The influence of psychosocial evaluation on candidacy for liver transplantation.
BACKGROUND
Although medical factors clearly dominate the evaluation of appropriateness for liver transplant, psychosocial factors are an important dimension in the evaluation process.


OBJECTIVE
To understand more about the weight assigned to psychosocial factors in the decision to list patients for liver transplant and about whether such differences create hidden inequities in the transplant allocation system.


METHODS
We conducted a mail survey of liver transplant surgeons and psychosocial evaluators at busy transplant centers assessing the importance these professionals assigned to psychosocial factors in evaluations for liver transplant candidacy.


METHODS
Liver transplant surgeons and psychosocial evaluators from the highest volume liver transplant centers in the United States.


METHODS
Mail survey.


RESULTS
Psychosocial evaluators assigned greater importance to availability of transportation, adaptation to stress, and coping skills than did surgeons. Transplant psychosocial evaluators were less likely than transplant surgeons to recommend that a patient with a history of poor social support be listed for liver transplant. We found no correlation between relative weight assigned to psychosocial factors and median wait times at transplant centers. These differences suggest that the relationship between the factors identified by psychosocial evaluators as important and transplant outcomes should be studied. Overall, more research into the predictive and ethical aspects of psychosocial evaluation for liver transplant is needed.
Flamme
Nancy E
NE
Charles Warren Fairbanks Center for Medical Ethics, Indianapolis, Indiana, USA.
Terry
Colin L
CL
Helft
Paul R
PR
D000223:Adaptation, Psychological; D000328:Adult; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010552:Personality Assessment; D012803:Sick Role; D012944:Social Support; D011795:Surveys and Questionnaires; D014187:Transportation of Patients; D014481:United States