Systematic bias in surgeons' predictions of the donor-specific risk of liver transplant graft failure


  • The authors have no relevant conflicts of interest.

Address reprint requests to Michael L. Volk, M.D., M.Sc., Division of Gastroenterology and Hepatology, University of Michigan Health System, 1500 East Medical Center Drive, 3912 TC, Ann Arbor MI 48109. Telephone: 734-232-1071; FAX: 734-936-8944; E-mail:


The decision to accept or decline a liver allograft for a patient on the transplant waiting list is complex. We hypothesized that surgeons are not accurate at predicting donor-specific risks. Surgeon members of the American Society of Transplant Surgeons were invited to complete a survey in which they predicted the 3-year risk of graft failure for a 53-year-old man with alcoholic cirrhosis and a Model for End-Stage Liver Disease score of 21 with a liver from (1) a 30-year-old local donor with traumatic brain death or (2) a 64-year-old regional donor with brain death from a stroke. Complete responses were obtained from 201 surgeons, whose self-reported case volume represents the majority of liver transplants in the United States. The surgeon-predicted 3-year risk of graft failure varied widely (more than 10-fold). In scenario 1, 90% of the respondents provided lower estimates of the graft failure risk than the literature-derived estimate of 21% (P < 0.001). In scenario 2, 96% of the responses were lower than the literature-derived estimate of 40% (P < 0.001). In conclusion, transplant surgeons vary widely in their predictions of the donor-specific risk of graft failure, and they demonstrate a systematic bias toward inaccurately low estimates of graft failure, particularly for higher risk organs. Liver Transpl 19:987–990, 2013. © 2013 AASLD.