*Purpose: At some centers, alcohol-related liver disease (ARLD) patients, who are unlikely to survive six months without a liver transplant (LT), are selected to receive life-saving early liver transplantation (ELT) despite zero to minimal sobriety. ELT recipients’ perceptions of their LT experiences have not been previously examined and can help inform ARLD transplant policies.

*Methods: We conducted a preliminary thematic analysis of in-depth semi-structured interviews with 17 ELT recipients transplanted between December 2013 and July 2020, at a single center. Interviews focus on the ELT experience, alcohol use, and the six-month wait period guideline and will continue until thematic saturation is reached.

*Results: A common participant perception was feeling thankful for a new liver. Participants expressed various motivations for taking care of their new livers and their health, characterizing the transplant as a “new lease on life.” Participants described their changed attitudes towards alcohol post-LT and disclosed ongoing challenges, such as maintaining sobriety, “fighting” for self-identity, navigating stressors, and redefining their relationships. Regarding the six-month wait period, participants expressed a range of perspectives, from beliefs that a guideline may be helpful in some cases to criticisms that the guideline groups patients into “black and white categor[ies]” and ignores their circumstances. Participants discussed the stigma of being perceived as an “alcoholic” and highlighted the struggle of trying to demonstrate sobriety while dealing with a “dead liver.” Participants expressed a desire for specific supports for ARLD LT patients.

*Conclusions: ELT recipients’ perceptions illuminate the struggles and stigma associated with ARLD, as well as the direct impact of the six-month wait period on ARLD patients in need of an LT. These findings can help inform an ethical and evidence-based policy for transplanting ARLD patients.

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