The dilemma of alcohol use by potential living liver donors.

Previous and current alcohol use by potential living liver donors presents ethical challenges for donor selection committees. Discussing these challenges, we offer guidelines for selection and management of these individuals. Donor safety and welfare should be the primary concern, thus relapse potential during the postdonation period for those with a history of alcohol dependence or abuse is of importance, especially because of the potentially severe consequences of mixing pain relievers (eg, acetaminophen) and alcohol during liver regeneration. Psychosocial and chemical dependency evaluations are critical for potential living donors as well as recipients.

Shopping for a transplant: when noncompliant patients seek wait listing at multiple hospitals.

United Network for Organ Sharing policy allows patients to be listed for a transplant at multiple hospitals. This strategy can sometimes lessen the transplant waiting time for patients because waiting times vary geographically. We explore the ethical dilemma of "shopping for a transplant" by presenting the case of a patient with an addictive disorder who was listed for liver transplantation at one hospital on the east coast of the United States and was seeking listing at 2 additional hospitals in midwestern United States, when marijuana use was suspected by 1 of the latter 2 facilities. Although the transplant team at this facility deferred listing the patient, the team's bioethicist posed the concept of a duty to notify the facility where the patient was already listed for transplantation about any confirmed substance abuse, in an effort to prevent a scarce resource from being allocated to an individual who is noncompliant.