Other causes of failed PEth test for alcohol abuse?

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My husband has had no alcohol since December 2022. He had a Peth Test done on May 11, 2023 as part of a liver transplant evaluation. It came back at 260 and 388 ng/mL. We immediately disputed the result with his doctor and had him re-tested elsewhere. The second test came back negative. They were done five days apart. The transplant hospital would not accept the re-test and denied a transplant.
More recently he was hospitalized on June 6, 2023 for an infection. He had a negative Peth test on June 7, 2023. He has been hospitalized continuously since June 6. with absolutely no access to alcohol. On June 12, 2023 he had another Peth test with a result of 38 ng/mL How can this be possible?
The tests are clearly erratic and unreliable. They should not be used to determine eligibility for liver transplant.

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Published just days ago:

"Phosphatidylethanol (PEth) is a marker of alcohol consumption used in clinical and forensic settings. PEth positivity in individuals expected to abstain from alcohol can have serious consequences. PEth is located on erythrocytes, thus packed red blood cell (pRBC) transfusion is a potential cause of false-positive results. This report is the first to demonstrate this phenomenon in an authentic patient who was negative for PEth immediately prior to transfusion."

Published just days ago:

Artificial elevation of phosphatidylethanol due to red blood cell transfusion
Author links open overlay panelChristine L.H. Snozek a, Theresa N. Kinard a, Kathy N. Alegria a, Paul J. Jannetto b, Loralie J. Langman b
a
Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
b
Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, 200 1st Street SW, Rochester, MN, 55905, USA

"Phosphatidylethanol (PEth) is a marker of alcohol consumption used in clinical and forensic settings. PEth positivity in individuals expected to abstain from alcohol can have serious consequences. PEth is located on erythrocytes, thus packed red blood cell (pRBC) transfusion is a potential cause of false-positive results. This report is the first to demonstrate this phenomenon in an authentic patient who was negative for PEth immediately prior to transfusion."

There are now several other published methods for false positives as well. And I know of another coming.

The irony is, they keep claiming it’s PERFECT, despite the obvious problem with that, while ignoring EASY problems that if identified would render this test VERY legit and useful.

I was kicked off my transplant list in Jan 2020 for a false reading. The hospital didn't complete cut me loose; my wife and I insisted on it was false. I submitted to weekly PEth and EtG tests for almost 2 years. I was transplanted in Sep 2021 in critical condition, on my very, very last day earth without it. The industry knows about test reliability and it isn't changing, far as I can see. People can be denied, and possibly die, and it can be over a false. With the ratio of donor organs to need where it usually is, I don't expect feds or the industry to have interest in changing this. I've set a low bar for this after my experience.

My wife is in a custody battle with her ex-husband about her quality of care involving her youngest child. The court has continuously ordered PEth blood tests which she scores in the 50-100 range. I know there's absolutely no alcohol consumption with her. I have a biochemistry, medicinal chemistry degree. There's a number of reasons that these scores can be explained, mostly the method, collection, and handling of the samples, but that's unlikely to consistently happen with multiple clinical samples from various collections at multiple test sites, e.g. her PCP, independent labs, drug testing facilities.
Does anyone know what if anything cam this be linked to these false positive results.

The RBC in the sample (in vitro) can absolutely continue to produce PEth. The PDL2 enzyme remains active until essentially frozen -80c