Cohen C, Benjamin M
Transplant and Health Policy Center, Ann Arbor, MI 48109-0716.
JAMA. 1991 Mar 13;265(10):1299-301. doi: 10.1001/jama.265.10.1299.
Two arguments underlie a widespread unwillingness to consider patients with alcoholic cirrhosis of the liver as candidates for transplantation. First, alcoholics are morally blameworthy, their condition the result of their own misconduct; such blameworthiness disqualifies alcoholics in unavoidable competition for organs with others who are equally sick but blameless. Second, because of their habits, alcoholics will not exhibit satisfactory rates of survival after transplantation; good stewardship of a scarce lifesaving resource therefore requires that alcoholics not be considered for liver transplantation. These arguments are carefully analyzed and shown to be defective. There is not good moral or medical reason for categorically precluding alcoholics as candidates for liver transplantation. It would, in addition, be unjust to implement such a preclusion simply because others might respond negatively if we do not.
普遍不愿意将酒精性肝硬化患者视为移植候选人有两个理由。其一，酗酒者在道德上应受谴责，他们的状况是自身行为不端的结果；这种应受谴责的行为使酗酒者在与其他同样患病但无过错的人不可避免的器官竞争中失去资格。其二，由于他们的习惯，酗酒者在移植后的存活率不会令人满意；因此，对稀缺的救生资源进行妥善管理要求不考虑酗酒者进行肝移植。对这些理由进行了仔细分析，结果表明它们存在缺陷。完全排除酗酒者作为肝移植候选人没有充分的道德或医学依据。此外，如果仅仅因为我们不这样做其他人可能会有负面反应就实施这种排除，那将是不公正的。
