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ADULT LIVER TRANSPLANT SURVEY: POLICIES TOWARDS ELIGIBILITY CRITERIA IN CANADA AND THE UNITED STATES IN 2007
KI Kroeker1, VG Bain1, T Shaw-Stiffel2, T Fong3, EM Yoshida4
1University of Alberta, Edmonton, Alberta; 2University of Ottawa, Ottawa, Ontario; 3USC, Los Angeles, CA; 4UBC, Vancouver, British Columbia
AIM: To assess the current practice patterns of liver transplant centers in Canada and the United States regarding transplant eligibility.
METHODS: A four-page questionnaire was developed and mailed to select liver transplant program directors in Canada and the United States.
RESULTS: One-third of centers responded, including all Canadian centers and representation from centers in 7/11 UNOS geographic regions. This study demonstrates that there is consensus in the use of some eligibility criteria including non-compliance, social status, abstinence from alcohol, and methadone and cocaine use. Three-quarters of respondents indicated they would not assess patients requiring re-transplantation due to non-compliance. Lack of social support was deemed to be either an absolute or relative contraindication by 62.5% and 37.5% of centers, respectively. Six months of abstinence and successful alcohol counselling is required by 94% of centers in patients with alcoholic liver disease. Seventy-five percent of centers indicated that recipients could continue with supervised methadone use. Cocaine was considered to be a contraindication to transplantation by 94% respondents. Interestingly, literature is lacking to support the use of these parameters as eligibility criteria with the exception of alcohol. There is a lack in consensus between US and Canadian centers regarding marijuana use, HIV status, ability to accept blood transfusions, and prisoner status as eligibility criteria in the setting of liver transplantation. Marijuana use is considered to be a contraindication by 70% of US centers but only 1/3 of Canadian centers. Half of US centers and 2/3 of Canadian centers indicated that would consider patients with HIV for liver transplantation. Thirty percent of US centers and 83% Canadian centers indicated they would consider patients who are unable to accept blood transfusions. While the literature is limited in regards to most of these parameters, there is evidence to suggest that liver transplantation in select patients who refuse blood transfusions results in good outcomes.
CONCLUSION: Important decisions regarding transplant eligibility still have to be made empirically in the absence of scientific literature about various social issues. While consensus is useful, it is important that we continue to use the evidence in the literature to revise these eligibility criteria, keeping in mind ethical principles applied to access and allocation of a scarce resource.