Psycho-social criteria for being accepted as a transplant candidate

 Not all decisions made in transplant centers are made on exclusively medical grounds.  Given the dire shortage of transplantable organs, other factors that predict transplant success are also examined.

The Harvard Gazette interviews Dr. Wei Zhang, a transplant hepatologist at Mass General Hospital.

Facing life-or-death call on who gets liver transplants
Surgeons, medical professionals apply risk calculus that gets even more complex for patients with drinking problems  by Anna Lamb

"Patients with decompensated liver disease, or what commonly has been referred to as end-stage liver disease, have drastically shortened life expectancies without transplantation. In one study, patients in this stage who developed complications lived only two years after diagnosis.

"But a transplant is not always a final solution. As many as 20 percent of all patients with a history of alcohol use disorder will relapse after surgery.

“If we know a patient is going to relapse after liver transplant, the evidence is that the chance of them developing recurrent cirrhosis in three years is about 50 percent and the chance of dying from the recurrent liver disease in five years is about 50 percent,” Zhang said. “We do a lot of interventions to prevent them from going back to drinking and improve their quality of life.”

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“I also understand that if a patient receives an organ, it means that another patient is not able to receive the organ,” he said. “So when I think of that, I find a little bit of comfort.”

"In the last decade, the field of transplant hepatology has changed drastically. In the not-so-distant past, all patients coming into the hospital with a failing liver and any history of alcohol abuse were denied life-saving surgery.

“When I was doing my residency, most of those patients did not have any chance of being evaluated for liver transplantation,” Zhang said.

"Now, he added, there are still quite a few hurdles that patients need to clear to be approved for transplantation. But there’s hope — especially for those with strong support at home.

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“Some of the factors that we look at is if a patient has insights, meaning, does the patient think that the liver disease is caused by alcohol?” Zhang said. “There are patients who, for various reasons — one of them is probably stigma — don’t acknowledge that the liver disease is caused by alcohol. The risk is that if they get a liver transplantation, and don’t think they need treatments, they may relapse.”

"The other piece of psychosocial criteria, Zhang said, is social support. This includes having strong family ties, stable housing, and the overall ability to seek support after surgery.

“Then those patients would be considered as good candidates with acceptable risk for post-liver-transplant relapse, and we can move on for a liver transplant evaluation,” Zhang said."