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Englschalk, Christine; Eser, Daniela; Jox, Ralf J.; Gerbes, Alexander; Frey, Lorenz; Dubay, Derek A.; Angele, Martin; Stangl, Manfred; Meiser, Bruno; Werner, Jens; Guba, Markus (2018): Benefit in liver transplantation: a survey among medical staff, patients, medical students and non-medical university staff and students. In: BMC Medical Ethics 19:7


Background: The allocation of any scarce health care resource, especially a lifesaving resource, can create profound ethical and legal challenges. Liver transplant allocation currently is based upon urgency, a sickest-first approach, and does not utilize capacity to benefit. While urgency can be described reasonably well with the MELD system, benefit encompasses multiple dimensions of patients' well-being. Currently, the balance between both principles is ill-defined. Methods: This survey with 502 participants examines how urgency and benefit are weighted by different stakeholders (medical staff, patients on the liver transplant list or already transplanted, medical students and non-medical university staff and students). Results: Liver transplant patients favored the sickest-first allocation, although all other groups tended to favor benefit. Criteria of a successful transplantation were a minimum survival of at least 1 year and recovery of functional status to being ambulatory and capable of all self-care (ECOG 2). An individual delisting decision was accepted when the 1-year survival probability would fall below 50%. Benefit was found to be a critical variable that may also trigger the willingness to donate organs. Conclusions: The strong interest of stakeholder for successful liver transplants is inadequately translated into current allocation rules.