The surgeon who performed George Best's liver transplant says urgent measures are needed to identify patients who are likely to abuse alcohol after their operations, so they can be kicked off hospital waiting lists.
Nigel Heaton, who heads the liver unit at King's College hospital in London and carried out the former Manchester United footballer's operation in 2002, said the shortage of liver donors has increased pressure on surgeons to pick patients who are likely to benefit most from transplant operations.
"Livers are in short supply and the waiting list has grown over the past two to three years. If you knew someone was going to be recidivist you wouldn't take them on for a transplant. The problem is there's just no way of spotting who those people are," said Prof Heaton.
Best, who yesterday remained in intensive care at the Cromwell hospital in London after suffering a kidney infection, satisfied surgeons that he was suitable for a liver transplant in 2002 after suffering alcohol-induced cirrhosis. But since his operation, he has resumed drinking against the advice of his doctor.
"We need to develop means of assessing patients to identify those who are inevitably going to go back to alcohol so we can exclude them," said Prof Heaton. "We also need to devise more stringent strategies to prevent them going back to alcohol once the transplant has been performed."
Liver transplants are a last resort for many alcoholics who have developed alcohol-related diseases such as cirrhosis.
Shortly after his transplant operation, Best was fitted with an implant designed to make it painful to drink alcohol. The implant, which is typically placed under the fat around the stomach, releases a drug into the blood stream that prevents the body breaking down alcohol properly.
Drinking with the implant in place leads to a rise in toxins in the blood known as aldehydes that can lead to violent convulsions, palpitations and changes in blood pressure.
"The problem with the implants is that they only last up to six months, so unless the patient has a replacement, the effect wears off eventually," said Kris Zakrzewski, a private consultant at Kent and Sussex clinical services who has fitted the implants in hundreds of patients. "There's also the danger that patients fail to get psychological support for their addiction and rely too much on the implant to stop them drinking. They need support too."
All patients who have organ transplants have a high chance of getting infections because they need to take immunosuppressant drugs that dampen their whole immune system to stop their bodies rejecting the new organ. But the danger faced by alcoholics who have received new livers is that alcohol suppresses the immune system even further, making them even more susceptible to infections.
"As a rule, they will face more infections and if they keep on drinking they will die of liver disease because transplants have a lower threshold to damage," said Prof Heaton.
The toll on our livers
· Between 1996 and 2000, alcohol-related liver disease necessitated almost 500 liver transplants at an estimated cost of £23.5m.
· Nearly half of all liver disease cases, including that of George Best (above), are alcohol related. Excess alcohol causes cirrhosis of the liver, where scar tissue replaces healthy tissue.
· With binge drinking on the rise, doctors are warning about younger deaths from cirrhosis.
· The first liver transplant was carried out by Thomas Starzl in 1963. The 10,000th operation took place in 2004.
· The UK performs between 600 and 700 liver transplants a year.
Data: British Liver Trust. Compiled by Guardian research department