title: Systematic bias in surgeons' predictions of the donor-specific risk of liver transplant graft failure.
abstract: 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.
authors.affiliation: Divisions of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Volk
authors.forename: Meghan
authors.initials: M
authors.lastname: Roney
authors.forename: Robert M
authors.initials: RM
authors.lastname: Merion
mesh_terms: D000328:Adult; D001926:Brain Death; D003657:Decision Making; D058625:End Stage Liver Disease / Q000628:therapy*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000628:therapy; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection / Q000941:ethics*; D010820:Physicians; D011287:Prejudice; D011336:Probability; D012306:Risk; D012720:Severity of Illness Index; D020521:Stroke / Q000401:mortality; D009927:Tissue and Organ Procurement / Q000379:methods*; D014481:United States