Oral+Presentation+Case+3

= Oral Presentation Case 3 =

//There will always be too few organs for the number of those needing them. What criteria should we use to decide who is given priority? For example, should we give a liver transplant to an alcoholic, when there is an equally needy non‐alcoholic also waiting?//

Background
//why is there a selection criteria?// - resources scarce and expensive, demand great, therefore allocation important //selection criteria// - best tissue, age, blood, size compatibility - health and age ( healthier, younger people take precedent as they will derive maximum benefit) - most likely to be compliant with trtment -location (patient's proximity to liver) - mental status (better prognosis if absent of mental illness)

Example
The indications for liver transplantation can be classified into four broad categories: 1. Acute liver failure (fulminant hepatic failure). 2. Chronic liver failure. 3. Metabolic liver disease. 4. Liver cancer. 5. Other metabolic diseases caused by liver based inborn errors of metabolism Unfortunately, there are far more patients who could potentially benefit from liver transplantation than there are donor organs. Thus the process of assessment for transplantation is one of making the most appropriate allocation of a scarce resource. **Based upon the principle that donor livers should be placed according to greatest benefit, it is currently recommended that organs should be allocated to patients who have at least 50% chance of surviving five years post** The assessment process must be objective, fair and equitable. Although prognostic models can predict survival without transplant for a few specific liver diseases, there is no scoring system that has universal applicability. Scoring systems may aid clinical decision-making but should not replace expert clinical judgement. The decision to recommend transplantation should be agreed by the transplant hepatologist and surgeon with input from other members of the multidisciplinary team (MDT). Except in emergencies, such decisions should be made at formal multidisciplinary team meetings. Selection of a particular recipient for an individual donor liver depends upon a number of factors. **Matching for age, size and blood group are important and, other factors being equal, time on the waiting list will then identify the recipient.** However, **the condition of patients on the waiting list and the quality of the donor liver** must also be taken into account. In contrast to a fitter patient, an unstable recipient will not tolerate a sub-optimal donor liver. Patients who deteriorate on the waiting list may be given priority; the decision to prioritise such patients should be a joint decision by clinicians taken at the multidisciplinary team meeting.
 * transplant. ** //There is no absolute age limit for prospective liver transplant candidates, but comorbidity becomes more common with advancing age and limits the prospects for long term survival in the geriatric population.//
 * Patients who deteriorate whilst waiting for a liver transplant may become too sick to stand a reasonable chance of surviving the procedure. All patients should be counselled that, in this situation, they might have to be removed from the waiting list because they are unlikely to survive the operation. ** Patients deemed unsuitable for transplantation should be informed of their right to seek a second opinion from another transplant centre.

Ayumi

Links
Something that I found frm the web....=) (UK National Transplant Standard) maybe useful for ppl who is doing this topic..

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4117855.pdf http://www.nhmrc.gov.au/publications/synopses/_files/e31.pdf