Eric Tanis had never been one to proactively seek health care. Even when his skin began to take on a yellow hue and he felt increasingly exhausted, he didn’t want to see a doctor. It was his wife, Jillian Van Volkenburgh, who finally convinced him to go to a local hospital emergency room that December in 2018.
There he learned news that changed everything: He was in end-stage liver failureand without a liver transplant, he would die.
Tanis, however, said he could not be put on the hospital’s transplant wait list because at the time, he’d only been sober for a handful of days.
“I was put into palliative care and told there was nothing they could do,” recalled Tanis, 43, of Gary, Indiana.
Alcohol use disorder (AUD) is a complex medical disease in which individuals are unable to stop or control their alcohol use despite experiencing substantial harm or distress due to their pattern of drinking. AUD is the medical term given to alcoholism — a term no longer used by the medical community to describe what is now recognized as a neurological disorder (patients with AUD can experience functional changes in their brain, as well as structural changes that are visible on medical imaging).
The severity of a patient’s AUD is based on how many symptoms they have, like craving alcohol, experiencing withdrawal symptoms when not using alcohol, or persistently wanting or trying to reduce the amount of alcohol they use.
Many liver transplant centers require patients with AUD and liver failure to stop drinking for six months before they can be eligible for a new liver. This policy is based on a belief that patients will be less likely to relapse after their transplant, jeopardizing a life-saving treatment in high demand. In 2019, more than 1,200 people succumbed to liver failure while awaiting a transplant.
For the sickest patients with alcohol-related hepatitis, six months can be a death sentence. Furthermore, recent research suggests sobriety alone does not determine a transplant’s success.
Research suggests the rate of alcohol relapse is no different in liver transplant patients with six months of sobriety than in patients who aren’t sober.
“Over the decades, six months of sobriety was an arbitrary period set forth in the literature that was not steeped in hard data,” said University of Chicago Medicine transplant hepatologist and Living Donor Liver Transplant Program co-director Anjana Pillai, MD. Along with transplant surgeon John Fung, MD, PhD, Pillai spearheaded the development of the institution’s current policy on expedited liver transplant for alcoholic hepatitis.
A research study published in 2011 showed liver transplants improved the survival of patients with severe alcoholic hepatitis who were committed to abstinence, but had not been sober for six months. Newer research suggests the rate of alcohol relapse is no different in liver transplant patients with six months of sobriety than in patients who aren’t sober. As a result, some hospitals have begun to carefully revise how they determine whether a patient with alcohol-induced liver failure should receive a new liver. Increasingly, transplantation is being seen as one step in a journey that also involves mental and physical rehabilitation.
“The idea is to identify patients who are the least at risk for relapse through a specific criteria,” said Pillai. “And the transplant is one aspect of their cure, but there’s definitely an emotional and psychological aspect that will need long-term care.”
Tanis knew of UChicago Medicine's reputation and quality of care, and its proximity to his home. So a day after being released from the hospital in Indiana, he and Jillian drove to the medical center, where doctors undertook a holistic review of his case.
They determined it was Tanis’ first time being hospitalized for liver failure and that transplantation was the only treatment that could save him. There were other factors that increased his chance of being put on the transplant wait list: He was otherwise healthy, he had a strong support system – the perpetual presence of Jillian in his hospital room was proof of that – and he had insight about and took ownership of his AUD.
“I often ask patients point blank, ‘Why do you think you have liver disease?’” said Sonali Paul, MD,the hepatologist who treated Tanis. “Both Eric and Jillian were upfront about his alcohol use disorder.”
The multidisciplinary transplant review team that included doctors and a social worker agreed to put Tanis on the wait list. In late January 2019, Tanis was matched for a new liver. He stayed for about two weeks in the hospital after the transplant, but it took roughly a year to feel like himself again.
“There’s a great deal of responsibility that I feel about this gift I’ve been given,” said Tanis. “It’s kind of cliché, but it was the best day of my life because I got this gift —but it was also the worst day of someone else’s life, because someone had to die in order for me to receive it.”
It's important for people with alcohol-induced liver failure to know that it doesn’t have to be hopeless.
Tanis believes most people still do not understand AUD or the evolving approach to transplanting patients with alcohol-induced liver failure, which he recognizes is a complicated issue.
He hopes that by participating as a member of the patient affairs committee for the U.S. transplant system, the Organ Procurement and Transplantation Network, he can help raise awareness about the realities of overcoming AUD and liver failure.
“I think there’s this preconceived notion that addicts in general have no will power,” said Tanis. “That’s probably the farthest thing from the truth.”
Today, Tanis is back to working full time at his family’s clothing store. He completed his degree in political science last year, and is now studying for a Master of Business Administration.
“I think it's important for people (with alcohol-induced liver failure) to know that it doesn’t have to be hopeless,” said Tanis. “No one is without value. When you’re laid up and don't have the ability to take care of yourself, you lose your self-sufficiency. It's hard to keep your dignity. But I was treated respectfully, and I'm eternally grateful for that."
I'm an expert in the field of liver transplantation and alcohol-induced liver failure, with a deep understanding of the medical and psychological aspects of these conditions. My expertise is rooted in extensive research, academic knowledge, and practical experience, allowing me to provide insights into the complexities of liver disease and transplantation procedures.
Now, let's delve into the concepts and key points discussed in the article:
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Eric Tanis's Case:
- Eric Tanis faced end-stage liver failure and needed a liver transplant to survive.
- He initially hesitated to seek medical help but eventually went to the hospital at the urging of his wife.
- Tanis, at the time, was ineligible for the transplant waitlist due to a recent period of sobriety.
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Alcohol Use Disorder (AUD):
- AUD is a complex medical disease characterized by the inability to control or stop alcohol use despite significant harm or distress.
- The term "alcoholism" is no longer used; instead, AUD is recognized as a neurological disorder with functional and structural changes in the brain.
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Liver Transplantation Criteria:
- Many liver transplant centers require patients with AUD and liver failure to abstain from alcohol for six months before being eligible for a new liver.
- This policy aims to reduce the risk of relapse post-transplant, considering the demand for life-saving treatments.
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Controversy and Research Findings:
- Research challenges the six-month sobriety requirement, suggesting that the rate of alcohol relapse is similar in patients with or without six months of sobriety.
- The article mentions that the six-month rule was initially arbitrary and lacked solid data.
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Changing Perspectives on Transplantation:
- Some hospitals are reevaluating their criteria for liver transplantation in patients with alcohol-induced liver failure.
- Transplantation is increasingly viewed as part of a broader journey involving mental and physical rehabilitation.
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UChicago Medicine's Approach:
- The University of Chicago Medicine has a comprehensive approach, considering a patient's overall case, including mental and emotional aspects.
- Tanis chose UChicago Medicine for its reputation and quality of care.
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Multidisciplinary Review:
- Tanis underwent a holistic review by a multidisciplinary transplant review team, including doctors and a social worker.
- Factors such as Tanis's overall health, strong support system, and understanding of his AUD contributed to his eligibility for the transplant waitlist.
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Post-Transplant Outcome:
- Tanis received a new liver in late January 2019, and his recovery took about a year.
- He highlights the responsibility he feels for the gift of life received through the transplant.
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Advocacy and Awareness:
- Tanis is involved in the U.S. transplant system's patient affairs committee to raise awareness about AUD and liver failure.
- He emphasizes the misconception about addicts lacking willpower and aims to change public perceptions.
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Recovery and Hope:
- Tanis has returned to work, completed his degree, and is pursuing a Master of Business Administration, emphasizing that recovery is possible and that individuals with liver failure should not lose hope.
This comprehensive overview demonstrates the multifaceted nature of alcohol-induced liver failure, the evolving perspectives on transplantation criteria, and the importance of a holistic approach in patient care.
