Agency Reorganizes Liver Transplant Priorities People With Best Chance Of Survival Will Be At Head Of List

People suffering from long-term liver failure of the sort often seen in alcoholics and drug addicts will no longer be first in line for new organs.

The shift, approved Thursday by the agency that sets nationwide transplant policy, is aimed at giving top priority to patients with the best chance of surviving the operation, rather than those who are the sickest.

In recent years, some people have questioned whether patients who ruined their livers through drugs or drink deserve new organs - a debate that was renewed in recent years when Mickey Mantle and “Dallas” star Larry Hagman received transplants.

Supporters of the new policy adopted by the United Network for Organ Sharing said they weren’t passing moral judgment on alcoholics or intravenous drug users, who often get hepatitis from dirty needles. Rather, they said, the goal is to make the most out of a limited number of donated livers.

“The criteria that you always give the liver to the sickest person was always a suspect criteria,” said George Annas, professor of health law at the Boston University School of Public Health.

Some warned that the change will mean alcoholics and other long-term liver patients will have to wait longer for a new liver, and more of them will die waiting.

“There’s only so much room in the lifeboats and a bunch of people are going to drown,” said Carol Beasley, managing director of the Boston-based Partnership for Organ Donation. “Whatever the allocation, somebody loses.”

Alcoholics currently represent about 20 percent of all liver transplants.

The old policy gave top priority to those patients - either acute or chronic sufferers - who were expected to die within seven days. Ninety percent of patients in the top group suffer from chronic conditions such as alcohol-induced liver damage, viral hepatitis and genetic liver disease.

The new policy removes “chronic” patients from the top of the list.

Acute liver patients - those who have developed liver malfunction suddenly - will take precedence because they have a much greater chance of full recovery than patients who have battled liver failure for some time, said James Wolf, UNOS medical affairs director.