October 22, 2012
News Office: Abigail Mortimore (415) 502-6397
Most liver transplant candidates who died or were removed from the transplant list actually received one or more liver donation offers, according to a recent UCSF study.
"What we found challenges the simplistic view that transplant dynamics are driven simply by organ availability," said lead author Dr. Jennifer Lai, assistant clinical professor in the UCSF Division of Gastroenterology and Hepatology. "Efforts to reduce wait-list mortality must target all aspects of mismatch between supply and demand."
Recognized as a world leader in organ transplantation since 1964, the UCSF Organ Transplant Service has performed transplants for more than 10,000 patients and has played a key role in defining the field. The UCSF Liver Transplant Program, designated as a "Center of Excellence" by the U.S. Department of Health and Human Services, performs more liver transplants than any other hospital in Northern California — over 2,300 liver transplants for adults and children since it began in 1988.
For this study, the research team analyzed data from 33,389 candidates listed in the United Network for Organ Sharing (UNOS)/Organ Procurement and Transplantation Network (OPTN) registry during the time frame of Feb. 1, 2005 to Jan. 31, 2010. Out of the candidates who had died or been delisted, 84 percent received one or more liver offers prior to death or delisting, indicating that they had an opportunity to undergo transplantation. Reasons for liver offer refusals were reported as donor quality, donor age or other donor-related factors, size compatibility or recipient readiness.
"Understanding the real-time factors involved in the decisions regarding liver transplant offers is vital to improving the wait-list process," said senior author Dr. John Roberts, chief of the UCSF Division of Transplantation and professor of surgery. "While some of the factors are beyond control, others can be managed."
Simply increasing the availability of deceased donor livers or the number of offers may not necessarily reduce wait-list mortality, according to the study, published in the leading journal in its field, Gastroenterology. Instead, the study suggests that efforts must be made to understand multiple factors involving candidates, donors and transplant centers to help influence what is often a complex and dynamic decision to accept or decline a liver offer.
More specifically, the study recommends that wait-list candidates efficiently complete their pre-transplant evaluations so they are ready for liver offers as soon as possible. Patients with a Model of End-stage Liver Disease (MELD) score of 15 or higher also should be thoroughly educated about the survival benefit of transplantation with any liver graft, as opposed to continued waiting. The MELD is a scoring system for assessing the severity of chronic liver disease and is used by UNOS for prioritizing allocation of liver transplants.
The team also suggests improving efforts within the transplant community to reduce the stigma associated with non-ideal livers and setting realistic expectations for wait-listed candidates regarding the available donor organs.
"The decision to accept a liver offer is not just about minimizing complications after transplant, but about reducing the unpredictability of death before transplant," Lai said.
Dr. Sandy Feng, an organ transplant surgeon, professor of surgery in the UCSF Division of Transplant Surgery, and director of the UCSF Abdominal Transplant Fellowship Program, is a co-author.
About UCSF Medical Center
UCSF Medical Center consistently ranks as one of the top 10 hospitals in the United States. Recognized for innovative treatments, advanced technology, collaboration among health care professionals and scientists, and a highly compassionate patient care team, UCSF Medical Center serves as the academic medical center of the University of California, San Francisco. The medical center's nationally preeminent programs include children's health, the brain and nervous system, organ transplantation, women's health and cancer. It operates as a self-supporting enterprise within UCSF and generates its own revenues to cover the operating costs of providing patient care.
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