Guidelines are in place regarding who is a candidate for liver transplantation.
Once a potential candidate is listed, there are no uniform guidelines indicating when he should be removed from the list because of a change in clinical status.
Drs Kevin Charpentier and Arun Mavanur from Rhode Island, USA sent a survey with 14 scenarios to the medical and surgical directors of all liver transplant programs in the United States.
In each scenario, clinical information was provided about a patient active on the transplant wait list.
Data regarding a clinical change were provided, and responders were questioned whether they would remove the patient from the wait list.
|All 11 United Network for Organ Sharing regions were represented|
The scenarios were designed to address the issues of age, etiology of liver disease, renal dysfunction, respiratory failure, infection, failure to thrive, and social support.
The researchers mailed 204 questionnaires and obtained 47 responses.
Of these, 24 were surgeons, and 15 were hepatologists.
All 11 United Network for Organ Sharing regions were represented.
The responders were well distributed among university programs, private practice programs, and health maintenance organization programs.
The team reported that 9 responses were from small-volume programs, 12 were from medium-volume programs, and 18 were from large-volume programs.
There was wide variability between responders regarding which patients should be removed from the transplant wait list.
The researchers found that patient age and etiology of liver disease led to the greatest discordance among responders.
Dr Charpentier and colleague comment, "There is a lack of agreement and standardization among US liver transplant programs regarding who should be removed from the wait list for a change in clinical status."