This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (113)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Alvin H. Moss, MD; Mark Siegler, MD

JAMA. 1991;265(10):1295-1298.

Abstract
The circumstances of liver transplantation are unique among organ transplantation because of the dire, absolute scarcity of donor livers and the predominance of one disease—alcohol-related end-stage liver disease—as the principal cause of liver failure. We propose that patients who develop end-stage liver disease through no fault of their own should have higher priority for receiving a liver transplant than those whose end-stage liver disease results from failure to obtain treatment for alcoholism. We base our proposal on considerations of fairness and on whether public support for liver transplantation can be maintained if, as a result of a first-come, first-served approach, patients with alcohol-related end-stage liver disease receive more than half the available donor livers. We conclude that since not all can live, priorities must be established for the use of scarce health care resources.

(JAMA. 1991;265:1295-1298)

Author Affiliations
From the Center for Clinical Medical Ethics, University of Chicago (Ill) Pritzker School of Medicine (Drs Moss and Siegler); and the Center for Health Ethics and Law, West Virginia University Health Sciences Center, Morgantown (Dr Moss).

Footnotes
Reprint requests to Center for Health Ethics and Law, West Virginia University Health Sciences Center North, Morgantown, WV 26506 (Dr Moss).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Who gets the liver transplant? The use of responsibility as the tie breaker
Thornton
J. Med. Ethics 2009;35:739-742.
ABSTRACT | FULL TEXT  

Ethical considerations related to pregnancy in transplant recipients.
Ross
NEJM 2006;354:1313-1316.
FULL TEXT  

Rationing Decisions and Individual Responsibility for Illness: Are all Lives Equal?
Wittenberg et al.
Med Decis Making 2003;23:194-211.
ABSTRACT  

Alcoholic cirrhosis is a good indication for liver transplantation, even for cases of recidivism
Pageaux et al.
Gut 1999;45:421-426.
ABSTRACT | FULL TEXT  

Patterns of alcohol consumption after liver transplantation
Tang et al.
Gut 1998;43:140-145.
ABSTRACT | FULL TEXT  

Ethical Considerations in the Allocation of Organs and Other Scarce Medical Resources Among Patients
Council on Ethical and Judicial Affairs, American et al.
Arch Intern Med 1995;155:29-40.
ABSTRACT  

Resource Utilization and Outcome of Liver Transplantation for Alcoholic Cirrhosis: A Case-Control Study
McCurry et al.
Arch Surg 1992;127:772-777.
ABSTRACT  

Rationing, Patient Preferences, and Cost of Care at the End of Life
Singer and Lowy
Arch Intern Med 1992;152:478-480.
ABSTRACT  

The Morality of Transplantation
Surman
JAMA 1991;266:213-213.
ABSTRACT