To the Editor:
Recently, Hester published a sonnet entitled “Bacchus Listed for a Liver Transplant.” 1 I believe the intent of this poem was to convey the remarkable but also complex nature of transplant medicine. I have been a liver transplant anesthesiologist for the past 13 yr. More significantly, my husband is a recent liver transplant recipient and the subject matter strikes exceedingly close to home. I understand the importance for physicians to use creative writing as a means to communicate our experiences. However, after reflecting on my interpretation of this poem, I feel obligated to refute the misconceptions it conveys regarding liver disease and organ donation.
Alcohol use disorder is a diagnosis supported by neurobiological effects on brain physiology, with both genetic and environmental factors influencing its etiology.2 It is not a character flaw. Perpetuating the stigma attached to alcohol use disorder and alcoholic liver disease contradicts our duty as physicians and fails to recognize the consequences of the disease.
The burden of alcohol use disorder vastly impacts society in terms of lost workforce productivity, healthcare costs, disability, and mortality.3 As physicians, we care for patients on a daily basis who are affected directly and indirectly by this disease. The personal impact of alcoholic liver disease on patients and their families is considerable and can seem insurmountable at times, particularly when facing barriers associated with the liver transplant evaluation process. Physician bias, equity of access, and abstinence from alcohol are a few of these barriers.4 Although some centers are performing transplants for patients with severe alcoholic hepatitis, most continue to require a minimum of 6 months of abstinence before consideration for liver transplant evaluation.5 The uncertainty of whether or not your loved one will survive 6 months to be placed on the transplant waitlist is daunting. The feeling of powerlessness is indescribable.
Geographic disparities in organ allocation and the implementation of a new liver distribution policy is a highly debated topic within the liver transplant community. The litigation surrounding this policy has received recent media coverage. As public awareness of this debate increases, it is imperative to maintain their trust. Public attitudes are a crucial component when establishing organ allocation policy.6 Organs are a scarce and life-saving resource and attracting negative exposure to organ donation is counterproductive.
This poem is a misguided representation of patients with liver disease and oversimplifies the transplantation process. It minimizes the true hardship, challenges, and emotional turmoil that patients and their loved ones endure. It also fails to acknowledge the overwhelming responsibility of the liver transplant selection committee which makes difficult decisions, especially in situations of alcohol recidivism. Most importantly, organ donor families deserve our highest respect and their altruistic gift must never be discredited.
Competing Interests
The author declares no competing interests.