Purpose of Review
To briefly summarize topical ethical issues in patients with cirrhosis.
Recent Findings
The “four quadrants” framework is ideally suited to address ethical issues in patients with cirrhosis. The presence of hepatic encephalopathy complicates any ethical analysis and stresses the importance of advanced directives and end of life planning, both of which appear to be poorly applied. Organ allocation in liver transplantation (LT) based on survival benefit, a “not unreasonable standard” to assess live donor LT (LDLT) in patients removed from the wait list, LT in patients with acute alcoholic hepatitis, and LT in undocumented immigrants are supported by sound ethical principles.
Summary
Significant ethical issues remain challenging and unresolved for patients with cirrhosis. Further research must be done to assess how frequently ethical problems occur in individual patients. Clear, detailed policies, based on strong ethical platforms, must be developed to further address these significant ethical challenges.