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Revise General Considerations In Assessment for Transplant Candidacy

eye iconAt a glance

Background

The Ethics Committee first published this white paper in 1998 and revised it in 2015. The Committee decided to revisit the paper again in order to update some sections and add new information.

Transplant programs develop their own polices and criteria for determining if a patient should be added to the waiting list. This white paper addresses ethical considerations about the use of non-medical criteria when evaluating a potential transplant candidate.

Supporting media

Presentation

View presentation slides

Ethical considerations

  • The criteria discussed in this white paper were selected because they are not directly part of a medical evaluation for transplant candidacy, but are important enough to warrant consideration. The ethical considerations of the following criteria are discussed in this white paper and can help transplant programs with their listing decisions:
    • Life Expectancy
    • Potentially Injurious Behavior
    • Adherence
    • Repeat Transplantation
    • Incarceration Status
    • Immigration Status
    • Social Support

Anticipated impact

  • This white paper is not policy that transplant programs must use when evaluating potential transplant candidates. Instead, the white paper can be used as a resource for transplant programs to consider as part of their potential transplant candidate evaluations.

Terms to know

  • Utility: is an ethical principle used in the analysis of the white paper looking at what has the greatest benefit for the entire community.
  • Justice: another ethical principle used in the analysis of the white paper which considers the fair pattern of distribution of benefits.
  • Respect for Persons: the third ethical principle used in the analysis of the white paper meaning the respect of a person’s right to make an informed decision on their own without outside pressure.
  • Click here to search the OPTN glossary

eye iconComments

Anonymous | 01/25/2021

As a recipient family, I'm strongly in support of these revisions. In particular, the social support revision. It can be a struggle to show traditionally-expected social support in lower income families. The recognition that this shouldn't factor into consideration for candidacy is greatly appreciated. My only wish is that this was published sooner, as that was something my family struggled with.

Renee Bacote | 01/31/2021

I would ask that Primary Billiary Cirrhosis (PBC) be included as well. THANK YOU!!! This will help thousands of people living with PSC who are in need of a transplant.

Region 4 | 02/04/2021

Region 4 sentiment: 2 strongly support; 14 support; 2 neutral/abstain; 1 oppose; 0 strongly oppose. During the meeting there were comments voiced during the discussion, submitted online and submitted as comments from the OPTN representatives. Overall, there was general agreement and support for this proposal. One attendee suggested that the committee include considerations for the practice of liver transplantation for alcoholic hepatitis patients. Another attendee commented that the proposal does not address pediatric patients or patients with disabilities and suggested reviewing the AAP April 2020 recommendations.

Region 3 | 02/18/2021

Region 3 sentiment: Strongly Support-2, Support-13, Neutral/abstain - 6, Oppose -0, Strongly Oppose - 1. During the meeting there were comments voiced during the discussion, submitted online and submitted as comments from the OPTN representatives. A member voiced support for a more standardized process that does not rely on the subjective decisions of individual transplant programs. He also supported the use of feedback measures. Another member recommended that once a candidate is listed, the new factors being considered factor into a "handicap score" to level the playing field compared to those without adverse psychosocial factors. An attendee suggested that objective metrics such as zip code data or census track data be considered and also commented that data relates to incarceration and immigration status would be a small subset of the waitlist. Another member commented that as well as access to transplant, social, financial and legal aspects should also be considered. They suggested that an algorithm that identified patients early as candidates as candidates for transplant would be helpful.

Region 5 | 02/19/2021

Region 5 sentiment: 7 strongly support, 24 support, 10 neutral/abstain, 0 oppose, 0 strongly oppose. During the meeting there were comments voiced during the discussion, submitted online and submitted as comments from the OPTN representatives. Overall, there was general agreement and support for this proposal. One member asked if ethics committee discussed the tension between what is appropriate for the patient versus the system? For example, a transplant for a patient with limited life expectancy but who can still benefit from quality of life considerations. Another member commented that there is an inordinate amount of time is spent discussing social support. The ethics representative agreed there is a lot of time and resources are spent on those discussions and it is an important consideration but one that ought not to exclude people from access to life saving treatment.

ANNA | 02/25/2021

ANNA supports this proposal.

Elizabeth Hathaway | 02/26/2021

A patient should not have to be on death's door to be a candidate for liver transplant. This needs to be reviewed and modified.