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March 11, 1988

Alcoholism and Orthotopic Liver Transplantation

JAMA. 1988;259(10):1546-1547. doi:10.1001/jama.1988.03720100064040

IT HAS been 31 years since the American Medical Association declared alcoholism to be within the scope of medical practice. Although great strides have been made in the diagnosis and management of this illness since then, a recent court case in the state of Michigan reminds us that continued vigilance is the cornerstone of progress. The case involves the denial of authorization of Michigan Medicaid funding for an orthotopic liver transplant in a young alcoholic man terminally ill with end-stage alcohol-related cirrhosis. There were no contraindications to surgery and sobriety was documented for at least six months; nevertheless, a request for funds was twice denied. Both of these decisions were based on a Michigan Department of Social Services requirement mandating a two-year period of abstinence before transplantation. Although the court challenge resulted in a favorable decision for the patient, he died of complications directly related to his liver disease before