Transplant candidates seek 'best quality' livers despite having to remain on waiting list
New research reveals that liver transplantation candidates want to be involved in decisions regarding quality of the donor organ, and many are reluctant to accept organs with a higher risk of failure. In fact, more than 42% of patients would choose to remain on the waiting list rather than accept a "lower quality" liver according to the study appearing in the December issue of Liver Transplantation, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases.
As of November 30, 2011, the Organ Procurement and Transplantation Network (OPTN) reports that 16,124 candidates are on the waiting list to receive a liver, with only 5,375 deceased donor organs recovered through August. Additionally, there is a large variation in quality of deceased donor livers, which is based on donor characteristics such as age, cause of death, and ischemia time. Previous research has shown that donor characteristics can make the difference between a 20% to 40% risk of graft failure by 3 years following transplantation.
"Organ quality is an important issue for all liver transplant candidates, increasingly so, given the aging donor pool and more frequent use of organs that carry a higher risk of failure," explains Dr. Michael Volk with the University of Michigan Health System in Ann Arbor. "The decision to accept or pass on an organ could mean the difference between life and death for patients with end-stage liver disease. Communication of the risks versus benefits of accepting a "lower quality" organ is critical, and understanding patient views on the subject is essential for physicians caring for transplant candidates."
For the current study, researchers tested presentation formats for communicating organ quality risks to patients, and factors that might influence patients' willingness to accept higher risk organs. First, the team conducted interviews with ten patients on the waiting list for liver transplantation to determine their knowledge of organ quality and preferences for accepting organs with greater risk of failure. Based on qualitative information obtained from interviews, the team created a web-based survey which 95 candidates completed.
The findings show that patients are reluctant to accept higher risk organs, wanting only the "best" organ. Of those completing the survey, 58% would only accept organs with a 25% (or less) risk of graft failure and 18% would only accept the lowest possible risk of 19% at 3 years following transplantation. Women were slightly more accepting of high risk organs than men. Researchers found that risk tolerance was increased by presenting organ quality as "average quality" rather than "best quality," and by providing feedback about the implications of these preferences on the likelihood of receiving a transplant. Additionally, 83% of candidates were found to prefer an equal or dominant role in deciding whether to accept a higher risk organ. This finding is striking given that, in most transplant centers, patient involvement in these decisions is minimal.
"Up until now, it has not been clear how much patients want to be involved in this complicated decision," says Dr. Volk. "Furthermore, explaining the intricacies of this topic to sick patients is easier said than done. Our findings offer transplant physicians some useful guidelines for how to council transplant candidates on issues of organ quality." The authors suggest future studies are needed to develop validated patient education tools that will enhance discussions between physicians and patients in need of liver transplantations.
More information: "Patient Decision Making about Organ Quality in Liver Transplantation." Michael L. Volk, Rachel S. Tocco, Shawn J. Pelletier, Brian J. Zikmund-Fisher and Anna S. F. Lok. Liver Transplantation; November 29, 2011. DOI: 10.1002/lt.22437
Provided by Wiley
- Most kidney transplant candidates will accept risk of infection Mar 25, 2010 | not rated yet | 0
- High-risk donor livers used with greater frequency in transplantations Sep 28, 2011 | not rated yet | 0
- Changes to distribution of livers for transplant proposed Sep 09, 2011 | not rated yet | 0
- Living donor liver transplantation improves survival over deceased donor transplants Sep 27, 2011 | not rated yet | 0
- HIV-infected donors present novel source of organs for HIV-infected transplant candidates May 23, 2011 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
High blood glucose is associated with poor outcomes in hospitalized patients, and use of intensive insulin therapy (IIT) to control hyperglycemia is a common practice in hospitals. But the recent evidence does not show a ...
Other 11 hours ago | not rated yet | 0
Two out of five medical students have an unconscious bias against obese people, according to a new study by researchers at Wake Forest Baptist Medical Center. The study is published online ahead of print in the Journal of ...
Other 17 hours ago | not rated yet | 0
Nanyang Technological University's (NTU) new medical school will be pioneering the use of plastinated bodies for medical education in Singapore.
Other May 23, 2013 | not rated yet | 0
A 2012 survey of internal medicine residents at Massachusetts General Hospital (MGH) – one of the nation's leading teaching hospitals – found that more than half rated the training they had received in addiction and other ...
Other May 22, 2013 | 5 / 5 (1) | 0
Early use of tracheostomy for mechanically ventilated patients not associated with improved survival
For critically ill patients receiving mechanical ventilation, early tracheostomy (within the first 4 days after admission) was not associated with an improvement in the risk of death within 30 days compared to patients who ...
Other May 21, 2013 | not rated yet | 0
Biological processes are generally based on events at the molecular and cellular level. To understand what happens in the course of infections, diseases or normal bodily functions, scientists would need to ...
20 minutes ago | not rated yet | 0 |
The news about youth and diabetes keeps getting worse. The latest data from the national TODAY diabetes study shows that children who develop Type 2 diabetes are at high risk to develop heart, kidney and eye problems faster ...
18 minutes ago | not rated yet | 0
In Parkinson's disease, the protein "alpha-synuclein" aggregates and accumulates within neurons. Specific areas of the brain become progressively affected as the disease develops and advances. The mechanism underlying this ...
17 minutes ago | not rated yet | 0
After studying noise in one French Quarter neighborhood of New Orleans to determine whether or not noise levels exceeded municipal ordinances, Annette Hurley, PhD, Assistant Professor of Audiology at LSU Health Sciences Center ...
6 minutes ago | not rated yet | 0
Transcatheter aortic valve implantation (TAVI) is effective and safe in Asian patients, according to early experience based on first results from a multicentre Asian registry reported at EuroPCR 2013.
15 minutes ago | not rated yet | 0
Young children who missed more than half of recommended well-child visits had up to twice the risk of hospitalization compared to children who attended most of their visits, according to a study published today in the American Jo ...
20 minutes ago | not rated yet | 0