M Tobiasch1, R Golluscio1, K S Umgelter2, A Umgelter3. 1. 2(nd) Medical Department, Technical University of Munich, München, Germany. 2. Department of Anaesthesiology, Technische Universität München, Munich, Germany. 3. 2(nd) Medical Department, Technical University of Munich, München, Germany. Electronic address: andreas.umgelter@tum.de.
Abstract
INTRODUCTION: The sickest-first principle has been pursued in the allocation of donor livers for transplantation with the introduction of algorithms based on the model of end-stage liver disease (MELD) score. In Germany outcomes of liver transplantation appear to be negatively influenced by the transplantation of patients with very high MELD scores and the use of donor organs with lower quality. Therefore, some have claimed, allocation should be based more on outcome-oriented criteria. METHODS: A survey with binary questions (yes/no) regarding the appreciation of values concerning the allocation of donor livers was performed among general medical outpatients of a university hospital. End-stage liver disease patients were excluded. Two hundred four returned forms were analyzed. Percentages of valid answers are given. RESULTS: In this study, 88%, 73%, and 41% of subjects answered they would be willing to undergo transplantation with an estimated outcome of 20%, 50%, and 80% 1-year mortality rate, respectively, for themselves. Choosing a possible recipient between 2 case examples, 68% of valid answers voted for the case with higher age and urgency and lower long-term survival. Seventy percent said urgency was more important than long-term outcome as a criterion for organ allocation. Under the assumption that urgency-based allocation would decrease average long-term survival of liver transplantation, 58% refused to deny even the sickest patients transplantation. Seventy-eight percent said that patients likely to achieve 50% long-term survival should not be denied liver transplantation. CONCLUSION: In our study a majority of subjects prioritize urgency and granting a chance to avert imminent death over long-term survival per procedure. Equitable distribution of chances for survival may be estimated more than outcome maximization in terms of aggregate life-years gained.
INTRODUCTION: The sickest-first principle has been pursued in the allocation of donor livers for transplantation with the introduction of algorithms based on the model of end-stage liver disease (MELD) score. In Germany outcomes of liver transplantation appear to be negatively influenced by the transplantation of patients with very high MELD scores and the use of donor organs with lower quality. Therefore, some have claimed, allocation should be based more on outcome-oriented criteria. METHODS: A survey with binary questions (yes/no) regarding the appreciation of values concerning the allocation of donor livers was performed among general medical outpatients of a university hospital. End-stage liver diseasepatients were excluded. Two hundred four returned forms were analyzed. Percentages of valid answers are given. RESULTS: In this study, 88%, 73%, and 41% of subjects answered they would be willing to undergo transplantation with an estimated outcome of 20%, 50%, and 80% 1-year mortality rate, respectively, for themselves. Choosing a possible recipient between 2 case examples, 68% of valid answers voted for the case with higher age and urgency and lower long-term survival. Seventy percent said urgency was more important than long-term outcome as a criterion for organ allocation. Under the assumption that urgency-based allocation would decrease average long-term survival of liver transplantation, 58% refused to deny even the sickest patients transplantation. Seventy-eight percent said that patients likely to achieve 50% long-term survival should not be denied liver transplantation. CONCLUSION: In our study a majority of subjects prioritize urgency and granting a chance to avert imminent death over long-term survival per procedure. Equitable distribution of chances for survival may be estimated more than outcome maximization in terms of aggregate life-years gained.