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. 2013 Sep;19(9):987-90.
doi: 10.1002/lt.23683. Epub 2013 Aug 13.

Systematic bias in surgeons' predictions of the donor-specific risk of liver transplant graft failure

Michael L Volk  1 , Meghan Roney, Robert M Merion
Affiliations

Systematic bias in surgeons' predictions of the donor-specific risk of liver transplant graft failure

Michael L Volk et al. Liver Transpl. 2013 Sep.

Abstract

The decision to accept or decline a liver allograft for a patient on the transplant waiting list is complex. We hypothesized that surgeons are not accurate at predicting donor-specific risks. Surgeon members of the American Society of Transplant Surgeons were invited to complete a survey in which they predicted the 3-year risk of graft failure for a 53-year-old man with alcoholic cirrhosis and a Model for End-Stage Liver Disease score of 21 with a liver from (1) a 30-year-old local donor with traumatic brain death or (2) a 64-year-old regional donor with brain death from a stroke. Complete responses were obtained from 201 surgeons, whose self-reported case volume represents the majority of liver transplants in the United States. The surgeon-predicted 3-year risk of graft failure varied widely (more than 10-fold). In scenario 1, 90% of the respondents provided lower estimates of the graft failure risk than the literature-derived estimate of 21% (P < 0.001). In scenario 2, 96% of the responses were lower than the literature-derived estimate of 40% (P < 0.001). In conclusion, transplant surgeons vary widely in their predictions of the donor-specific risk of graft failure, and they demonstrate a systematic bias toward inaccurately low estimates of graft failure, particularly for higher risk organs.

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Conflict of interest statement

The authors have no relevant conflicts of interest.

Figures

Figure 1
Figure 1. Surgeon predictions of 3-year risk of death or graft failure, with overlaid normal distribution curves, for a) 30 year-old local donor, and b) 64 year-old regional donor
Figure 1
Figure 1. Surgeon predictions of 3-year risk of death or graft failure, with overlaid normal distribution curves, for a) 30 year-old local donor, and b) 64 year-old regional donor
Figure 2
Figure 2
Surgeons' opinions regarding importance of visual inspection in deciding whether to accept liver allografts.
See this image and copyright information in PMC

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