Removing patients from the liver transplant wait list: A survey of US liver transplant programs

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Original Articles

Removing patients from the liver transplant wait list: A survey of US liver transplant programs

P. Charpentier 1 *, Arun Mavanur 2

1Rhode Island Hospital, Department of Surgery, Division of Transplant Surgery, Providence, RI2Hartford Hospital, Department of Surgery, Division of General Surgery, Hartford, CT

email: P. Charpentier (kcharpentier@...)

*Correspondence to P. Charpentier, Rhode Island Hospital, 593 Eddy Street, APC 921, Providence, RI 02903Telephone: ; FAX:

Abstract

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. A survey with 14 scenarios was sent 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. 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. Two hundred four questionnaires were mailed with 47 responses (23%): 8 return to sender, 24 surgeons, and 15 hepatologists. All 11 United Network for Organ Sharing regions were represented. The responders were well distributed among university programs (n = 28), private practice programs (n = 10), and health maintenance organization programs (n = 1). Nine responses were from small-volume programs (25 transplants), 12 were from medium-volume programs (26-50 transplants), and 18 were from large-volume programs (51 transplants). There was wide variability between responders regarding which patients should be removed from the transplant wait list. Patient age and etiology of liver disease led to the greatest discordance among responders. In conclusion, 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. Liver Transpl 14:303-307, 2008. © 2008 AASLD.

Received: 1 May 2007; Accepted: 20 August 2007

Digital Object Identifier (DOI)

10.1002/lt.21353

Liver Transplantation

Volume 14, Issue 3 , Pages 303 - 307

Published Online: 27 Feb 2008

Copyright © 2008 American Association for the Study of Liver Diseases