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).