The Organ Transplant Imperative

Mayo Clinic Proceedings
Wil L SantivasiThomas J Beckman

Abstract

More than 120,000 US patients were listed for solid organ transplants in 2016. Although data are scarce, we suspect that many of these patients will die while awaiting transplant and without engaging in goals-of-care discussions with their physicians. The challenges of addressing goals of care in patients with malignancy, end-stage renal disease, and heart failure have been studied. However, there is sparse literature on addressing goals of care throughout the dynamic process of transplant assessment and listing. We propose the concept of an organ transplant imperative, which is the perceived obligation by patients and health care providers to proceed with organ transplant and to avoid advance care planning and triggered goals-of-care discussions, even in situations in which patients' clinical trajectories have worsened, resulting in poor quality of life and low likelihood of meaningful survival. We situate this concept within the paradigms of clinical inertia and the treatment and technological imperatives. We illustrate this concept by describing a patient with end-stage liver disease (ESLD) who was hoping for a liver transplant, who was caught between the conflicting perspectives of specialist and primary care physicians, an...Continue Reading

Citations

May 8, 2018·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Chiara MazzarelliMary D Cannon
Apr 4, 2020·Progress in Transplantation : Official Publication, North American Transplant Coordinators Organization ... [et Al.]·Patricia C PawlowMary Ersek
Sep 27, 2020·Clinical Transplantation·Patricia C PawlowMary Ersek
Sep 23, 2021·ACS Synthetic Biology·Fatemeh GhorbaniAmmar Ebrahimi

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