title: National survey of provider opinions on controversial characteristics of liver transplant candidates.
abstract: 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.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: Katharine
authors.initials: K
authors.lastname: Secunda
authors.forename: Elisa J
authors.initials: EJ
authors.lastname: Gordon
authors.forename: Min W
authors.initials: MW
authors.lastname: Sohn
authors.forename: Laura A
authors.initials: LA
authors.lastname: Shinkunas
authors.forename: Lauris C
authors.initials: LC
authors.lastname: Kaldjian
authors.forename: Michael D
authors.initials: MD
authors.lastname: Voigt
authors.forename: Josh
authors.initials: J
authors.lastname: Levitsky
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D015992:Body Mass Index; D000075202:Contraindications; D003661:Decision Support Techniques; D004608:Eligibility Determination / Q000941:ethics / Q000592:standards; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000941:ethics / Q000592:standards; D016015:Logistic Models; D008297:Male; D002189:Marijuana Abuse / Q000150:complications; D008385:Marijuana Smoking / Q000009:adverse effects; D001523:Mental Disorders / Q000150:complications / Q000523:psychology; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D050177:Overweight / Q000150:complications / Q000175:diagnosis; D018579:Patient Selection / Q000941:ethics; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000941:ethics / Q000592:standards; D011329:Prisoners; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult