the “6-month rule” centered around whether it could accurately predict alcohol relapse post-transplant. However, it may be unethical to center a behavioral outcome (relapse) as the most important factor in making transplant selection decisions, rather than patient or even allograft survival.
Learning Objectives:
After participating in this conference, attendees should be able to:
At the end of this session, attendees will be able to describe transplant providers' varied perceptions regarding the 6-month alcohol abstinence requirement for liver transplantation.
Attendees will also be able to recognize instances of moral distress arising from morally complex or morally ambiguous policies, even when individuals express general agreement with the policy.
Finally, attendees will be able to evaluate the ethical implications of using providers’ perceptions to guide transplant policymaking.
