To the Editor:
Members of the Society for the Advancement of Transplant Anesthesia (Miami, Florida) read “Bacchus Listed for a Liver Transplant” with considerable interest.1 We understand this piece was intended as “creative expression” and anticipate all publications in a scientific journal still adhere to accepted principles of scholarly review, and that artistic privilege plays on the imagery and presentation of a topic to enrich our understanding in substantial and meaningful ways. But good creative expression doesn’t misrepresent the facts. This prose fails scientific scrutiny as it misleads the reader by painting a picture of irreverent patients and a derelict transplant system that is simply wrong.
There is a wealth of literature on selection criteria and outcomes that gives a true perspective of patients with alcoholic liver disease. These confirm that liver transplant is a bridge to a lifelong commitment of behavioral and social recovery for the majority of patients.2 Prospective studies show that within 5 yr of transplant only 20% of patients return to harmful drinking; physicians continue to improve those numbers by using better tools to manage alcohol addiction and predict relapse.3,4 Survival rates in patients with liver disease after transplantation are similar to those with liver disease due to other causes. These outcomes exceed many equally resource-intensive cancer treatments.
The transplant system uses a transparent consensus building process that invites comment from all members participating in patient care and the public. We encourage those unfamiliar with the details of the transplant system and governance to visit https://unos.org/ where readers can appreciate the tireless work that transplant professionals do to serve the best interest of their patients and the American public. Organ donation distinguishes our specialty from other medical practices by the intense public trust and individual altruism that motivates grieving families to give “the gift of life” to another who is suffering. These facts should invigorate and motivate us whether these practices involve each of us in the care of these patients or not.
We provide quite a different perspective than the cynical and disturbing picture painted by the prose “Bacchus Listed for a Liver Transplant.” From our creative expression, we present a picture painted with scientific evidence that highlights a positive outlook for many with alcoholic liver disease. The canvas reflects a culture of courage and trust in our system and care providers for all-comers to critically appraise.
We believe the misleading picture presented in a single prose piece such as this one highlights why all publications in scientific journals need a reliable and transparent review process that holds authors responsible for the accuracy of their information, even for that used in creative pieces. As transplant anesthesiologists wedged in the middle of this debate, it is apparent to us that these types of misperceptions are probably best prevented by a stronger and more involved working relationship between anesthesiology and transplant surgery.
All authors are members of the Executive Council of The Society for the Advancement of Transplant Anesthesia (SATA): M. Susan Mandell, M.D., Ph.D., SATA President (Department of Anesthesiology, University of Colorado, Aurora, Colorado); Tetsuro Sakai, M.D., Ph.D., SATA President-Elect (Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania); Gebhard Wagener, M.D., SATA Secretary (Department of Anesthesiology and Critical Care, Columbia University, New York, New York); Lorenzo De Marchi, M.D., SATA Treasurer (Department of Anesthesiology, Georgetown University, Washington D.C.), Ryan Chadha, M.D., SATA Councilor at Large (Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida); Jiapeng Huang, M.D., Ph.D., SATA Councilor at Large (Department of Anesthesiology, Kentucky One Health, Louisville, Kentucky); Kathirvel Subramanian, M.D., SATA Councilor at Large (University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania); and Jeron Zerillo, M.D., SATA Councilor at Large (Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, New York).
Dr. Sakai reports the following financial relationships: Instrumentation Laboratory Company (Bedford, Massachusetts; consultation), Spring Publishing Company (New York, New York; textbook royalty), and Siemens, Inc. (Munich, Germany; sponsored lecture). The other authors declare no competing interests.