How Do We Determine Futility for Patients in Need of Liver Transplantation?

AbstractFutility remains poorly defined in healthcare and entails a large portion of healthcare spending. With limited resources, the field of liver transplantation attempts to minimize cases of futility but struggles to balance the difficulty to provide a life-saving procedure to an increasingly sick patient population as seen with rising Model-for-End-Stage-Liver Disease (MELD) scores. This paper aims to explore the historical context of organ allocation, utilize the medical ethical principles for organ allocation, and review the literature on how to improve transplant outcomes and reduce ‘futile’ cases. In addition, the piece will also delve into the application of palliative care in the management of both listed patients and those who are deemed futile. As transplant centers continue to be challenged with higher expectations and sicker patients, the field needs to develop a con sensus statement on how to define futility and determine what measurements should be used to assess centers’ transplant performance.
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research

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Purpose of review End-stage liver disease (ESLD) is associated with high symptom burden, poor quality of life, and significant healthcare costs. Palliative care, which is not synonymous with hospice or end-of-life care, is a multidisciplinary model of care that focuses on patient-centered goals with the intent of improving quality of life and reducing suffering. This review will summarize current literature supporting the benefits of early integration of palliative care in patients in this population. Recent findings Advance care planning (ACP) and goals of care discussions have been associated with improved quality o...
Source: Current Opinion in Gastroenterology - Category: Gastroenterology Tags: LIVER: Edited by Don C. Rockey Source Type: research
AbstractHepatocellular carcinoma (HCC) as an indication to liver transplant (LT) started as palliative treatment, then moved to potentially curative anti-cancer therapy and more recently entered the era of competition with non-cancer indications, consequent to the need of the society to target equal distribution of the limited resource of donated organs among different indications. Nowadays HCC is a leading indication to LT, currently representing up to 50% of the indications in most transplant Centers. The risk of post-transplant death and the causes of mortality significantly vary along the post-transplant follow-up. Ove...
Source: Digestive Diseases and Sciences - Category: Gastroenterology Source Type: research
This article reviews the lights and shadows of AFP as a surveillance test for patients at risk of HCC, and as a diagnostic test for those with chronic liver disease and a suspected hepatic mass. Moreover, the article scrutinizes the large body of evidence supporting the prognostic relevance of AFP in patients undergoing both curative and palliative treatment of HCC and the growing importance attributed to this biomarker (as a static or a dynamic variable) in the selection of potential candidates for liver transplantation. In fact, the inclusion of AFP among transplant criteria would improve the ability of identifying poor ...
Source: Seminars in Liver Disease - Category: Gastroenterology Authors: Tags: Review Article Source Type: research
Alcohol-associated cirrhosis (AC) contributes up to 50% of the overall cirrhosis burden in the United States. AC is typically a comorbid condition in association with alcohol-use disorder. AC is often coexistent with other conditions. Several noninvasive methods are available to assist in recognizing the presence of AC. The natural history of AC is governed by the patients continued drinking or abstinence. All treatment starts with abstinence. After decompensation, the progression to acute-on-chronic liver failure heralds death. When patients who have deteriorated are declined liver transplant, palliative care should be considered.
Source: Clinics in Liver Disease - Category: Gastroenterology Authors: Source Type: research
Semin Liver Dis 2018; 38: 351-356 DOI: 10.1055/s-0038-1669936Neuroendocrine tumors are slow-growing tumors and associated with prolonged overall survival even in the presence of untreated liver metastases. The presence of liver metastases may be responsible for severe symptoms with impairment of quality of life. Liver resection has been proposed to achieve better symptom control and/or improve overall survival, but this concerns less than 20% of patients with liver metastases. In addition, the chance to be really cured after liver resection is around 40%, which prompts consideration of liver transplantation as the only pot...
Source: Seminars in Liver Disease - Category: Gastroenterology Authors: Tags: Review Article Source Type: research
DiscussionLTADs could potentially improve end-of-life care in patients with refractory ascites due to ESLD by improving symptom control, reducing hospital visits and enabling some self-management. Our trial is designed to see if such patients can be recruited, as well as to inform the design of a subsequent definitive trial.Trial registrationISRCTN,ISRCTN30697116. Registered on 7 October 2015.
Source: Trials - Category: Research Source Type: clinical trials
Abstract OBJECTIVE: Structured, empirically supported psychological interventions are lacking for patients who require organ transplantation. This stage IA psychotherapy development project developed and tested the feasibility, acceptability, tolerability, and preliminary efficacy of an 8-week group cognitive behavioral stress management intervention adapted for patients with end-stage liver disease awaiting liver transplantation. METHOD: Twenty-nine English-speaking United Network for Organ Sharing-registered patients with end-stage liver disease from a single transplantation center enrolled in 8-week, group...
Source: Palliative and Supportive Care - Category: Palliative Care Authors: Tags: Palliat Support Care Source Type: research
Liver Transplantation,Volume 0, Issue ja, -Not available-.
Source: Liver Transplantation - Category: Transplant Surgery Authors: Source Type: research
Of the 400,000 patients with end-stage liver disease (ESLD) in the United States, only about 2% are transplanted; the remainder will die from the disease. However, despite high symptom burden and advanced care planning needs, only 10% of ESLD patients deactivated from the transplant list are referred to palliative care. There is a paucity of high quality data and standardization in use of palliative care in ESLD compared to other forms of end-stage organ dysfunction (e.g., heart failure, chronic obstructive pulmonary disease).
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Source Type: research
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Source: Liver International - Category: Gastroenterology Authors: Tags: Reviews Source Type: research
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