|National survey of provider opinions on controversial characteristics of liver transplant candidates.|
|PMID: 23197388 Owner: NLM Status: MEDLINE|
|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.|
|Katharine Secunda; Elisa J Gordon; Min W Sohn; Laura A Shinkunas; Lauris C Kaldjian; Michael D Voigt; Josh Levitsky|
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|Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2013-03-17|
|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|
|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|
|Languages: eng Pagination: 395-403 Citation Subset: IM|
|Copyright © 2013 American Association for the Study of Liver Diseases.|
|APA/MLA Format Download EndNote Download BibTex|
Aged, 80 and over
Attitude of Health Personnel*
Body Mass Index
Decision Support Techniques
Eligibility Determination* / ethics, standards
Health Care Surveys
Health Knowledge, Attitudes, Practice*
Liver Transplantation* / adverse effects, contraindications, ethics, standards
Marijuana Abuse / complications
Marijuana Smoking / adverse effects
Mental Disorders / complications, psychology
Overweight / complications, diagnosis
Patient Selection* / ethics
Physician's Practice Patterns* / ethics, standards
Practice Guidelines as Topic
Liver Transpl. 2014 Apr;20(4):497-8
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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