History of liver transplantation
Drug that revolutionized liver transplantations.
What is Cyclosporin?
This is the drug of choice for severe alcoholic hepatitis.
What is Prednisolone?
The standard sobriety period before being listed for transplant
What is 6 months?
Moss and Thiele saw this as "Choice between health of the many and expensive, albeit live-saving, health for the few"
What is a choice facing American healthcare?
The most prevalent psychiatric illness in candidates for liver transplantation
What is depression?
It was the mid 1980's before Dr. Starzl started using this in preparation for transplants.
What is multidisciplinary evaluation?
Six month mortality rate (within 10%) of pts with severe alcoholic hepatitis.
What is 70%? (Accept anywhere from 60 - 80%)
Change in number of liver transplants for ALD between 1992 and 2001
No change
Moss and Thiele thought many of general rules of health care equity didn't apply to liver transplants because of this
What is a scarce resource? Also, livers are an absolute scarce resource as we can't yet manufacture new organs. Ventilators would be relative scarce resource as we could choose to manufacture more.
This is the most important factor in pre-transplant psych eval and the thing most likely to predict it.
WHat are noncompliance and history of noncompliance?
These were 2 early explanations for why pts with AUD should not get liver transplantations.
What are nutritional deficiencies and risk of relapse? (also accept physical and emotional fragility)
25% of pts with alcoholic hepatitis have this in addition to AUD.
What is infection?
Current % of pts who meet medical criteria for liver transplant because of ALD who are referred to liver transplant center (ball park number)
What is 10%?
Moss and Thiele though public opinion supporting liver transplants might erode because of these 2 issues.
WHat are too many pts with AUD getting transplants and too much money being spent on pts with AUD?
These are 2 psychosocial stressors that must be carefully assessed for in transplant evals.
What are financial stability and personal support? (also accept housing stability and care-giver support)
Dr. Starzl suggested this was the "ultimate sobering experience."
What is liver transplantation?
This is the typical age and common drinking pattern of pts with alcoholic hepatitis.
What are ages 40 - 50? What is heavy drinking for 20 or more years?
Relapse rate of alcoholic hepatitis pts given liver transplant without period of sobriety vs. ALD given liver transplants after period of sobriety (lower, the same, higher)
What is the same?
This is Ho's opinion of physicians ability to attribute moral responsibility to pts with AUD (2 factors).
What are difficult to do and error prone?
These are difficult emotions (2) that may affect the care pts get prior to transplantation
Wat are anger and envy?
Dr. Starzl's view on manditory sobriety periods prior to liver transplantation.
"It would seem medically unsound or even inhumane."
These are 2 "stringent criteria" for liver transplantation in pts with severe alcoholic hepatitis and AUD.
What is the desire for sobriety after surgery? What is good psychosocial support?
This is the typical 6 month survival of pts with severe alcoholic hepatitis without liver transplant vs. with liver transplant (+/- 10%)
What is 25% vs. 85%?
Ho believes morality should not be used as a criterion for liver transplantation because of these 2 arguments
What are undermining of physician-patient relationship and addiction is caused by many things besides moral choices? (Also accept what is undermining of medicine as a whole.)
This is best motivation for becoming a liver donor.
WHat is concern for the recipient?