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Liver transplantation candidates want to be involved in decisionsregarding quality of the donor organ, and many are reluctant toaccept organs with a higher risk of failure, according to researchby U-M physicians and experts. More than 42 percent of patients would choose to remain on thewaiting list rather than accept a "lower quality" liver accordingto the study's lead author Michael L. Volk, M.D., M.S., assistantprofessor in U-M's Department of Internal Medicine, Division ofGastroenterology. Research from Volk and his colleagues will appear in the Decemberissue of Liver Transplantation, a journal published byWiley-Blackwell on behalf of the American Association for the Studyof Liver Diseases. As of November 30, the Organ Procurement and TransplantationNetwork (OPTN) reports that 16,124 candidates are on the waitinglist to receive a liver, with only 5,375 deceased donor organsrecovered through August. Additionally, there is a large variationin quality of deceased donor livers, which is based on donorcharacteristics such as age, cause of death, and ischemia time.Previous research has shown that donor characteristics can make thedifference between a 20 to 40 percent risk of graft failure bythree years following transplantation. "Organ quality is an important issue for all liver transplantcandidates, increasingly so, given the aging donor pool and morefrequent use of organs that carry a higher risk of failure," saysVolk, who is a hepatology specialist. "The decision to accept or pass on an organ could mean thedifference between life and death for patients with end-stage liverdisease. Communication of the risks versus benefits of accepting a'lower quality' organ is critical, and understanding patient viewson the subject is essential for physicians caring for transplantcandidates." For the current study, researchers tested presentation formats forcommunicating organ quality risks to patients, and factors thatmight influence patients' willingness to accept higher-risk organs.First, the team conducted interviews with ten patients on thewaiting list for liver transplantation to determine their knowledgeof organ quality and preferences for accepting organs with greaterrisk of failure. Based on qualitative information obtained frominterviews, the team created a web-based survey which 95 candidatescompleted. The findings show that patients are reluctant to accept higher-riskorgans. Of those completing the survey, 58 percent would onlyaccept organs with a 25 percent (or less) risk of graft failure and18 percent would only accept the lowest possible risk of 19 percentat three years following transplantation. Women were slightly more accepting of high-risk organs than men.Researchers found that risk tolerance was increased by presentingorgan quality as "average quality" rather than "best quality," andby providing feedback about the implications of these preferenceson the likelihood of receiving a transplant. Additionally, 83percent of candidates were found to prefer an equal or dominantrole in deciding whether to accept a higher-risk organ. Thisfinding is striking given that, in most transplant centers, patientinvolvement in these decisions is minimal. "Up until now, it has not been clear how much patients want to beinvolved in this complicated decision," says Volk. "Furthermore, explaining the intricacies of this topic to sickpatients is easier said than done. Our findings offer transplantphysicians some useful guidelines for how to council transplantcandidates on issues of organ quality." The authors suggest future studies are needed to develop validatedpatient education tools that will enhance discussions betweenphysicians and patients in need of liver transplantations. Additional authors: All from U-M: Rachel S. Tocco, researchspecialist in the Department of Physical Medicine andRehabilitation; Shawn J. Pelletier, M.D., associate professor ofSurgery; Brian J. Zikmund-Fisher, Ph.D., research assistantprofessor in Department of Internal Medicine and assistantprofessor of Health Behavior and Education in the School of PublicHealth; and Anna S. Lok, M.D., F.R.C.P., Alice Lohrman AndrewsResearch Professor in Liver Disease and professor in the Departmentof Internal Medicine. Additional References Citations. We are high quality suppliers, our products such as iPad Flex Cable , China iPod Flex Cable for oversee buyer. To know more, please visits iPhone Replacement Housing.
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