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.
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.
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.
Cites: CMAJ. 1992 Jun 1;146(11):1937-441596842
Cites: J Am Geriatr Soc. 1992 Mar;40(3):269-731538048
Cites: Am J Med. 1989 Jun;86(6):645-811659207
Cites: N Engl J Med. 1984 Apr 26;310(17):1115-66708993
Cites: N Engl J Med. 1986 Feb 13;314(7):457-603945276
Cites: J Gen Intern Med. 1986 Nov-Dec;1(6):373-93794836
Cites: Wis Med J. 1986 Oct;85(10):17-233798951
Cites: J Gen Intern Med. 1988 Jul-Aug;3(4):317-213404292
Cites: J Gen Intern Med. 1988 Jul-Aug;3(4):322-53042932
Cites: J Am Geriatr Soc. 1988 Sep;36(9):840-43411069
Cites: JAMA. 1989 Jun 9;261(22):3288-932636851
Cites: West J Med. 1989 Jun;150(6):705-72750162
Cites: JAMA. 1989 Nov 3;262(17):2415-92795827
Cites: N Engl J Med. 1991 Mar 28;324(13):889-952000111
Cites: N Engl J Med. 1991 Apr 25;324(17):1210-32011167
Cites: Adv Intern Med. 1991;36:57-792024588
Cites: J Am Geriatr Soc. 1993 Feb;41(2):112-68426030