Liver Transpl. 2012 Nov 29. doi: 10.1002/lt.23581. [Epub ahead of print]
A national survey of provider opinions on controversial characteristics of liver transplant candidates.
Source
Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Abstract
Candidate selection in liver transplantation presents challenging ethical issues that require balancing the principles of justice and utility. The goal of this study was to assess the opinions of U.S. transplant providers regarding how controversial medical and psychosocial characteristics influence patient eligibility for liver transplantation. An online anonymous survey about adult patient characteristics was sent to providers (hepatologists, surgeons, psychiatrists, social workers) at all 102 active adult U.S. liver transplant centers. Most providers (251/444; 56.5%) completed the survey. Of the eight characteristics queried, the three ranked most controversial were incarceration, marijuana use, and psychiatric diagnoses. Most providers identified patient age ≥ 80 years (62.7%), BMI ≥ 45 kg/m(2) (56.6%), and current incarceration with lifetime sentence (54.7%) as absolute contraindications to liver transplantation. In multivariable analysis, identification of absolute contraindications varied significantly by provider type, center volume, and geographical region. Less than half of providers reported that their centers had written policies regarding most of the characteristics examined. In conclusion, providers differ significantly in their opinions on controversial patient characteristics and transplant contraindications. Along with a paucity of literature data on outcomes, these provider differences may play a role in the reason many centers do not have formal policies for selecting patients with these characteristics. Evidence-based data on outcomes of such patients are needed to guide formation of written policies to better standardize eligibility criteria.
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