Decision-Making about a Deceased Donor Liver “Offer”
For the first 5 questions, we want you to consider the decision-making processes involved when you are called about a potential organ that you would
deem "suitable" for an ambulatory candidate who is listed for liver transplantation.
1. At your primary institution, when a deceased donor liver becomes
available… (Check all that apply)
Transplant
surgeon
Hepatologist
Transplant
coordinator
Other
Who initially contacts the candidate?
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Who makes the offer and discusses the suitability of the donor with the candidate?
2. At your institution, what is the likelihood…
>90 (Always)
>75-90%
(Usually)
>50-75%
(Often)
>25-50%
(Sometimes)
10-25%
(Infrequently)
<10%
(Rarely)
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That the provider who makes the offer has previously
evaluated the candidate personally?
That the candidate's transplant hepatologist is involved in
deciding the suitability of the offer for a particular
candidate?
That the candidate's transplant hepatologist is involved in
discussing the offer with the particular candidate?
3. How often do ambulatory patients refuse organs that your
program believes are suitable for them?
<10%
(Rarely)
10-25%
(Infrequently)
>25-50%
(Sometimes)
>50-75%
(Often)
>75-90%
(Usually)
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4. At your institution, when an ambulatory candidate
refuses a suitable offer, how
frequently are the following actions taken?
>90
(Always)
>75-90%
(Usually)
>50-75%
(Often)
>25-50%
(Sometimes)
10-25%
(Infrequently)
<10%
(Rarely)
The refusal by a competent candidate is
accepted without further discussion.
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There is an attempt to convince the candidate to accept the organ.
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A second colleague is consulted.
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The candidate is recontacted at another time for
further education about transplant, donor, quality, and/or
the desire to remain listed for transplant.
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The candidate is removed from the waitlist.
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>90
(Always)
>75-90%
(Usually)
>50-75%
(Often)
>25-50%
(Sometimes)
10-25%
(Infrequently)
<10%
(Rarely)
Age
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Race
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Gender
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Size (Height)
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Cause of death (cerebrovascular accident [CVA] or other)
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DCD (donation after circulatory death)
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Partial/split liver
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CDC defined high risk, if applicable
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Details regarding histology, if biopsy performed
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Geographic distance between donor site and transplant hospital
(local, regional, national sharing)
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Anticipated cold ischemia time
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5. How frequently do you mention the following
factors about a deceased donor organ to your
candidates?
Liver Donor Risk Index
The liver donor risk index (LDRI) model developed by Feng et al (2006) identifies seven donor factors associated with relative risk of allograft failure.
These factors are: 1) Age; 2) Race; 3) Height; 4) Cause of death (Cerebrovascular Accident [CVA]); 5) Other cause of death 6) DCD (Donation after
Circulatory Death); and 7) Partial/split liver. Feng et al’s model was modified and the final LDRI model also factors in regional and national sharing and
cold ischemia time. 20% of transplants had an LDRI <=1 (1 year survival 87.6%) and 6% of transplant had an LDRI >=2 (1 year survival 71.4%).
6. How familiar are you with the LDRI?
□ Very familiar
7. How do you use the LDRI?
□ Moderately familiar
□ Not familiar at all
Yes Always
Yes Usually
Yes
Sometimes
Yes Rarely
No
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Do you or a member of your team currently discuss the
concept of LDRI to your patients at the time of listing?
Do you or a member of your team currently tell the patient
the specific LDRI of the liver graft that is being offered?
If LDRI were to become a part of a new liver allocation
system, do you think a candidate should be told the specific
LDRI of the liver graft that is being offered?
Other (please specify):
8. In your opinion…
Does LDRI adequately describe the relative risk of a given donor liver?
Are there individual factors for each donor (and recipient) that make
discussing a donor liver LDRI potentially misleading?
Feel free to elaborate:
9. What impact, if any, will providing a
specific LDRI number have on the
following ethical considerations?
□ Somewhat familiar
Yes
No
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Increase/Improve
Decrease/Worsen
No Change
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Patient autonomy
Physician autonomy
Shared decision-making
Candidate refusal of an "offer"
Demographics
Professional
Role
□ Transplant
surgeon
□ Hepatologist
Age
_____________
How would you best describe your practice?
□ Internist
What is your
gender?
□ Academic
Medical Center
Clinical care
How would you describe the percent of your time
spent on each of the following responsibilities?
Research
Teaching
Administration
What is the approximate number of deceased donor
liver transplants done at your center yearly?
__________
□ Nonphysician
transplant professional
□ Female
□ Male
□ Private
Practice
0-24%
□ Other
(please specify):______________________________
□ HMO
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□ Other
(please specify):_____________________________
25-49%
50-74%
75-100%
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What is the approximate number of living donor
liver transplants done at your center yearly?
What percentage of the liver transplants performed
at your institution are outpatients (ambulatory) at
the time of the offer?
□ >90%
Virtually all
□ >75-90%
□ >50-75%
Most
Frequently
□ >25-50
Sometimes
What is the average MELD score at time of
transplantation for ambulatory patients of blood
type O at your institution?
□ <15
□ 15-20
□ 21-25
□ 26-30
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□ 10-25%
□ <10%
Infrequently
Rarely
□ 31-35
□ 36-40