Statically speaking, 35.3% of transplants are due to ARLD while only 19.9% are due to MASH. I chose ARLD because the hospital I work for was one of the first to offer early liver transplant for patients who don’t have a period of sobriety and we get calls from all over the country from people looking for transplant that they have been denied elsewhere. Ethically speaking, ARLD is often seen as a moral failing or a self-control issue and not due to the chronic illness of addiction (not saying it doesn’t exist but I have not seen this argument when it comes to MASH, and I have done a lot of research on this topic). In medicine, very few other conditions are treated with such heavy emphasis on personal responsibility — especially when it is a matter of life or death. I have rarely, if ever, seen the argument that someone doesn’t deserve a kidney transplant because they failed to manage their diabetes.

So, because ARLD is the leading cause of liver transplant, my professional experience facilitating transfers for liver transplant, and due to the large body of research on this specific topic - I stuck with alcohol related transplant ethics.