Candidate selection for liver transplantation presents challenging ethical issues that require balancing the principles of justice and utility.
Dr Katharine Secunda and colleagues assessed the opinions of US transplant providers regarding the ways in which controversial medical and psychosocial characteristics influence patient eligibility for liver transplantation.
The researchers reported that an online, anonymous survey about adult patient characteristics was sent to providers at all 102 active adult liver transplant centers in the United States.
A majority of the providers completed the survey.
The researchers queried providers about 8 characteristics, of which 3 were ranked most controversial including incarceration, marijuana use, and psychiatric diagnoses.
Most providers identified a patient age 80 years, a body mass index 45 kg/m2 or more, and current incarceration with a lifetime sentence as absolute contraindications to liver transplantation.
|Current incarceration with a lifetime sentence was an absolute contraindications to liver transplants|
|Liver Transplantation |
The doctors found that 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.
Dr Secunda's team commented, "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."