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Access to adult liver transplantation in Canada: a survey and ethical analysis.

https://arctichealth.org/en/permalink/ahliterature212821
Source
CMAJ. 1996 Feb 1;154(3):337-42
Publication Type
Article
Date
Feb-1-1996
Author
M A Mullen
N. Kohut
M. Sam
L. Blendis
P A Singer
Author Affiliation
University of Toronto Joint Centre for Bioethics, Ont.
Source
CMAJ. 1996 Feb 1;154(3):337-42
Date
Feb-1-1996
Language
English
Publication Type
Article
Keywords
Adult
Canada
Data Collection
Health Care Rationing - organization & administration
Health Services Accessibility - organization & administration
Humans
Liver Transplantation
Organizational Policy
Patient Selection
Resource Allocation
Waiting Lists
Abstract
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.
Mailed survey.
Medical directors of all seven Canadian adult liver transplantation centres, or their designates. Six of the questionnaires were completed.
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.
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.
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.
Notes
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PubMed ID
8564903 View in PubMed
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Advance directives in family practice.

https://arctichealth.org/en/permalink/ahliterature221091
Source
Can Fam Physician. 1993 May;39:1087-93
Publication Type
Article
Date
May-1993
Author
N. Kohut
P A Singer
Author Affiliation
Centre for Bioethics, University of Toronto.
Source
Can Fam Physician. 1993 May;39:1087-93
Date
May-1993
Language
English
Publication Type
Article
Keywords
Advance Directives - legislation & jurisprudence
Attitude of Health Personnel
Attitude to Health
Canada
Communication
Decision Making
Family Practice - methods
Government Regulation
Humans
Internationality
Judicial Role
Patient Education as Topic - methods
Physician's Role
Abstract
Family physicians can play an important role in helping patients and their families to discuss life-sustaining treatments and to complete advance directives. This article reviews the legal status of, and empirical studies on, advance directives and addresses some important clinical questions about their use relevant to family practice.
Notes
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PubMed ID
8499789 View in PubMed
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Stability of treatment preferences: although most preferences do not change, most people change some of their preferences.

https://arctichealth.org/en/permalink/ahliterature208004
Source
J Clin Ethics. 1997;8(2):124-35
Publication Type
Article
Date
1997