The Influence of Psychosocial Evaluation on Candidacy for Liver Transplantation

Author:

Flamme Nancy E.1,Terry Colin L.1,Helft Paul R.1

Affiliation:

1. Charles Warren Fairbanks Center for Medical Ethics (NEF, PRH), Clarian Health Partners, Inc (NEF, CLT, PRH), Indiana University School of Medicine and Center for Bioethics (PRH), Methodist Research Institute (CLT, PRH), Indianapolis, Indiana

Abstract

Context Although medical factors clearly dominate the evaluation of appropriateness for liver transplant, psychosocial factors are an important dimension in the evaluation process. Objective To understand more about the weight assigned to psychosocial factors in the decision to list patients for liver transplant and about whether such differences create hidden inequities in the transplant allocation system. Design We conducted a mail survey of liver transplant surgeons and psychosocial evaluators at busy transplant centers assessing the importance these professionals assigned to psychosocial factors in evaluations for liver transplant candidacy. Participants Liver transplant surgeons and psychosocial evaluators from the highest volume liver transplant centers in the United States. Intervention Mail survey Results Psychosocial evaluators assigned greater importance to availability of transportation, adaptation to stress, and coping skills than did surgeons. Transplant psychosocial evaluators were less likely than transplant surgeons to recommend that a patient with a history of poor social support be listed for liver transplant. We found no correlation between relative weight assigned to psychosocial factors and median wait times at transplant centers. These differences suggest that the relationship between the factors identified by psychosocial evaluators as important and transplant outcomes should be studied. Overall, more research into the predictive and ethical aspects of psychosocial evaluation for liver transplant is needed.

Publisher

SAGE Publications

Subject

Transplantation

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