I came across this article which you might like read: http://www.bradenton.com/2011/12/01/3694642/transplant-candidates-seek-best.html.  It describes a study that reached the conclusion that: “Liver transplantation candidates want to be involved in decisions regarding  quality of the donor organ, and many are reluctant to accept organs with a  higher risk of failure, according to research by U-M (University of Michigan) physicians and experts.”

Well, when I first read this my somewhat sarcastic side immediately responded: Duh.  Who would want to receive an organ that was not the best possible.  Then my responsible self took over.  The concept of “best possible” does indeed have to factor in, depending on how sick sick you might be getting.

But there are a couple of comments found that I think are very important.  The first is that patients in the past have had very little discussion regarding the quality of the donated organ found for them.  Should they have more of a say?  It’s their life, their risk.  Or do they put their full trust in their team knowing that they will do the very best to do the very best.  As I’ve stated before here, I am a firm believer that the patient and family need to be a fully informed part of their team. What do you think?

My second comment is that I am willing to bet that any one living on a organ transplant waiting list, if given a choice, would not choose a sub-optimal organ for themselves.  It’s just not about livers.

All this again points to the fundamental problem – as the waiting lists continues to grow, the number of viable organs available simply does not meet the need.  That’s why I cheer any organ donation awareness efforts and find hope in the developing technology that maybe can make those less than grade A organs better.

Your thoughts?

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About the author

Dave Gerber
In May of 2010 I received a liver transplant. This was after 30 years of helping people with making very similiar and difficult decisions as to both receiving and donating an organ for transplantation. My experiences on both sides of the issue gives me a rather unique perspective and the personal and professional wisdom to help YOU AND YOUR FAMILY face this challenging, but hopeful journey.

4 Comments for Here’s a Shock: Liver Transplant Patients Prefer the Best Quality Organ

Luis

Dear Dave: As you say, in the past, the patient have had very little discussion regarding the quality of the donated organ found for them. The reason was that the teams involved in procurement & transplantation always choose the optimal organs!. With larger expertise and the dramatical growing in waiting list, we expanded the criteria for organ donation for “suboptimal” organs.
In this point, I agree the patient and family need to be a fully informed part of their team. However, I think the selection must be done previosly. I mean: The medical team has to discuss the posibility the patient will recieve an organ for a marginal donnor and make a separate list with whom will agree to receive that kind of organs. It might be a previous discution because, when the organ appears, nor the patient, either the family, is always enough clear to make such a decision.
Of course, if you give a choise betwen an optimal or suboptimal organ, patients would not choose a sub-optimal organ for themselves. But you have to think that the real choise is betwen Tx. vs. NO Tx.
Best regards

Luis

Reply

Dave Gerber

Luis, thanks for your thoughts. You are quite right in terms of the evolution of the process. It was kind of strange in my case – I had over two decades of working on the hospital donation side with our local OPO. When I found myself on the other side of the coin, but with the same folks, I did not even give a thought to the quality of liver that would come my way. Part of that was that I knew so very well how diligent these people were with their screening process. And, to be quite honest, as you again point out I don’t know if I would have been able to make a decision when my it was my turn. I think the point is that these issues need to be presented as part of the tx. discussion. Thanks for adding to ours!

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Neal Beswick

Hi Dave,

Your thoughts on this are timely as there is a significant trend in new technology to better preserve and recondition organs exvivo (outside the donor) so evaluation of organ quality may improve significantly. However, i certainly agree that this conversation needs to happen well in advance of an offer and more information about the organ could make the discussion with patients more complicated for physicians. As you state the severity of the disease changes the tolerance for risk for both physician and patient.

Best Regards

Neal

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Dave Gerber

Neal, we really appreciate your thoughts and hope to hear more from you!

All the Best!

Dave

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