Editorials

Psychosocial factors in selection for liver transplantation

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7230.263 (Published 29 January 2000) Cite this as: BMJ 2000;320:263

Need to be explicitly assessed and managed

  1. George Masterton, consultant psychiatrist
  1. Department of Psychological Medicine, Royal Infirmary of Edinburgh, Edinburgh EH3 9YW

    The findings of an opinion poll commissioned to examine liver transplant selection preferences among the general public, general practitioners, and gastroenterologists were published in the BMJ last year.1 Vignettes of eight potential candidates were given; four livers were available. The constituencies agreed the bottom of the pecking order—a prisoner, preceded by a man with alcoholic liver disease—but if only two candidates were to be chosen, those selected by the specialists (a teenager with an impulsive paracetamol overdose and a woman who had acquired viral hepatitis through drug abuse 20 years before) differed from the public's choices (a baby and a pregnant woman with a cancer that offered little hope of prolonged life). The authors concluded that selection was more emotionally driven for the public, although varying degrees of prejudice is perhaps a more accurate description. In the face of such apparent prejudices not being confined to the public, what can we do to ensure that livers are allocated “fairly”?

    The scenario may have been artificial, but it did reflect the reality that demand will increasingly outstrip supply of livers: the latest figures show a 23% increase in the waiting list against no change in the number of transplants during the first quarter of 1999 compared with 1998.2 Despite measures to eke out resources such as using living donors and split grafts, …

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