Hepatitis C No Longer the Main Reason for Liver Transplants in The USA. Which is No.1? 

source: Pi

Nearly 17,000 Americans are on the waiting list for a liver transplant, and the majority of them are suffering from alcohol-related liver disease, according to a medical study published in Jama Internal Medicine. Alcohol-related disorders are now edging out hepatitis C as the primary reason for liver transplants in our country, experts say. 

One of the leading explanations for that is the scientific advancement in hepatitis C treatment and its more accessible treatment with drugs nowadays. In addition to that, the increased transparency within the transplant community about the candidate's alcohol-dependent past is also a factor worth mentioning. 

For instance, in the last decades,  there was a widespread belief that alcohol addicts who did not have a certain period of sobriety would probably not qualify to get a new liver. The so-called ''six-month rule'' became standard in medicine in the 1990s. It assumed that if a person could stay sober for half a year, he/she would not return quickly to the harmful drinking behavior. Also, back then there were serious concerns that the public would stop donating livers if they thought they would be going to patients with alcohol issues.

However, the new study on 33,000 liver transplant patients since 2002, conducted by the University of California - San Francisco, found out that 36.7 percent of them suffered from an alcohol-related disease, up from 24.2 percent in 2002. 

Dr. Brian P. Lee, who co-authored the research study commented that people are changing their minds across the US, and more medical care providers are willing to transplant patients with alcohol-related conditions. Dr. Lee also added that the transplant centers which used to get stick to the six-month sobriety rule in the past, are nowadays more relaxed in that regard. Currently, a multi-disciplinary team of doctors, psychologists, and social workers take into account diverse factors, including family support, financial situation, etc. to determine whether the patient will relapse after the liver transplant or not. 

A 2010 analysis by the University of Pittsburgh and a 2011 French study also proved that, highlighting that in any given year, there was insufficient evidence to suggest that half a year without alcohol would affect the chances of relapse. Dr. Michael Lucey, medical director of the University of Wisconsin liver transplant program also believes there is nothing magical about the six-month sobriety. In his view, it only shows the underestimation of alcohol abuse as a complex behavioral disorder.

As a result, many transplant centers follow the six-month sobriety rule, while others do not. It is worth mentioning that sometimes the transplant center can approve a transplant, but the insurance company may impose its own requirements on how long the patient must be abstinent before they cover the medical expenses.

Should the patients in waiting lists for liver transplant be sober for six months to qualify for the procedure?