Document Detail


National survey of provider opinions on controversial characteristics of liver transplant candidates.
MedLine Citation:
PMID:  23197388     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Candidate selection for 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 the ways in which 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, and social workers) at all 102 active adult liver transplant centers in the United States. A majority of the providers (251/444 or 56.5%) completed the survey. The providers were queried about 8 characteristics, and the 3 that were ranked most controversial were incarceration, marijuana use, and psychiatric diagnoses. Most providers identified a patient age ≥ 80 years (62.7%), a body mass index ≥ 45 kg/m2 (56.6%), and current incarceration with a lifetime sentence (54.7%) as absolute contraindications to liver transplantation. In a multivariate analysis, the identification of absolute contraindications varied significantly with the provider type, the center volume, and the geographical region. Less than half of the 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 fact that many centers do not have formal policies for selecting patients with these characteristics. Evidence-based data on the outcomes of such patients are needed to guide the formation of written policies to better standardize eligibility criteria.
Authors:
Katharine Secunda; Elisa J Gordon; Min W Sohn; Laura A Shinkunas; Lauris C Kaldjian; Michael D Voigt; Josh Levitsky
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2013-03-17
Journal Detail:
Title:  Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society     Volume:  19     ISSN:  1527-6473     ISO Abbreviation:  Liver Transpl.     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-28     Completed Date:  2013-09-13     Revised Date:  2014-05-02    
Medline Journal Info:
Nlm Unique ID:  100909185     Medline TA:  Liver Transpl     Country:  United States    
Other Details:
Languages:  eng     Pagination:  395-403     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 American Association for the Study of Liver Diseases.
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Aged
Aged, 80 and over
Attitude of Health Personnel*
Body Mass Index
Decision Support Techniques
Eligibility Determination* / ethics,  standards
Female
Health Care Surveys
Health Knowledge, Attitudes, Practice*
Health Policy
Humans
Liver Transplantation* / adverse effects,  contraindications,  ethics,  standards
Logistic Models
Male
Marijuana Abuse / complications
Marijuana Smoking / adverse effects
Mental Disorders / complications,  psychology
Mental Health
Middle Aged
Multivariate Analysis
Odds Ratio
Overweight / complications,  diagnosis
Patient Selection* / ethics
Physician's Practice Patterns* / ethics,  standards
Practice Guidelines as Topic
Prisoners
Questionnaires
Risk Factors
Treatment Outcome
United States
Young Adult
Comments/Corrections
Comment In:
Liver Transpl. 2014 Apr;20(4):497-8   [PMID:  24376167 ]
Liver Transpl. 2014 Apr;20(4):499   [PMID:  24478058 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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