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Incarceration, marijuana use and suicide attempts may hinder liver transplant eligibility

Results from an anonymous survey of U.S. transplant providers report that incarceration, marijuana use, and psychiatric diagnoses, particularly suicide attempts, may lower patients' eligibility for liver transplantation. The study published in the April issue of Liver Transplantation, a journal of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, also found that most providers would not offer transplants to patients with advanced age, those severely obese, or with lifetime imprisonment.

"For patients with end-stage liver disease, transplantation is the only treatment option to extend life," explains lead investigator Dr. Josh Levitsky from Northwestern University Feinberg School of Medicine in Chicago, Ill. "With donated livers in such short supply, selecting candidates becomes an ethical exercise for transplant specialists who must balance equal access to transplantation with graft and patient survival."

Currently, the model for end-stage liver disease (MELD) is used to measure the severity of liver disease. The MELD score provides transplant providers with standardized criteria to allocate donated livers. However, the authors point out that subjective assessment of the candidates' medical and psychosocial characteristics could influence the providers' selection process. Medical evidence shows that controversial characteristics such as alcohol abuse, HIV status, obesity, or advanced age may impact allocation, leading to an inequity among patients being waitlisted.

To further understand the ethics involved in selecting transplant candidates, Dr. Levitsky and colleagues sent an online survey to hepatologists, surgeons, psychiatrists and social workers at 102 liver transplant centers across the U.S. Responses were received from 251 providers who answered questions regarding their opinions of characteristics that could prevent patients from receiving a liver transplant.

The majority of responders were male (71%), between 41 and 60 years of age (68%) and mainly white (77%). The three characteristics ranked most controversial were incarceration, marijuana use, and psychiatric diagnoses. Responses from transplant providers indicate that 63% would not waitlist patients 80 years or older, 57% would not transplant patients with a body mass index (BMI) greater than 45 kg/m2, and 55% specified incarceration with lifetime sentence a contraindication to liver transplantation.

Furthermore, less than half of the providers reported their centers had written policies regarding controversial characteristics that would prevent some patients from receiving liver transplants. "We found significant variation in provider opinions of criteria that are contraindications for liver transplantation, which may be why many centers do not have formal policies for selecting candidates with questionable characteristics," concludes Dr. Levitsky. "Standardized eligibility criteria, supported by evidence-based data of outcomes, are necessary to develop formal policies for selecting controversial candidates for liver transplantation."

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This study is published in Liver Transplantation. Media wishing to receive a PDF of the articles may contact sciencenewsroom@wiley.com.

Full citation: "A National Survey of Provider Opinions on Controversial Characteristics of Liver Transplant Candidates." Katharine Secunda, Elisa J. Gordon, Min W. Sohn, Laura A. Shinkunas, Lauris C. Kaldjian, Michael D. Voigt and Josh Levitsky. Liver Transplantation; (DOI: 10.1002/lt.23581) Print Issue Date: April, 2013.

URL: http://doi.wiley.com/10.1022/lt.23581

Author Contact: Media wishing to speak with Dr. Levitsky may contact Colleen Sheehan with Northwestern Memorial Hospital at csheehan@nmh.org or at +1-312-926-7769.

About the Journal

Liver Transplantation is published by Wiley on behalf of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Since the first application of liver transplantation in a clinical situation was reported more than twenty years ago, there has been a great deal of growth in this field and more is anticipated. As an official publication of the AASLD and the ILTS, Liver Transplantation delivers current, peer-reviewed articles on surgical techniques, clinical investigations and drug research the information necessary to keep abreast of this evolving specialty. For more information, please visit http://wileyonlinelibrary.com/journal/livertransplantation

About Wiley

Wiley is a global provider of content-enabled solutions that improve outcomes in research, education, and professional practice. Our core businesses produce scientific, technical, medical, and scholarly journals, reference works, books, database services, and advertising; professional books, subscription products, certification and training services and online applications; and education content and services including integrated online teaching and learning resources for undergraduate and graduate students and lifelong learners.

Founded in 1807, John Wiley & Sons, Inc. (NYSE: JWa, JWb), has been a valued source of information and understanding for more than 200 years, helping people around the world meet their needs and fulfill their aspirations. Wiley and its acquired companies have published the works of more than 450 Nobel laureates in all categories: Literature, Economics, Physiology or Medicine, Physics, Chemistry, and Peace. Wiley's global headquarters are located in Hoboken, New Jersey, with operations in the U.S., Europe, Asia, Canada, and Australia. The Company's website can be accessed at http://www.wiley.com.



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