A comparison between two questionnaires on informed consent for extended criteria liver donors

AIM. A questionnaire concerning informed recipient’s consent for “extended criteria liver donors”(ECD), after approval of the Institutional Review Board(IRB), was sent in different times by e-mail to members of 2 scientific societies, ELPAT (Ethical,Legal and Psychologic Aspects of Organ Transplantation) and ELITA (European Liver and Intestine Transplant Association)-ELTR(European Liver Transplant Registry) . MATERIALS AND METHODS. The results were published in different papers in Transplantation Proceedings. RESULTS. By comparing tables in the 2011 ELPAT an AIM: A questionnaire concerning informed recipient’s consent for “extended criteria liver donors”(ECD), after approval of the Institutional Review Board(IRB), was sent in different times by e-mail to members of 2 scientific societies, ELPAT (Ethical,Legal and Psychologic Aspects of Organ Transplantation) and ELITA (European Liver and Intestine Transplant Association)-ELTR(European Liver Transplant Registry. MATERIALS AND METHODS: The results were published in different papers in Transplantation Proceedings. RESULTS: By comparing tables in the 2011 ELPAT and 2013 ELITA papers, in the most recent paper less Liver Transplant Centers(LTC) considered age as high as 80 years (p<.002)and SGOT>90 IU (p<.02), or all criteria together (p<.0001), as indicators of ECD. DISCUSSION: This may reflects the fact that more recently LTC have become less selective, due to the rising mortality in the increasing liver transplant waiting list. In all these studies we highlighted both a disparity of practice across centres and the relatively large contribution made by ECD livers to the transplantation effort. CONCLUSIONS: Therefore patients should receive all the required informations concerning the quality of the liver offered to them for transplantation, not only when they are enlisted, but also when the liver becomes available and is proposed to them. It is also possible to create a special waiting list of patients not accepting ECD, although this option could delay liver transplantation and consequently increase mortality.

Un questionario riguardante il consenso informato del ricevente per i cosiddetti donatori marginali di fegato (“extended criteria donors”-ECD) è stato inviato, previa approvazione del Comitato Etico, via e-mail ai membri di 2 società scientifiche, ELPAT(Ethical,Legal and Psychologic Aspects of Organ Transplantation) ed ELITA (European Liver and Intestine Transplant Association)-ELTR(European Liver Transplant Registry) : i risultati sono stati pubblicati in diversi lavori apparsi su Transplantation Proceedings. Analizzando statisticamente le tabelle negli articoli 2011 ELPAT e 2013 ELITA, nel lavoro più recente meno Centri Trapianto di fegato (LTC) hanno considerato l’età fino a 80 anni (p<.002) e SGOT>90 IU (p<.02), o tutti i criteri insieme (p<.0001), come indicatori di donatore marginale. Ciò potrebbe riflettere il fatto che nel tempo i LTC sono divenuti meno selettivi, a causa della crescente mortalità dei pazienti in lista di attesa. Considerando che in tutti i nostri studi abbiamo riscontrato un notevole ricorso agli ECD, è necessario che i pazienti ricevano tutte le informazioni che vogliano richiedere sia al momento dell’iscrizione in lista di attesa, sia quando il fegato di un donatore venga effettivamente loro proposto. E’ anche possibile creare una lista di attesa separata, per pazienti che non accettano ECD: tale scelta però ritarda in modo inevitabile il trapianto e quindi, potenzialmente, aumenta la mortalità in lista di attesa.