Bacchus Listed for a Liver Transplant: Comment

As the directors of liver transplant anesthesia and transplant surgery, and the medical director of the liver transplant program, we were deeply concerned and disappointed to read “Bacchus Listed for a Liver Transplant” published in Anesthesiology, June 11, 2019.¹  The poem envisions an alcoholic cirrhotic patient as Bacchus, the Roman god of wine, drunkenly awaiting his upcoming liver transplant, undeserving of the gift he is about to receive. This piece does a disservice to all patients with end-stage liver disease, regardless of etiology, and harms the entire transplant community—patients, donor families, and their medical teams. Patients require liver transplantation for a variety of reasons, not just alcoholic cirrhosis. To suggest otherwise is to stigmatize all transplant recipients and potential recipients. Furthermore, to depict patients with alcoholic liver disease like Bacchus, frivolously drinking and unperturbed by the consequences, is patient shaming.

Multiple protocols are in place to ensure that potential organ recipients are not only eligible but will be stewards of the organs gifted to them. Before being listed for liver transplantation, patients with alcoholic liver disease must abstain from alcohol and drugs for several months, visit with transplant social workers who assess risk of recidivism, show evidence of ongoing participation in Alcoholics Anonymous or other recovery groups, and have significant support systems.² 

The implication that our patients are unappreciative of donors’ gifts is disrespectful both to transplant recipients and to families of organ donors. Organ donors are truly giving the gift of life. Liver transplant recipients have a high survival rate and frequently are able to return to a high quality of life and even return to active employment. Moving stories of gratitude from transplant recipients can be found on the United Network for Organ Sharing website and are widespread throughout the media.^3,4  In addition to the disrespect to donor families and transplant patients, this piece may potentially cause great harm to the entire field of transplantation by discouraging future donation. Finally, this piece discredits the work of all transplant healthcare professionals, many of whom are readers of Anesthesiology, and who devote countless hours and sleepless nights to caring for these patients. We are privileged to care for transplant patients in some of their most difficult hours. Like the opioid epidemic, alcoholic liver disease is a widespread global cause of morbidity and mortality,⁵  and patients suffering from this disease deserve our help and support. Shaming our patients is contrary to our professional ethics as physicians, and we are disheartened that this piece was published in our national society’s journal. We should strive to be advocates for our patients instead of mocking them.

The authors declare no competing interests.