Liver Donation if You Have a Family History of Alcohol-associated Liver Disease (ALD) or Alcohol use Disorder (AUD)

What is alcohol-associated liver disease (ALD) or alcohol use disorder (AUD)?

Alcohol-associated liver disease (ALD) is liver damage caused by drinking too much alcohol.

Alcohol use disorder (AUD) is a health condition in which a person cannot stop or control drinking alcohol even when it causes problems with their relationships, work, or health. It is also called alcoholism, alcohol abuse, alcohol dependence, or alcohol addiction.

Over time, drinking too much alcohol can cause liver damage, including:

  • Fatty liver (build-up of extra fat in liver cells)
  • Permanent liver damage
  • Cirrhosis (scarring in your liver) 

If you have a family history of ALD or AUD, you have a higher chance of having it yourself. If you have ALD or AUD and a family history, you have a higher chance of liver damage because you may have genetic changes that prevent your liver from safely breaking down alcohol.

To treat ALD and AUD, a person needs to stop drinking alcohol.   

What causes ALD and AUD?

ALD and AUD are caused by a mix of your:

  • Genes, which are passed down from your parents
  • Situation you grew up in
  • Mental and emotional health and ways of coping
  • Behaviors and habits, such as how much you drink and if you use tobacco

How much is “too much” alcohol?

If you were born a man, too much alcohol is:

  • 3 or more drinks per day, or
  • 15 or more drinks per week

If you were born a woman, too much alcohol is:

  • 2 or more drinks per day, or 
  • 8 or more drinks per week

One standard alcohol drink is:

  • 12 ounces of beer, such as a 12 oz. can
  • 5 ounces of wine
  • 1.5 ounces of distilled spirits, such as 1 shot glass of vodka, tequila, gin, or whiskey  

How will I know if I have ALD or AUD?

As part of the living liver donor evaluation, your doctor will ask about your family history of ALD, AUD, and liver disease. They will also ask you:

  • How many standard drinks you have when you drink alcohol
  • How many days per week you usually drink alcohol

Your transplant center’s psychosocial team (social worker, psychologist, or psychiatrist) will also do a social and emotional assessment to learn about your mental and emotional health and ways of coping

Can I donate if I have a family history of ALD or AUD?

Each transplant center has its own rules about who can donate.

  • If you have a family history of ALD or AUD, most centers may let you donate if:
    • You are currently in good health
    • You understand that drinking alcohol can damage your liver 
  • If you currently have ALD or AUD, you may not be able to donate
  • If you had AUD in the past, but have stopped drinking, you may be able to donate if you can continue to not drink alcohol. Your psychosocial team will help to see if it is safe to donate.
  • If you had ALD in the past, you may not be able to donate 




  1. Osna NA, Donohue TM Jr, Kharbanda KK. Alcoholic Liver Disease: Pathogenesis and Current Management. Alcohol Res. 2017;38(2):147-161.
  2. Stickel F, Hampe J. Genetic determinants of alcoholic liver disease. Gut. 2012 Jan;61(1):150-9
  3. Tawa EA, Hall SD, Lohoff FW. Overview of the Genetics of Alcohol Use Disorder. Alcohol Alcohol. 2016 Sep;51(5):507-14

Note: This information is the opinion of the Living Donor Community of Practice (LDCOP) of the American Society of Transplantation. The LDCOP is a group of health care professionals and researchers who specialize in living donation. The LDCOP’s recommendations are meant to offer you helpful information, but you may find opinions from other groups or organizations that are helpful to you, too.

Last Updated: 
June 03, 2022