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. 2014 Jul;20(7):831-7.
doi: 10.1002/lt.23879.

Decision making in liver transplantation--limited application of the liver donor risk index

Leslie Mataya  1 , Andrew Aronsohn, J Richard Thistlethwaite Jr, Lainie Friedman Ross
Affiliations

Decision making in liver transplantation--limited application of the liver donor risk index

Leslie Mataya et al. Liver Transpl. 2014 Jul.

Abstract

The liver donor risk index (LDRI), originally developed in 2006 by Feng et al. and since modified, is a method of evaluating liver grafts from deceased donors through the determination of the relative risk of graft failure after transplantation. Online and paper surveys about attitudes and practices regarding decision making in liver transplantation and the role of the LDRI were sent to liver transplant physicians. One hundred forty-seven of 401 eligible respondents (37%) returned partial or complete surveys. The majority of the respondents were male (116/134 or 87%) and practiced in academic medical centers (128/138 or 93%). Transplant coordinators initially contacted the candidate with an offer in 81% of the programs. Eighty-eight of 143 respondents (62%) reported that they were very familiar with the LDRI, but the vast majority (114/137 or 83%) rarely or never discussed the concept of the LDRI with their patients. A majority of the respondents (96/132 or 73%) believed that the LDRI does not adequately describe a liver's relative risk of graft failure and that there are factors making the LDRI potentially misleading (122/138 or 88%). Nevertheless, 60 of 130 respondents (46%) believed that the LDRI would increase/improve shared decision making. The LDRI has not been widely adopted because of concerns that (1) it does not accurately reflect posttransplant survival, (2) it excludes relevant donor and recipient factors, and (3) it is too complicated for candidates to grasp. There is a need to improve it or to develop other decision-making tools to help promote shared decision making. There is also great diversity in how liver offers are made to ambulatory candidates and in how transplant programs address a candidate's refusal. Research is needed to determine evidence-based best practice.

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Figures

Figure 1
Figure 1
LDRI is not currently utilized
Figure 2
Figure 2
Deceased donor liver factors mentioned to candidates
Figure 3
Figure 3
LDRI does not adequately describe relative risk and is potentially misleading
Figure 4
Figure 4
Impact of LDRI on Decision Making
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References

    1. Feng S, Goodrich NP, Bragg-Gresham JL, Dykstra DM, Punch JD, DebRoy MA, et al. Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant. 2006;6:783–90. - PubMed
    1. Akkina SK, Asrani SK, Peng Y, Stock P, Kim WR, Israni AK. Development of organ-specific donor risk indices. Liver Transpl. 2012;18:395–404. - PMC - PubMed
    1. Palmiero HOM, Kajikawa P, Boin IFSF, Coria S, Pereira LA. Liver recipient survival rate before and after model for end-stage liver disease implementation and use of donor risk index. Transplant Proc. 2010;42:4113–5. - PubMed
    1. Asrani SK, Lim Y-S, Therneau TM, Pedersen RA, Heimbach J, Kim WR. Donor race does not predict graft failure after liver transplantation. Gastroenterology. 2010;138:2341–7. - PMC - PubMed
    1. Eckhoff DE, McGuire BM, Young CJ, Sellers MT, Frenette LR, Hudson SL, et al. Race: a critical factor in organ donation, patient referral and selection, and orthotopic liver transplantation? Liver Transpl Surg. 1998;4:499–505. - PubMed

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