title: [Actors in liver transplantation advocate greater transparency and systematic evaluations of transplant centres].
abstract: BACKGROUND
  Following the introduction of the MELD score, the survival rates have worsened after liver transplantation (LTX) in Germany. Existing organ shortages, shorter survival rates after LTX, and failures in the liver allocation process provide true challenges. Facilitated by a structured questionnaire, the appropriate German liver transplantation actors were approached with regard to these challenges for the first time. The aim was to provide a balanced experts' view in an anonymous fashion thereby identifying areas for potential improvement.
  
  
  METHODS
  Data collection was performed by a structured, standardised, anonymous survey of all LTX centres in Germany.
  
  
  RESULTS
  We received 75 % replies of the questionnaires, 35 of 36 participants responded to more than 75 % of all questions. The following key points were highlighted. A minimum amount of LTX per centre was deemed important and monetary incentives must not exist. The ultimate goal of LTX is a prolongation of life and social as well as occupational reintegration. Quality management and transparent LTX registers are prerequisites for both adequate organ allocation and distribution of resources in order to achieve the best possible transplant outcomes.
  
  
  CONCLUSIONS
  The German liver transplant experts consider transparency of organ allocation and systematic evaluation of the quality of transplant centres and the transplantation process itself to be mandatory, however, executed in a participatory way. A scoring system to facilitate the decision making process in order to predict the likelihood of satisfactory LTX outcome thereby circumventing some of the ethical and constitutional doubts would be highly appreciated.
authors.affiliation: Schwerpunkt Gastroenterologie, Justus-Liebig-Universität Gießen.
authors.forename: E
authors.initials: E
authors.lastname: Roeb
authors.affiliation: Klinischer Direktor, Klinikum Stuttgart.
authors.forename: J
authors.initials: J
authors.lastname: Graf
authors.affiliation: Fachbereich Wirtschaft und Recht, Fachhochschule Frankfurt am Main, Frankfurt.
authors.forename: H J
authors.initials: HJ
authors.lastname: Meyer
mesh_terms: D022126:Access to Information / Q000331:legislation & jurisprudence*; D005858:Germany; D006782:Hospitals, Special / Q000331:legislation & jurisprudence*; D006801:Humans; D017093:Liver Failure / Q000401:mortality / Q000601:surgery*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000331:legislation & jurisprudence* / Q000401:mortality; D009313:National Health Programs / Q000331:legislation & jurisprudence*; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality*; D011785:Quality Assurance, Health Care / Q000331:legislation & jurisprudence*; D040841:Resource Allocation / Q000331:legislation & jurisprudence*; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D014019:Tissue Donors / Q000331:legislation & jurisprudence / Q000600:supply & distribution; D014342:Truth Disclosure; D014850:Waiting Lists / Q000401:mortality