How Should We Prioritize Patients Waiting For Liver Transplants

July 17, 1998

(Assessing priorities for allocation of donor liver grafts: survey of public and clinicians)

The number of patients who could benefit from a liver transplant is far greater than the number of donor livers available. This means that criteria, other than medical, need to be developed to allocate donor livers to potential recipients. In this week's BMJ, Dr James Neuberger et al from the Queen Elizabeth Hospital in Birmingham, asked members of the public, family doctors and hospital based gastroenterologists to select four of eight possible recipients, as part of a hypothetical exercise.

The authors found that there were considerable differences between the choices of the three groups: the public tended to use emotive criteria rather than medical benefit and those with possible "antisocial" behaviour (such as a former drug misuser, an alcoholic and a serving prisoner) were given lowest priority.

Based on their findings the authors conclude that when rationing limited resources, such as donor livers, doctors must work with other health professionals and the public to agree priorities that are both open and equitable.


Dr James Neuberger, Consultant Physician, Liver Unit, Queen Elizabeth Hospital, Birmingham


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