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Survey Explores Public Opinion on Liver Transplants for Individuals with Alcohol Use Disorder

May 15, 2025
in Social Science
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The process of becoming an organ donor has been streamlined in recent years, making it more accessible than ever before. Individuals can now register online when renewing their driver’s license or, in an increasingly digital world, iPhone users can sign up directly through a dedicated app. Despite these improvements in registration accessibility, the critical disparity between the number of patients in need of organ transplants and the availability of organs persists as a public health crisis. In the United States, a new patient is added to the transplant waiting list every eight minutes, yet tragically, 17 people die daily due to the unavailability of a suitable organ.

Amid these sobering statistics, researchers have sought to understand public attitudes towards who deserves access to these life-saving transplants. Simon F. Haeder, PhD, a health policy analyst at Texas A&M University’s School of Public Health, co-led a seminal study published in Social Science Quarterly that probes the complex interplay of perceived recipient deservingness, racial and ethnic identity, and transplantation eligibility. This research fills a notable gap in the literature, which to date has only sporadically examined biases—both explicit and implicit—affecting organ allocation decisions.

Unlike previous studies, this investigation uniquely considered organ failure arising from workplace-related injuries and mental health conditions, elevating the conversation beyond genetic or acute illnesses. The study specifically analyzed public opinions about prospective recipients suffering from diseases such as black lung, a debilitating condition caused by prolonged coal dust exposure, and alcohol use disorder, a chronic mental health disorder often stigmatized despite its widespread recognition as a treatable medical condition. This approach addresses a more holistic range of medical and social factors influencing organ transplant needs.

To achieve comprehensive insights, Haeder and a collaborator from Utah Valley University conducted a national survey involving 4,177 American adults between March and April of 2022. Participants were presented with four hypothetical scenarios, each depicting a patient in desperate need of an organ transplant but differing in the cause of their organ failure and ethnic background, indicated by culturally recognizable names. This survey design robustly isolated the impact of the recipient’s backstory and ethnicity on public perceptions of deservingness.

The four scenarios included individuals with distinct health profiles: a man with a hereditary kidney disease requiring a kidney transplant; a former coal miner afflicted by black lung disease necessitating a lung transplant; a severely ill but unvaccinated COVID-19 patient in need of a lung transplant; and a patient diagnosed with alcohol use disorder who required a liver transplant. These diverse medical circumstances were selected to evaluate societal biases related both to cause and behavior, as well as to parse out racial and ethnic prejudice.

Remarkably, the study found strong differentiation in public support based on the specific life circumstances that led to organ failure. The highest approval rates were given to the coal miner suffering from black lung disease, underscoring a collective empathy for those harmed by occupational exposures beyond their control. Next in deservingness ranking was the individual with genetic kidney disease, suggesting broad public sympathy for inherited conditions perceived as “blameless.”

In contrast, the unvaccinated COVID-19 patient garnered less widespread support, reflecting contentious societal debates about personal responsibility during the pandemic, although the political divide mirrored differing opinions on this issue. The individual with alcohol use disorder was consistently viewed as the least deserving transplant candidate, highlighting the enduring stigma attached to substance use disorders despite medical evidence categorizing it as a disease rather than a moral failing.

Importantly, the study also examined the role of race and ethnicity in public transplantation attitudes. Using racially and ethnically identifiable names—Ronny Nielsen (White), DeShawn Washington (Black), Luis Hernandez (Hispanic), and Yang Chen (Asian)—the research explored whether these identifiers influenced judgments of deservingness. Findings revealed that race and ethnicity did not constitute significant factors in public opinion on transplant eligibility. In instances where differences appeared, slight biases tended to favor minority candidates, suggesting a possibly progressive shift in public sentiment regarding racial equity in healthcare.

The interplay of political ideology and racial resentment further nuanced these perceptions. Liberals and individuals exhibiting lower racial resentment did not markedly distinguish between the alcohol use disorder patient and the unvaccinated COVID-19 patient, whereas conservatives and those scoring higher on racial resentment scales expressed stronger differential attitudes. This political polarization reflects broader societal divisions impacting health policy debates and potentially organ allocation protocols.

Haeder emphasized that the results raise critical ethical and policy questions about the role of public opinion in the highly regulated organ allocation process. While aligning organ transplantation policies with public sentiment could enhance donation rates by fostering trust and perceived fairness, the scarcity of organs necessitates transparent and equitable criteria to govern distribution. Balancing these considerations remains a formidable challenge for policymakers, clinicians, and bioethicists alike.

The study’s comprehensive dataset and robust methodological design open pathways for refining organ allocation frameworks. By recognizing the nuanced ways people perceive deservingness, healthcare systems might develop tailored communication strategies targeting donation advocacy. Moreover, the findings point toward innovative solutions to expand organ availability, including reexamining stigma associated with certain diseases to facilitate more inclusive policies.

In a healthcare landscape increasingly attentive to social determinants and structural inequities, this research sheds vital light on public attitudes that shape life-and-death decisions. The discernible ranking of transplant candidates based on perceived deservingness linked to disease origin, along with the relative insignificance of racial biases, offers hopeful insights. These data underscore a growing public consensus that medical need and context, rather than racial identity, should guide life-saving organ allocation.

Yet, the persistent stigma toward individuals with alcohol use disorder signals enduring cultural barriers. This highlights the imperative for ongoing education and advocacy to reframe substance use disorders within a compassionate, medicalized lens. Addressing such stigmas could profoundly influence fairness and outcomes in transplantation ethics and practice.

As organ donation systems grapple with the perennial challenge of supply-demand mismatch, integrating empirical data on social attitudes will be crucial. Findings like these inform not only policy formation but also the broader societal dialogue about justice, responsibility, and solidarity in healthcare. Ultimately, expanding the organ pool while honoring equitable access must remain the guiding objective.

The intricate intersection of medical ethics, public perception, and systemic organ scarcity continues to provoke essential discussions. Research led by Haeder et al. represents a pioneering step toward understanding—and potentially transforming—the factors influencing who lives, who waits, and who loses in the arena of organ transplantation. Their work calls for ongoing engagement across disciplines to reconcile compassion with fairness in managing one of medicine’s most precious resources.


Subject of Research: Public attitudes on transplant recipient deservingness considering disease cause and racial/ethnic factors.

Article Title: Who’s to Blame? How Recipient Deservingness Influences Attitudes About Access to the Organ Transplants

News Publication Date: 31-Mar-2025

Web References:

  • Original Study DOI: http://dx.doi.org/10.1111/ssqu.70021
  • Organ donation facts: https://www.donornetworkwest.org/about-donation/organ-donation-facts-statistics/
  • iPhone organ donor app: https://support.apple.com/guide/iphone/register-as-an-organ-donor-iphd5a30e6e3/ios
  • Black lung disease information: https://www.lung.org/lung-health-diseases/lung-disease-lookup/black-lung

References: Simon F. Haeder et al., Social Science Quarterly, 2025

Keywords: Organ donation, transplant ethics, public opinion, deservingness, stigma, black lung disease, alcohol use disorder, racial bias, health policy, social attitudes, healthcare equity, COVID-19, organ scarcity

Tags: biases in transplant eligibility criteriadisparities in organ transplant availabilityhealth policy and organ allocationimpact of racial and ethnic identity on organ donationimplications of workplace-related organ failureliver transplants and alcohol use disorderorgan donor registration process improvementsperceptions of deservingness in transplant recipientspublic health crisis of organ shortagespublic opinion on organ donationsocial science research on healthcare accessTexas A&M University health research
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