The Morality of Transplantation

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To the Editor. —Moss and Siegler1believe that patients with alcohol-related end-stage liver disease should not compete equally for liver transplantation. One risk of this position, were it extended to other areas, would be for all who seek medical care to be hostage to their pasts. I once performed short-term psychotherapy for a young woman whose insurance company canceled her coverage 4 years after our last clinical encounter. My note to her internist about the patient's past alcohol history inadvertently had become part of her insurance file. Alcoholics experience a low social esteem and may seem an acceptable target for discrimination. In effect, all with a particular disorder (alcohol-related end-stage liver disease) would be excluded or given second-class status, a form of passive exclusion, given the long queues for donor organs. And this would be accomplished irrespective of prognosis. It is unimaginable that a similar proposition would be considered

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