Outcomes, Attitudes, and Updated Ethical Analysis of Early Liver Transplantation for Severe Alcoholic Hepatitis

Early liver transplantation (ELT) refers to transplantation for alcohol-related liver disease (ALD) that takes place before 6 months of sobriety. We provide a summary of recent literature as well as a detailed analysis of various ethical issues in ELT. Literature continues to show that survival rates between ELT and standard liver transplantation (SLT) are comparable. Discussions of post-transplant sobriety are becoming more nuanced, with not all alcohol use being seen as equally problematic. Nevertheless, there continues to be controversy around ELT. Data continues to show that the 6-month rule does not further the goal of promoting patient and graft survival. Instead, it perpetuates stigma toward those who consume alcohol and inappropriately singles out ALD as morally exceptional. Further work in transplant should focus on promoting the health and well-being of all transplant patients, including those who consume alcohol, supporting the transplant teams who take on this responsibility, and rooting out disparities and structural injustice in liver transplantation.