Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

Difficulties In Donor Organ Allocation Given The Limited Supply

Robert S. Brown, Jr., MD, MPH

Robert S. Brown, Jr., MD, MPH

The November 10, 2011 issue of the New England Journal of Medicine features an editorial by Robert S. Brown, Jr., MD, MPH, Director of the Center for Liver Disease and Transplantation, titled Transplantation for Alcoholic Hepatitis — Time to Rethink the 6-Month “Rule.”

In this editorial, Dr. Brown addresses the difficult questions surrounding how to fairly allocate donor organs, which are in far shorter supply than their demand. In the case of patients with alcoholic hepatitis, current guidelines exclude such patients from the liver transplant waiting list unless they have successfully abstained from alcohol for at least six months. Yet as Dr. Brown points out, many die before this required, albeit arbitrary, window elapses. And a new study indicates that if they are permitted to receive liver transplants, such patients may do at least as as well as, if not better than, some other patients who receive transplants far more often.

As Dr. Brown explains in this editorial, the typical recidivism rate among alcoholics is approximately 30%. Yet organs are regularly allocated to patients with hepatitis C, who have a 100% disease recurrence rate, and a much higher rate of graft failure than those with alcoholic hepatitis, at five years. A study by Mathurin et al in this issue found that carefully selected patients with alcoholic hepatitis experienced a 77% survival rate after liver transplantation at six months, and a recidivism rate of 11.5%. Based on these encouraging results, Dr. Brown writes, “…this study highlights the need to rethink our approach to transplantation for alcoholic liver disease, including applying better rules for selecting patients who are at low risk for recidivism that can be applied in a uniform and fair way.”

*This blog post was originally published at Columbia University Department of Surgery Blog*


You may also like these posts

Read comments »


Comments are closed.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »