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Researchers shine light on factors that keep people from receiving a liver

Category: Liver Diseases

What can lower a person's chances of getting a liver transplant?

The sooner a liver condition is detected, the better, since an issue with this organ could progress to the point of needing a transplant. To avoid this issue, people should regularly get liver function profile lab tests to make sure this organ is functioning properly. Recently, researchers from the Northwestern University Feinberg School of Medicine in Chicago conducted an anonymous survey of U.S. transplant providers to discover what lowers a person's eligibility to receive one.

According to the findings, psychiatric factors, particularly suicide attempts, incarceration and marijuana use, can all harm a person's chances of receiving a liver transplant.

Harming eligibility
Researcher Josh Levitsky, M.D., explained that for many patients with end-stage liver disease, a transplant is the only chance to extend their life. However, there are only so many donor livers available, so choosing who gets one and who does not becomes an ethical dilemma for transplant specialists who have to determine whether a person's transplant is likely to be successful.

Currently, there is something called the model for end-stage liver disease (MELD), which is used to determine how serious a person's liver disease is. The MELD score is supposed to give transplant providers standard criteria that they can use to determine who should get donated livers. However, according to the scientists, some specialists may use a patient's medical history and lifestyle to help make this decision.

For example, in the past studies have shown that alcohol abuse, HIV status, obesity or being older may all lead to a person not being placed on a transplant waitlist.

To better understand what criteria doctors and other professionals are actually using to decide who gets a liver, the researchers sent out a survey to social workers, surgeons, psychiatrists and hepatologists at more than 100 liver transplant centers across the U.S. More than 250 individuals responded anonymously with their opinions of what factors could keep a patient from being a priority on the liver transplant list.

The top three controversial characteristics were marijuana use, psychiatric diagnoses and incarceration. Furthermore, 63 percent said they would not place patients over the age of 80 on the waitlist, and 55 percent would not put someone on this list who has a lifetime prison sentence. Also, 57 percent would not put an individual with a body mass index greater than 46 on the list.

One of the most concerning findings was that less than half of the respondents said that their centers had an actual written policy about these controversial characteristics.

"We found significant variation in provider opinions of criteria that are contraindications for liver transplantation, which may be why many centers do not have formal policies for selecting candidates with questionable characteristics," said Levitsky. "Standardized eligibility criteria, supported by evidence-based data of outcomes, are necessary to develop formal policies for selecting controversial candidates for liver transplantation."

Protecting the liver
One of the best ways to avoid being rejected for a liver transplant is to keep the liver healthy. Bastyr University recommends that people who want to keep the liver healthy consume more vegetables such as Brussels sprouts, collard greens and broccoli, as well as leafy greens and high-fiber foods. Furthermore, alcohol is a major contributor to liver disease, so people should drink moderately or not at all.

The also recommended that people drink water regularly and cut back on soda, juice and coffee.

Finally, individuals should get regular liver panel tests to make sure that this organ is healthy and functioning properly. This way, any issues can be spotted early and dealt with accordingly, before a condition worsens to the point where a transplant is required.

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