Results from an anonymous survey of U.S. transplant providers report
that incarceration, marijuana use, and psychiatric diagnoses,
particularly suicide attempts, may lower patients’ eligibility for liver
transplantation. The study published in the April issue of Liver Transplantation,
a journal of the American Association for the Study of Liver Diseases
and the International Liver Transplantation Society, also found that
most providers would not offer transplants to patients with advanced
age, those severely obese, or with lifetime imprisonment.
“For patients with end-stage liver disease,
transplantation is the only treatment option to extend life,” explains
lead investigator Dr. Josh Levitsky from Northwestern University
Feinberg School of Medicine in Chicago, Ill. “With donated livers in
such short supply, selecting candidates becomes an ethical exercise for
transplant specialists who must balance equal access to transplantation
with graft and patient survival.”
Currently, the model for end-stage liver disease
(MELD) is used to measure the severity of liver disease. The MELD
score provides transplant providers with standardized criteria to
allocate donated livers. However, the authors point out that subjective
assessment of the candidates’ medical and psychosocial characteristics
could influence the providers’ selection process. Medical evidence
shows that controversial characteristics such as alcohol abuse, HIV
status, obesity, or advanced age may impact allocation, leading to an
inequity among patients being waitlisted.
To further understand the ethics involved in selecting
transplant candidates, Dr. Levitsky and colleagues sent an online
survey to hepatologists, surgeons, psychiatrists and social workers at
102 liver transplant centers across the U.S. Responses were received
from 251 providers who answered questions regarding their opinions of
characteristics that could prevent patients from receiving a liver
The majority of responders were male (71%), between
41 and 60 years of age (68%) and mainly white (77%). The three
characteristics ranked most controversial were incarceration, marijuana
use, and psychiatric diagnoses. Responses from transplant providers
indicate that 63% would not waitlist patients 80 years or older, 57%
would not transplant patients with a body mass index (BMI) greater than
45 kg/m2, and 55% specified incarceration with lifetime sentence a contraindication to liver transplantation.
Furthermore, less than half of the providers
reported their centers had written policies regarding controversial
characteristics that would prevent some patients from receiving liver
transplants. “We found significant variation in provider opinions of
criteria that are contraindications for liver transplantation, which may
be why many centers do not have formal policies for selecting
candidates with questionable characteristics,” concludes Dr. Levitsky.
“Standardized eligibility criteria, supported by evidence-based data of
outcomes, are necessary to develop formal policies for selecting
controversial candidates for liver transplantation.”
Full citation: “A National Survey of Provider
Opinions on Controversial Characteristics of Liver Transplant
Candidates.” Katharine Secunda, Elisa J. Gordon, Min W. Sohn, Laura A.
Shinkunas, Lauris C. Kaldjian, Michael D. Voigt and Josh Levitsky. Liver Transplantation; (DOI: 10.1002/lt.23581) Print Issue Date: April, 2013.
Author Contact: Media wishing to speak with Dr. Levitsky may contact Colleen Sheehan with Northwestern Memorial Hospital at firstname.lastname@example.org or at +1-312-926-7769.
About the Journal
Liver Transplantation is published by Wiley on behalf of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.
Since the first application of liver transplantation in a clinical
situation was reported more than twenty years ago, there has been a
great deal of growth in this field and more is anticipated. As an
official publication of the AASLD and the ILTS,
Liver Transplantation delivers current, peer-reviewed articles on
surgical techniques, clinical investigations and drug research — the
information necessary to keep abreast of this evolving specialty. For
more information, please visit http://wileyonlinelibrary.com/journal/livertransplantation
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