Peter R. Martin: Historical Vocabulary of Addiction, Vol. II
Transplantation
According to the electronic version of the Oxford English Dictionary (OED) the noun transplantation is formed within English as a combination of the verb transplant (“To remove [a plant] from one place or soil and plant it in another”) and the suffix -ation (“The particular form of the compound suffix ‑t‑ion [‑s‑ion, ‑x‑ion], which forms nouns of action from Latin participles in ‑āt‑us of verbs in ‑āre, French verbs in ‑er, and their English representatives”). The verb transplant itself is a borrowing from the post-classical Latin verb transplantāre which is a combination of the prefix trans (“With the sense ‘across, through, over, to or on the other side of, beyond, outside of, from one place, person, thing, or state to another’: in verbs and their derivative nouns and adjectives”) and the verb plantāre ( “to plant,” meaning “To set or place [a seed, bulb, or growing thing] in the ground so that it may take root and grow; to establish [a garden, orchard, etc.] by doing this”).
The earliest use of the noun transplantation in the English language was with its meaning from the field of Agriculture, defined in OED as: “The removing of a plant from one place or soil and planting it in another.” An early example of this use is the translation by the English schoolmaster and physician Philemon Holland (1552–1637) of a quotation from the encyclopedic Naturalis Historia originally written in Latin by Gaius Plinius Secundus (AD 23/24–79), the Roman author, naturalist and natural philosopher, known as Pliny the Elder (Pliny and Holland 1601): “Neither need they any remoouing or transplantation at all.”
In the mid-1660s, transplantation was a term used in Medicine, but that meaning is historical and now obsolete and is defined in OED as: “The pretended magical cure of disease by causing it to pass to another person, or to an animal or plant.” An early quotation with this meaning is from Some Considerations Usefulnesse Experimental Natural Philosophy by Robert Boyle (1627–1691), an Anglo-Irish natural philosopher, chemist, physicist, alchemist and inventor, one of the founders of modern chemistry and early practitioner of the modern experimental scientific method (Boyle and Sharrock 1671): “An Example of a most violent pain of the Arme, removed by Transplantation.” The meaning of transplantation in this quotation seems to be confounded with that of amputation and the pain experienced by the individual from whom the limb was removed — possibly what we now refer to as phantom-limb pain (according to OED, “Pain perceived in a phantom limb; a pain of this nature.”)
The contemporary meaning of transplantation relevant to the present discussion started to be used in the field of Surgery in the 1810s and is defined as: “The operation of transferring an organ or a portion of tissue from one part of the body, or from one person or animal, to another.” An early quotation from Lectures on Inflammation by John Thomson (1765–1846), a Scottish surgeon and physician and President of the Royal College of Physicians of Edinburgh, exemplifies this meaning (Thomson 1813): “Besides those examples that are seen in the transplantation of the teeth, it must be confessed that instances of reunion among parts which had been entirely separated are very rare in the human body.” This quotation raises technical issues in surgical transplantationin the modern sense of the word, namely a targeted surgical procedure intended to replace dysfunctional with viable tissues. Such surgical procedures involve an addition (or substitution) to the body in order to enhance or normalize functioning with the ultimate goal of improving the quality or prolonging the length of life.
The long and at times quite fanciful history of transplantation in medicine has been extensively documented (Billingham 1963; Hamilton 2012; Barker and Markmann 2013). Greek mythology is replete with examples of chimeric gods and heroes comprised of human and animal body parts, combinations which gave them special powers. Such myths planted the seed in the human imagination and led to medical aspirations to accomplish similar ends. Success was initially uncommon until scientific advances could provide the tools for these inspired experiments. Unanticipated complications were the rule rather than the exception — an example is the observation of John Hunter (1728 –1793), the Scottish surgeon and early advocate of scientific methods in medicine, that “lues venerea” or syphilis could unexpectedly be transferred via transplantation of teeth (Hunter 1786).
Billingham (1963) recounts important historical and scientific “landmarks” in the history of transplantation until the present day when transplantation has become a widely accepted medical discipline with excellent clinical outcomes. He emphasizes “a very special relationship between ‘tissue transplanters’ and dermatologists,” as skin grafting seems to have been how the field began well before the start of the Common Era, when Hindu surgeons used flap-grafts of forehead skin to repair amputated noses. Among the many other landmarks noted, John Hunter transplanted gonads in chickens and spur of cock to its comb in 1771, Carrell and Guthrie successfully auto transplanted kidneys in dogs in 1905 and blood transfusion was popularized as a routine therapeutic procedure during World War II.
A watershed moment between the many centuries when these fantastical surgical procedures had very little likelihood of success and when transplantations became evidence-based surgical practice is widely thought to be the work of Sir Peter Brian Medawar (1915 – 1987). Medawar was a British scientist, whose work on graft rejection and the discovery of acquired immune tolerance, formed the bulwark of the medical practice of tissue and organ transplantation (Medawar 1958a,b). It was for this work that he shared the 1960 Nobel Prize in Physiology or Medicine with the Australian virologist Frank Macfarlane Burnet (1899 – 1985) — “for discovery of acquired immunological tolerance.” They established that tissue derived from another, termed an allograft, is destined to be immunologically rejected by the host due to antigenic stimuli that characterize the donor and are recognized by the host as foreign. However, if the donor is appropriately selected based on genetic and immunological principles so as to be (relatively) compatible with the recipient and/or the immune response resulting in rejection can be sufficiently dampened pharmacologically, the transplanted organ or tissue can thrive.
The first successful transplantation of a kidney from one monozygotic twin to another was performed by Joseph Murray (1919 – 2012) and John Merrill (1917 – 1984) at the Peter Bent Brigham Hospital in Boston USA on December 23, 1954 – an important surgical accomplishment that has been considered a “medical miracle” with enduring impact (Merrill, Murray, Harrison et al. 1956; Morris 2004). Many of the technical challenges inherent in transplantation surgery were encountered on that day, but further advances in immunology were still needed before such procedures could be widely employed (Starzl 2000).
Moreover, while this single achievement reified the notion that diseased organs can indeed be surgically replaced, a plethora of ethical questions emerged and remained to be addressed in transplantation research and practice in the years to come (Starzl 1967; Jonsen 2012). These ethical considerations were compounded by insufficiently anticipated psychiatric effects of transplantation — such “life extending operations” resulted in an unprecedented human experience of “acute and chronic stress and of alteration of the body image” (Castelnuovo-Tedesco 1981).
The team of the American transplantation surgeon Thomas Earl Starzl (1926 – 2017) was the first to demonstrate that human liver transplantation could be lifesaving for those with terminal liver disease (Penn, Halgrimson and Starzl 1970):
“Until quite recently it was possible to give only highly tentative opinions on the role of liver transplantation in the treatment of patients dying of incurable liver disease. Now, a much more authoritative position concerning clinical liver transplantation can be taken, since there have been six patients who have lived for more than a year after removal of their own diseased livers and replacement with cadaveric organs.
“The mortality has been high, just as it was in the first trials with renal transplantation. Nevertheless, we believe that the future role of liver transplantation in hepatic disease will not be fundamentally different than cadaveric kidney transplantation in the field of renal disease.”
The Starzl team progressed to successfully perform liver transplantation in increasingly ill patients, such as those with hepato-renal syndrome, one of whom was suffering from severe alcohol use disorder complicated by Laennec's cirrhosis (Shunzaburo, Popovtzer, Corman et al. 1973). The decision to save the life of this patient with alcohol use disorder by a liver allograft transplantation immediately raised concerns as expressed in an early letter to the Editor of The New England Journal of Medicine where the research had been published (Rybak 1974). The major points were based on limited availability of transplantable organs and the tremendous medical expenditures involved — the inferred message was that because these individuals “did it to themselves,” why not give this valuable resource to another more “deserving” patient!
Ethical and psychiatric challenges associated with transplantation in individuals suffering from addictive disorders are, therefore, compounded by biases held concerning responsibility for loss of the organ to be replaced. Many in society see addiction as a shortcoming or failure of the individual, voluntary behaviors due to irresponsible choices made, rather than a medical condition with which the individual is unavoidably afflicted (Martin 2022, 2024). The borderlands between the guilt of choice versus innocence of powerlessness in the causation of addictive disorders and the question of whose responsibility it is to manage the consequences have been examined for centuries (Erickson 1992; Leshner 1997; Charland 2020).
Early thoughts on this issue in the U.S. are ascribed to the father of American Psychiatry, Benjamin Rush (1746 – 1813), signatory to the U.S. Declaration of Independence, who served as Surgeon General of the Continental Army and became a Professor of Chemistry, Medical Theory and Clinical Practice at the University of Pennsylvania. As expressed in his treatise Medical Inquiries and Observations on the Diseases of the Mind, Rush recognized that addictive disorders such as alcoholism should rightfully be considered a medical illness to be treated, rather than a form of criminality to be adjudicated and punished (Rush 1812):
“When the will becomes the involuntary vehicle of vicious actions, through the instrumentality of the passions, I have called it moral derangement. I have selected… two symptoms [lying and drinking] of this disease (for they are not vices) from its other morbid effects, in order to rescue persons affected with them from the arm of the law, and to render them the subjects of the kind and lenient hand of medicine.”
Addictive disorders are now accepted as psychiatric conditions characterized by the repeated out-of-control, self-destructive use of alcohol/drugs or engagement in other harmful behaviors which can injure various organ systems of the body via numerous pathophysiological mechanisms (Martin 2016). Among these conditions, alcohol use disorder has probably received most attention with respect to transplantation because alcohol consumption is so prevalent in the population and the associated hepatotoxicity with harmful use is often complicated by cirrhosis and terminal liver disease (Martin 2019a).
Other drug use disorders are equally relevant to this discussion, especially smoking cigarettes, to which many conditions that can progress to organ failure, among them heart and pulmonary diseases, can be attributed (Martin 2021a). Intravenous use of opioids or stimulants with shared needles is often associated with microinjection of infectious viral particles like hepatitis B and C that are common precursors of hepatitis and cirrhosis (Martin 2019b, 2021b).
Additionally, overeating and resultant obesity may be viewed as a behavioral addiction (Martin 2025) that can result in non-alcoholic steatohepatitis (NASH) progressing to cirrhosis in association with the widespread consequences of severe systemic inflammation. Although treatment of addictive disorders can often be effective (Martin 2020a,b), abstinence may not always restore advanced organ failure related to these conditions. Consequently, complicating severe liver impairment due to cirrhosis is often terminal — transplantation, under appropriate circumstances, is currently the only available treatment for such patients.
Eligibility for organ transplantation in a given patient has never been taken lightly due to considerable complexity and risk of the surgery, the scarcity of available organs and the requirements for patient adherence to an intricate post-transplant regimen in order to maintain a functioning organ that is not rejected. A variety of evolving factors determine eligibility guidelines for transplantation, including the type of organ and the specific protocols and criteria of the transplant center where the procedure is performed.
The primary determinant of whether a patient qualifies for a transplant is the severity of their illness and the prognosis for a successful outcome of their surgery — they must have a condition that is life-threatening or significantly impairs quality of life which can be improved by a transplant. The patient must also be healthy enough to undergo major surgery and the subsequent recovery process, as determined by evaluations of heart and lung function, infection status and other comorbidities. Demographic factors such as age, weight and nutritional status are considered in the decision-making as these may also influence the risks of surgery.
With technical advances, psychosocial considerations have probably become the most relevant in determining eligibility for transplantation, including mental health, social support and the ability to adhere to complex post-transplant care regimens. (The ability to afford the procedure and post-transplant medications, either through insurance or other means, is also typically assessed in the U.S.) Another factor under consideration is availability of donor organs which are a limited resource made rarer still by the precise requirements for matching donor organs in terms of size, blood type and tissue compatibility. Ultimately, each candidate for transplantation is evaluated on an individual basis and the decision is made by a multidisciplinary team of healthcare professionals, including transplant surgeons, physicians, psychiatrists, psychologists and social workers.
Due to an intermingling of medical, psychiatric and ethical concerns with stigmatization of addictive disorders as mentioned above, the decision as to whether a person suffering from addiction qualifies for transplantation has been particularly perplexing. The earliest clinical experience with outcomes of liver transplantation suggested that the presence of alcoholism in a patient posed a particularly high medical risk — “only the occasional potential recipient with alcoholic liver disease, free of infectious or other complications, is an acceptable candidate for this procedure” (Starzl, Putnam, Ishikawa et al. 1975). However, as the surgical techniques required for these complicated surgical procedures evolved and outcomes in patients with alcoholism were demonstrated not to be significantly different from those in whom liver failure was due to other causes, refusing such individuals for transplantation became less easily justified (Van Thiel, Gavaler, Tarter et al. 1989; Musto, Palmer, Nemer et al. 2024). Therefore, early variability in the eligibility criteria for transplantation among different centers, greatly influenced by local opinions and biases, essentially became standardized over the decades (Lucey, Brown, Everson et al. 1997).
Nevertheless, the stigmatization of patients who suffer from addiction continued in many centers and thereby adversely influenced acceptance for transplantation (Martens 2001). Eligibility criteria also served a role as a rationing tool for limited availability of appropriate organs (Giacomini, Cook, Streiner et al. 2001). For example, the ethical considerations for why an addicted patient may not “deserve” or is “wasting” a transplanted organ continued to be argued, suggesting that resources should better be utilized in prevention (Glannon 1998):
“I have argued that moral considerations may be invoked in assigning priority to some people over others concerning liver transplantation, especially in the light of the fact that livers are scarce organs… In an era of scarce medical resources, there has been a necessary shift in emphasis from treatment to prevention of disease. This shift presupposes that people are able to make autonomous choices and actions and to take responsibility for their health. If we are to make good on this claim, and to affirm the value of autonomy and responsibility so essential to our personhood, then we have to hold people responsible for diseases they contract when they are able but fail to exercise control over the events that cause these diseases. This may mean giving lower priority to some versus others concerning claims to medical treatment. But provided that these decisions are based on control and responsibility, it may be fair to discriminate on these grounds.”
In contrast, if addiction is considered a disease rather than an unfortunate choice that results in an illness, and therefore, is much the same as many other conditions for which transplantation is an acceptable form of treatment, then liver transplantation in alcoholics with terminal liver failure is highly appropriate and it would be considered unethical to exclude such patients from an effective treatment (Cohen and Benjamin 1991):
“Two arguments underlie a widespread unwillingness to consider patients with alcoholic cirrhosis of the liver as candidates for transplantation. First, alcoholics are morally blameworthy, their condition the result of their own misconduct; such blameworthiness disqualifies alcoholics in unavoidable competition for organs with others who are equally sick but blameless. Second, because of their habits, alcoholics will not exhibit satisfactory rates of survival after transplantation; good stewardship of a scarce lifesaving resource therefore requires that alcoholics not be considered for liver transplantation. We have argued that there is now no good reason, either moral or medical, to preclude alcoholics categorically from consideration for liver transplantation. We further conclude that it would therefore be unjust to implement that categorical preclusion simply because others might respond negatively if we do not.”
A striking example of failure in ethical decision-making was a report of a young man with alcoholism-related end-stage liver failure who died seemingly because Medicaid would not finance transplantation in a timely manner (Flavin, Niven and Kelsey 1988). This decision by Medicaid was made despite the strong likelihood that a transplant could have saved this man’s life and mounting evidence for noninferior outcomes in individuals with alcohol use disorder compared to those with other conditions who undergo transplantation (Starzl, Van Thiel, Tzakis et al. 1988). At this time, most liver transplant programs enforced mandatory fixed intervals of alcohol abstinence, typically six months, prior to eligibility for transplantation. This fixed, albeit arbitrary, abstinence period was primarily intended early in the history of transplantation surgery as the duration of observation to determine whether spontaneous improvement in liver function would occur with alcohol abstinence (Starzl 1967).
Even according to more recent standardized eligibility criteria, individuals who suffer from substance use disorders (e.g., alcohol, drugs) can be disqualified from consideration, or some centers still require a period of abstinence as evidence of a commitment to staying substance-free (Lucey, Brown, Everson et al. 1997). However, the arbitrary period of demonstrated abstinence still demanded at certain centers can result in mortality for some patients and is probably not justified based on rates of alcohol relapse at 1 and 3 years after orthotopic liver transplant of 6 and 9%, respectively (Berlakovich, Windhager, Freundorfer et al. 1999), as well as reports that short-term and long-term patient and graft survival of patients undergoing liver transplant for alcoholic liver disease are comparable to other indications for liver transplants (Musto, Palmer, Nemer et al. 2024). All the same, with the availability of pharmacotherapy for Hepatitis C (HCV) in the past decade, alcoholic liver disease has now replaced HCV infections as the leading indication for liver transplantation in the United States (Cholankeril and Ahmed 2018). As liver disease accounts for 4% of deaths worldwide (Devarbhavi, Asrani, Arab et al. 2023), the number of liver transplantations performed each year will continue to increase, in particular, the proportion of these which represent an important life-saving surgical procedure and vital component of the comprehensive management of the most severe cases of addictive disorders.
There is continued need to develop better tools to identify patients with addictive disorders who may benefit from liver (and other organ) transplantation, improve the pre-transplant and post-transplant management of addictive disorders and continue to evaluate the impact of liver transplantation for addictive disorders on the organ donation and transplantation systems (Simonetto, Winder, Connor et al. 2024). For example, it is necessary to develop and specifically adapt strategies which blend recovery from substance use disorders and from relevant behavioral addictions and post-transplant management of individuals who have successfully undergone transplantation (Luchsinger and Zimbrean 2020;(Rodgman and Pletsch 2012) ). Such approaches that should be directed at addressing unique problems associated with transplantation in individuals with addictive disorders rather than simply justifying their access to these life-extending surgical procedures are greatly needed as these individuals comprise a greater proportion of all transplantations (Cholankeril and Ahmed 2018).
In summary, addiction has been closely intertwined with the history of transplantation over the last 60 years as organ failure is a prevalent outcome in the most severe and insufficiently treated addictive disorders. The essential issue has related to how stigmatization of addictive disorders has adversely affected eligibility for transplantation of individuals with these disorders. This was primarily due to their perceived responsibility for the organ damage caused by substances of abuse and/or behavioral addictions — the fact that was thought to be the reason these individuals needed a transplant in the first place. Addiction has also been viewed as a serious deterrent for the reliable delivery and adherence with post-transplant care. None of these biases have proved to be valid and the proportion of transplants to patients with addictive disorders keep increasing. There is a clear need for comprehensive psychosocial support which must be two-pronged in these patients, focused on both the medical and psychiatric issues related to transplantation as well as recovery from addictive disorders. Addressing these intertwined factors is crucial for improving transplantation outcomes and reducing mortality for individuals with addictive disorders.
References:
Barker CF, Markmann JF. Historical overview of transplantation. Cold Spring Harb Perspect Med 2013; 3(4):1-18.
Berlakovich GA, Windhager T, Freundorfer E, Lesch OM, Steininger R, Mühlbacher F. Carbohydrate deficient transferrin for detection of alcohol relapse after orthotopic liver transplantation for alcoholic cirrhosis. Transplantation 1999; 67(9):1231-35.
Billingham RE. Transplantation: past, present and future. J Invest Dermatol 1963; 41(4):165–80.
Boyle R, Sharrock R. Some considerations touching the usefulnesse of experimental natural philosophy. Propos’d in a familiar discourse to a friend, by way of invitation to the study of it. By the Honourable Robert Boyle Esq; Fellow of the Royal Society. A second edition since the first published June 1663. Oxford: printed by Hen: Hall printer to the University, for Ri: Davis; 1671.
Castelnuovo-Tedesco P. Transplantation. In: Levy NB, editor. Psychonephrology Psychol Factors Hemodial Transplant Boston, MA: Springer US; 1981. pp. 219–25.
Charland LC. A puzzling anomaly: decision-making capacity and research on addiction. In: Iltis AS, MacKay D, editors. Oxf Handb Res Ethics Oxford University Press; 2020.
Cholankeril G, Ahmed A. Alcoholic liver disease replaces hepatitis C virus infection as the leading indication for liver transplantation in the United States. Clin Gastroenterol Hepatol 2018; 16(8):1356–8.
Cohen C, Benjamin M. Alcoholics and liver transplantation. JAMA 1991; 265(10):1299–301.
Devarbhavi H, Asrani SK, Arab JP, Nartey YA, Pose E, Kamath PS. Global burden of liver disease: 2023 update. J Hepatol 2023; 79(2):516–37.
Erickson PG. The law in addictions: principles, practicalities and prospects. In: Erickson PG, Kalant H, editors. Window Sci. Toronto, Canada: Addiction Research Foundation; 1992. pp. 125–60.
Flavin DK, Niven RG, Kelsey JE. Alcoholism and orthotopic liver transplantation. JAMA 1988; 259(10):1546–7.
Giacomini MK, Cook DJ, Streiner DL, Anand SS. Guidelines as rationing tools: a qualitative analysis of psychosocial patient selection criteria for cardiac procedures. Can Med Assoc J 2001; 164(5):634-40.
Glannon W. Responsibility, alcoholism, and liver transplantation. J Med Philos Forum Bioeth Philos Med 1998; 23(1):31–49.
Hamilton D. A History of Organ Transplantation: Ancient Legends to Modern Practice. Pittsburgh: University of Pittsburgh Press; 2012.
Hunter J. Of diseases, supposed to be venereal, produced by transplanted teeth. Lond Med J 1786;7(7):205–16.
Jonsen AR. The Ethics of Organ Transplantation: A Brief History. Virtual Mentor 2012;14(3):264–8.
Leshner AI. Addiction is a brain disease, and it matters. Science 1997; 278(5335):45.
Lucey M, Brown K, Everson G, Fung J, Gish R, Keeffe E, Kneteman N, Lake J, Martin P, McDiarmid S, Rakela J, Shiffman M, So S, Wiesner R. Minimal criteria for placement of adults on the liver transplant waiting list: A report of a national conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases. Liver Transpl 1997; 3(6):628–37.
Luchsinger W, Zimbrean P. Systematic review: treatment for addictive disorder in transplant patients. Am J Addict 2020; 29(6):445–62.
Martens W. Do alcoholic liver transplantation candidates merit lower medical priority than non-alcoholic candidates? Transpl Int 2001; 14(3):170–5.
Medawar PB. The Croonian Lecture: The homograft reaction. Proc R Soc Lond B Biol Sci 1958a; 149(935):145–66.
Medawar PB. The immunology of transplantation. Harvey Lect 1956—1957. NY: Academic Press 1958b;144-76.
Merrill JP, Murray JE, Harrison JH, Guild WR. Successful homotransplantation of the human kidney between identical twins. J Am Med Assoc 1956; 160(4):277–82.
Martin PR. Addiction. Historical Vocabulary of Addiction. INHN Publisher/Peter R. Martin: Historical Vocabulary of Addiction/Addiction. November 24, 2016.
Martin PR. Alcoholism. Historical Vocabulary of Addiction. INHN Publisher/Peter R. Martin: Historical Vocabulary of Addiction/Alcoholism. June 27,
2019a.
Martin PR. Opium. Historical Vocabulary of Addiction. INHN Projects/Ebooks/Peter R. Martin: Historical Vocabulary of Addiction/Opium. July 4, 2019b.
Martin PR. Recovery. Historical Vocabulary of Addiction. INHN Projects/Ebooks/Peter R. Martin: Historical Vocabulary of Addiction/Recovery. February 20, 2020a.
Martin PR. Self-help. Historical Vocabulary of Addiction. INHN Projects/Ebooks/Peter R. Martin: Historical Vocabulary of Addiction/Self-help. April 2, 2020b.
Martin PR. Nicotine. Historical Vocabulary of Addiction. INHN Projects/Ebooks/Peter R. Martin: Historical Vocabulary of Addiction/Nicotine. February 4, 2021a.
Martin PR. Stimulant. Historical Vocabulary of Addiction. INHN Projects/Ebooks/Peter R. Martin: Historical Vocabulary of Addiction/Stimulant. October 21, 2021b.
Martin PR. Competence. Historical Vocabulary of Addiction. INHN Projects/Ebooks/Peter R. Martin: Historical Vocabulary of Addiction/Competence. April 21, 2022.
Martin PR. Stigma. Historical Vocabulary of Addiction, Vol. II. INHN Projects/Ebooks/Peter R. Martin: Historical Vocabulary of Addiction II/Stigma. September 26, 2024.
Martin PR. Obesity. Historical Vocabulary of Addiction, Vol. II. INHN Projects/Ebooks/Peter R. Martin: Historical Vocabulary of Addiction II/Obesity. February 12, 2025.
Morris PJ. Transplantation — A medical miracle of the 20th Century. N Engl J Med 2004; 351(26):2678–80.
Musto JA, Palmer G, Nemer M, Schell T, Waclawik G, Glover Q, Lucey MR, Osman F, Rice JP. Early liver transplant for alcohol-associated liver disease has excellent survival but higher rates of harmful alcohol use. Clin Gastroenterol Hepatol 2024; 22(8):1646-56.e2.
Penn I, Halgrimson CG, Starzl TE. Liver transplantation in man. Ann N Y Acad Sci 1970; 170(1):251–8.
Pliny, Holland P. The historie of the world: commonly called the naturall historie of C. Plinius Secundus. Londini: Impensis G.B.; 1601.
Rodgman C, Pletsch G. Double successful buprenorphine/naloxone induction to facilitate cardiac transplantation in an iatrogenically opiate-dependent patient. J Addict Med. 2012; 6(2):177-178.
Rush B. Medical Inquiries and Observations on the Diseases of the Mind. Philadelphia: B. & T. Kite; 1812.
Rybak LP. Liver transplants for the chronic alcoholic. N Engl J Med 1974; 290(6):346.
Shunzaburo I, Popovtzer MM, Corman, Jacques L., Ishikawa, Makoto, Putnam, Charles W., Katz, Fred H., Starzl, Thomas E. Recovery from “hepatorenal syndrome” after orthotopic liver transplantation. N Engl J Med 1973; 289(22):1155–9.
Simonetto DA, Winder GS, Connor AA, Terrault NA. Liver transplantation for alcohol-associated liver disease. Hepatology 2024; 80(6):1441-61.
Starzl TE. Ethical problems in organ transplantation. Ann Intern Med 1967; 67(3_Part_2):32–6.
Starzl TE. History of clinical transplantation. World J Surg 2000; 24(7):759–82.
Starzl TE, Putnam CW, Ishikawa M, Picache R, Husberg B, Halgrimson CG, Schroter G, Porter KA. Current policies in hepatic transplantation: candidacy of patients with alcoholic liver disease or preformed antidonor antibodies and reappraisal of biliary duct reconstruction. Ann N Y Acad Sci 1975; 252(1):145–58.
Starzl TE, Van Thiel D, Tzakis AG, watsuki S, Todo S, Marsh JW, Koneru B, Staschak S, Stieber A, Gordon RD. Orthotopic Liver Transplantation for Alcoholic Cirrhosis. JAMA 1988; 260(17):2542–4.
Thomson J. Lectures on inflammation, exhibiting a view of the general doctrines, pathological and practical, of medical surgery. Edinburgh: W. Blackwood; 1813.
Van Thiel DH, Gavaler JS, Tarter RE, Dindzans VJ, Gordon RD, Iwatsuki S, Makowka L, Todo S, Tzakis A, Starzl TE. Liver transplantation for alcoholic liver disease: a consideration of reasons for and against. Alcohol Clin Exp Res 1989; 13(2):181–4.