An increasingly blurred understanding of the distinctive challenges posed to transplantation medicine and, by extension, public health, by the debilitating reality of alcoholism suggests a critical need to revisit the relationship between causality, candidacy, and culpability in light of substance addiction. This essay grounds its arguments in two, straightforward premises: (i) compassionate medical practice - understood as the sympathetic willingness to enter into the existential suffering of another in order to ameliorate the anguish invoked by disease - rests on the fiduciary relationship shared between provider and patient; and (ii) allocating medical goods according to moral desert rather than existential disposition undermines the fundamental nature of medicine and the functioning of the provider-patient relationship. Drawing from this syllogism, the aim and proposal of this essay posits the argument that employing moral desert as an allocation criteria to inhibit alcoholic patients from equal consideration and treatment is, and ought to remain, at odds with the fundamental nature of medicine and the functioning of the provider-patient relationship.