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1996-03-09
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Document 0231
DOCN M9650231
TI Access to adult liver transplantation in Canada: a survey and ethical
analysis.
DT 9605
AU Mullen MA; Kohut N; Sam M; Blendis L; Singer PA; University of Toronto
Joint Centre for Bioethics, Ont.
SO Can Med Assoc J. 1996 Feb 1;154(3):337-42. Unique Identifier : AIDSLINE
MED/96164731
AB OBJECTIVES: To describe the substantive and procedural criteria used for
placing patients on the waiting list for liver transplantation and for
allocating available livers to patients on the waiting list; to identify
principal decision-makers and the main factors limiting liver
transplantation in Canada; and to examine how closely cadaveric liver
allocation resembles theoretic models of source allocation. DESIGN:
Mailed survey. PARTICIPANTS: Medical directors of all seven Canadian
adult liver transplantation centres, or their designates. Six of the
questionnaires were completed. OUTCOME MEASURES: Relative importance of
substantive and procedural criteria used to place patients in the
waiting list for liver transplantation and to allocate available livers.
Identification of principal decision-makers and main limiting factors to
adult liver transplantation. RESULTS: Alcoholism, drug addiction, HIV
positivity, primary liver cancer, noncompliance and hepatitis B were the
most important criteria that had a negative influence on decisions to
place patients on the waiting list for liver transplantation. Severity
of disease and urgency were the most important criteria used for
selecting patients on the waiting list for transplantation. Criteria
that were inconsistent across the centres included social support (for
deciding who is placed on the waiting list) and length of time on the
waiting list (for deciding who is selected from the list). Although a
variety of people were reported as being involved in these decisions,
virtually all were reported to be health to be health care
professionals. Thirty-seven patients died while waiting for liver
transplantation in 1991; the scarcity of cadaveric livers was the main
limiting factor. CONCLUSIONS: Criteria for resource allocation decisions
regarding liver transplantation are generally consistent among the
centres across Canada, although some important inconsistencies remain.
Because patients die while on the waiting list and because the primary
limiting factor is organ supply, increased organ acquisition efforts are
needed.
DE Adult Canada Data Collection Health Care Rationing/*ORGANIZATION &
ADMIN Health Services Accessibility/ORGANIZATION & ADMIN Human *Liver
Transplantation Organizational Policy Support, Non-U.S. Gov't
*Waiting Lists JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).