Langlee Whitney, Kalluri Divya, Abedon Rivka, Teles Aura T, Brundage Janetta, Chen Po-Hung, Cameron Andrew M, Sung Hannah C, Kates Olivia S
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
SSM Qual Res Health. 2025 Jun;7. doi: 10.1016/j.ssmqr.2025.100567. Epub 2025 May 5.
Public stigma surrounding alcohol use disorder (AUD) negatively impacts people with alcohol-related liver disease (ALD) in need of liver transplants (LT). Representations of LT for ALD are socially constructed in part through media, but media on this topic has been underexplored in current research.
Research team members conducted systematic searches during 7/2022-5/2024 for online, publicly available articles about LT for ALD within leading English-language news sites in the US by monthly visits (n = 24). Using inductive framing analysis, we coded and identified patterns in news articles (n = 42) from 1990 to 2021 to generate frames.
Our inductive analysis generated 4 main frames: (a) making individual exceptions: good people in a bad group, (b) appealing to societal costs: individual actions putting a strain on society, (c) questioning professionals' judgements: doctors' discretionary power, and (d) portraying healthcare as a competition: unfair play in a zero-sum game. Media characterized people with ALD as less deserving of liver transplant, but with individual exceptions. Articles described people with "self-induced" illnesses as irresponsible towards themselves, other LT candidates, and society; doctors as "gatekeepers" with discretionary power over how to apply criteria or rules; and the liver transplant waitlist as a competitive zero-sum game in which people with ALD are or should be deprioritized.
News articles reflect our society's stigmatization of alcohol-related conditions as well as misconceptions about transplant listing and allocation. Such mischaracterizations can further marginalize stigmatized patients with alcohol-related conditions in need of LTs. We offer recommendations for public communications, including avoiding representations of patients with ALD as exceptions to the norm and contextualizing LT for ALD within the context of public health and social and systemic factors.
围绕酒精使用障碍（AUD）的公众污名对需要肝移植（LT）的酒精性肝病（ALD）患者产生负面影响。ALD肝移植的形象部分是通过媒体在社会上构建的，但当前研究对这一主题的媒体报道探索不足。
研究团队成员在2022年7月至2024年5月期间，每月访问美国主要英文新闻网站，对有关ALD肝移植的在线公开文章进行系统检索（共24次访问）。我们采用归纳框架分析，对1990年至2021年的新闻文章（共42篇）进行编码并识别模式，以生成框架。
我们的归纳分析产生了4个主要框架：（a）制造个体例外：不良群体中的好人；（b）诉诸社会成本：个体行为给社会带来压力；（c）质疑专业人员的判断：医生的自由裁量权；（d）将医疗描绘成一场竞争：零和博弈中的不公平竞争。媒体认为ALD患者不太值得进行肝移植，但有个体例外情况。文章将患有“自身诱发”疾病的人描述为对自己、其他肝移植候选人以及社会不负责任；将医生描述为对如何应用标准或规则拥有自由裁量权的“把关人”；并将肝移植等待名单描述为一场竞争性的零和博弈，在这场博弈中，ALD患者正在或应该被排在较后位置。
新闻文章反映了我们社会对与酒精相关疾病的污名化以及对移植名单和分配的误解。这种错误描述会进一步边缘化那些需要肝移植但患有与酒精相关疾病且受到污名化的患者。我们为公共传播提供了建议，包括避免将ALD患者描绘为例外情况，并在公共卫生以及社会和系统因素的背景下对ALD肝移植进行情境化描述。
