Beyond utilitarianism: a method for analyzing competing ethical principles in a decision analysis of liver transplantation

Medical Decision Making : an International Journal of the Society for Medical Decision Making
M L VolkSandeep Vijan

Abstract

The utilitarian foundation of decision analysis limits its usefulness for many social policy decisions. In this study, the authors examine a method to incorporate competing ethical principles in a decision analysis of liver transplantation for a patient with acute liver failure (ALF). A Markov model was constructed to compare the benefit of transplantation for a patient with ALF versus the harm caused to other patients on the waiting list and to determine the lowest acceptable 5-y posttransplant survival for the ALF patient. The weighting of the ALF patient and other patients was then adjusted using a multiattribute variable incorporating utilitarianism, urgency, and other principles such as fair chances. In the base-case analysis, the strategy of transplanting the ALF patient resulted in a 0.8% increase in the risk of death and a utility loss of 7.8 quality-adjusted days of life for each of the other patients on the waiting list. These harms cumulatively outweighed the benefit of transplantation for an ALF patient having a posttransplant survival of less than 48% at 5 y. However, the threshold for an acceptable posttransplant survival for the ALF patient ranged from 25% to 56% at 5 y, depending on the ethical principles involv...Continue Reading

References

Apr 1, 1996·Social Science & Medicine·P A Ubel, G Loewenstein
Oct 9, 1996·JAMA : the Journal of the American Medical Association·L B RussellM C Weinstein
Jul 17, 1998·BMJ : British Medical Journal·J NeubergerM Speed
Dec 24, 1998·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·J M LlovetJ Bruix
Jul 1, 1999·Liver Transplantation and Surgery : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·D M BravataD K Owens
Sep 12, 2000·Medical Care·P A UbelJ Richardson
May 9, 2001·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·F P SarasinA Hadengue
Mar 23, 2002·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Julie RatcliffeUNKNOWN Cost-Effectiveness of Liver Transplantation Team
Jul 30, 2003·Archives of Internal Medicine·Peter A UbelA Mark Fendrick
Dec 16, 2003·Health Economics·Louise Longworth, Stirling Bryan
Feb 3, 2004·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Pratima SharmaRussell H Wiesner
May 8, 2004·Quality of Life Research : an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation·Cindy L BryceJoel Tsevat
Sep 24, 2004·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Robert M Merion
Nov 24, 2004·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Manish G AminJohn B Wong
Jan 13, 2005·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Robert M MerionRobert A Wolfe
Jan 28, 2005·Medical Decision Making : an International Journal of the Society for Medical Decision Making·James E StahlMark S Roberts
Apr 1, 2005·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Steven M ShechterMark S Roberts
Jun 24, 2005·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Matthew JacobJan H P van der Meulen
Aug 13, 2005·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Hector Rodriguez-LunaDavid Mulligan
Oct 29, 2005·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Colin C GeddesAnita Ganai
May 12, 2006·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·R B FreemanA M Harper
Jun 7, 2006·The American Journal of Bioethics : AJOB·Jonathan Baron
Jun 7, 2006·The American Journal of Bioethics : AJOB·Liva H Jacoby
Jun 7, 2006·The American Journal of Bioethics : AJOB·David Emmanuel Gray
Jun 7, 2006·The American Journal of Bioethics : AJOB·Carson Strong
Aug 31, 2006·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·J P RobertsF K Port
Nov 30, 2006·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Josep M Llovet

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Citations

Oct 14, 2009·Journal of Gastroenterology and Hepatology·M Thamara P R PereraElwyn Elias
Jan 11, 2014·World Journal of Gastroenterology : WJG·Alessandro VitaleUmberto Cillo
Apr 13, 2010·Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver·Umberto CilloDavide F D'Amico
Jul 20, 2011·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Fredrik ÅbergHelena Isoniemi
Oct 31, 2009·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Alessandro VitaleUmberto Cillo
Mar 25, 2017·Journal of Palliative Medicine·Elizabeth J LilleyAnne C Mosenthal
May 5, 2017·Annals of Surgery·Elizabeth J LilleyAnne C Mosenthal
Mar 13, 2014·Current Opinion in Organ Transplantation·Jacob Appel, Swapna Vaidya
Nov 20, 2016·Pediatric Blood & Cancer·Heidi V RussellStacey Berg

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