By Richard Warry
BBC News Online health staff
The failure of footballer George Best to refrain from drinking alcohol despite a life-saving liver transplant just 12 months ago has prompted questions about the merits of offering transplant surgery to alcoholics.
Best has been drinking again
Some say it is a waste of a precious and scarce resource, but others say there is no reason why people suffering from such a debilitating disease should be discriminated against.
The George Best case may give the impression that people suffering from alcoholism take their place in the transplant queue like any other person with severe liver disease.
In fact, this is not the case. Many units operate a vigorous screening policy to determine whether there is a good chance that a patient will give up dangerous drinking following surgery.
If the signs are bad, then they may very well be denied a transplant.
The Scottish Liver Transplant Unit in Edinburgh is one which takes this line.
It is headed by Mr John Forsythe, vice president of the British Transplantation Society.
He told BBC News Online: "You could say no patient with alcoholic liver disease should receive a transplant, but that would be pretty harsh on the truly reformed alcoholic who would do very well.
"Alternatively, you could say that that these patients should always be considered for a transplant, but that is plainly ridiculous.
"In cases where the likelihood of recidivism is high that would mean a vital resource given after a lot of thought by a donor family is likely to be wasted.
"That leaves us with something in between. We have a robust procedure to assess whether there is a good chance that a patient will not return to harmful drinking.
"If there is, then we will consider surgery. After all we have a duty of care to the recipient which is obvious, but we also feel we have a duty of care to the donor family."
Mr Forsythe said the chances of a patient returning to dangerous levels of drinking following surgery were low. Around 15-20% of patients do drink following surgery, but only about 2% of these do so at levels which could damage their new liver.
Dr Robert Lefever, who runs the Promis Recovery Centre for addicts in Kent, believes that patients with alcoholic liver disease should only be offered surgery if they have made a tangible commitment to staying off drink.
"People need to go to Alcoholics Anonymous and demonstrate that they understanding that they have to make a long-term commitment to tackling their problems," he said.
"Just simply saying 'I'm never going to drink again' is not good enough - anybody could say that."
Many would question whether George Best was a suitable candidate for surgery.
But his surgeon is not one of them. Professor Roger Williams said Best's weekend drinking session - which included a scuffle with a photographer, was a temporary lapse.
"Up to about a week ago he had been in extraordinarily good form," he said.
"He was at a House of Commons reception to launch a joint parliamentary group on liver disease and I had never seen him look so well, or talk so well. He was altogether a transformed person."
Eric Appleby, of the charity Alcohol Concern, agreed. He stressed that Best needed sympathy - not criticism.
Best's wife Alex has stood by him
He said: "This isn't like swapping over a component in your car. If you get a new liver, it doesn't stop the problems you had which got you into trouble in the first place.
"I'm sure George Best was absolutely sincere in his wish to stop drinking.
"But drinking in this country is almost how you define yourself, and sitting at home with a glass of orange juice is not what a guy like him has been used to.
"How he leads his life, where his mates are, what he does is down the pub, and it's a tough call to cut that out of your life."
Mr Appleby rejected the idea that alcoholics should be made a low priority for a liver transplant.
"Whatever aspect of health you look at there is always some contributory factor.
"What we need to ensure is that those people who do get transplants actually get the help and support they need to make the most of it."
Deepak Mahtani is from the organisation Transplants in Mind, which works to increase public awareness of the benefits of organ donation.
He said everybody deserved equal treatment from the NHS - including George Best.
"When he received the liver transplant a year ago he made a resolution to stop drinking, and I do believe he was sincere in that.
"Nevertheless, drinking is part of the society in which we live, and he is only human with human frailties."
Mr Mahtani accepted that the negative publicity surrounding Best might put some people off donating their organs.
"I have heard people saying 'why should we register on the organ donor register if our organs are going to be wasted in this way'. But I don't think this is the rule, this is an exception."
Best also won support from Labour MP Helen Clark, a member of the all-party hepatology group, which the footballer helped to launch last week.
She criticised the media for adding to the pressure on Best by camping outside the pub in which he was seen drinking.
"George hadn't touched a drop of alcohol for three years, and nobody knows what caused this blip.
"He is not an evil, wicked person behaving in a terrible, bad way, he is ill, and he does need help."