This study was supported by the Informed Consent and Disparities Workgroup of the Northwestern University Transplant Outcomes Research Collaborative. Katharine Secunda was supported by a summer research grant from the Northwestern University Feinberg School of Medicine through the Medical Student Summer Research Program.
National survey of provider opinions on controversial characteristics of liver transplant candidates
Article first published online: 17 MAR 2013
Copyright © 2013 American Association for the Study of Liver Diseases
Volume 19, Issue 4, pages 395–403, April 2013
How to Cite
Secunda, K., Gordon, E. J., Sohn, M. W., Shinkunas, L. A., Kaldjian, L. C., Voigt, M. D. and Levitsky, J. (2013), National survey of provider opinions on controversial characteristics of liver transplant candidates. Liver Transpl, 19: 395–403. doi: 10.1002/lt.23581
- Issue published online: 27 MAR 2013
- Article first published online: 17 MAR 2013
- Accepted manuscript online: 29 NOV 2012 01:31PM EST
- Manuscript Accepted: 24 OCT 2012
- Manuscript Received: 10 AUG 2012
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 US 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. Liver Transpl 19:395–403, 2013. © 2012 AASLD.