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35th AM (2025) - Poster Session
Predicting Relapse or Precluding Recovery Ethical ...
Predicting Relapse or Precluding Recovery Ethical Challenges in Liver Transplant Assessment
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Pdf Summary
This poster examines ethical challenges and limitations in psychiatric evaluations used during liver transplant assessments for patients with alcohol-related liver disease (ALD), now the leading cause for liver transplant in the U.S. A case study of a 51-year-old man with severe alcohol use disorder and decompensated ALD illustrates key points: despite multiple relapses, poor insight, suspected bipolar and narcissistic traits, fragmented family support, and a high-risk SIPAT psychosocial score of 45, the patient ultimately received a liver transplant. One year post-transplant, he maintained complete abstinence and sustained recovery, with resolution of psychiatric symptoms related to substance use and good adherence to care.<br /><br />The literature review reveals significant issues with current psychiatric assessments and relapse prediction tools. Psychosocial scoring tools show low positive predictive value (~25%), and traditional benchmarks like the "6-month sobriety rule" do not lower relapse rates and actually increase mortality by delaying transplant. Additionally, symptoms observed during active substance use—intoxication, withdrawal, or hepatic encephalopathy—can mimic chronic psychiatric disorders, often leading to misdiagnoses or overestimation of psychiatric pathology. Many such symptoms remit after abstinence, challenging assumptions used in evaluations.<br /><br />The authors argue for longitudinal, context-sensitive clinical assessments to distinguish transient from enduring psychiatric symptoms. They advocate research to develop more reliable relapse prediction models, education to improve diagnostic accuracy, and policy revisions to reconsider abstinence mandates and transplant exclusion criteria. Ethically, denying life-saving transplants based on flawed psychiatric assessments or outdated guidelines risks unfair bias and inequitable treatment access.<br /><br />In conclusion, integrating nuanced psychiatric evaluation with an emphasis on fairness, clinical context, and updated evidence is essential to optimizing transplant outcomes for patients with alcohol-related liver disease. The poster calls for balancing relapse risk assessment with ethical imperatives to provide equitable care.
Keywords
alcohol-related liver disease
liver transplant
psychiatric evaluation
ethical challenges
relapse prediction
SIPAT score
substance use disorder
psychosocial assessment
6-month sobriety rule
transplant eligibility
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