Critical Care Minutes

This has been a hot topic surrounding not only the transplant community but also the critical care and anesthesia world. It is not uncommon for Dr. Sanjay Gupta or Dr. Oz (the premier TV celebrity docs) to come on national television usually on major broadcast shows such as Oprah and describe fantastic success stories that describe recent transplanted patient’s lives. Of course it is great that these patients did well, but this doesn’t mean they ALL do well!! This is certainly evidenced by some of the “expanded” criteria patients we take care of in the ICU.

Certainly we should be doing our best to give as many patient’s a chance at a new life – at a new liver. But the patient’s need to be better informed of the risks and alternatives and given realistic expectations. “Mr. Patient it isn’t gonna be like Dr. Gupta described – you won’t be as lucky but don’t worry you will have a new LIVER.”. Sometimes they might choose a shorter survival when faced with near definitive trach/dialysis/nursing home or chronic vent support situation that many of the high risk patients face today. It isn’t all about 28 and 90 day mortality rates! It should be about QUALITY OF LIFE.

November WSJ article was an excellent look at the exact phenomenon. Take a look at it here
“DOING A VOLUME BUSINESS IN LIVER TRANSPLANTS”

So the next couple of posts will be dedicated to revisiting the criteria for liver transplant and a detailed look at the “Expanded” criteria opened up for high risk patients to increase recruitment of potential recipients. Let us see if this is really for the patient’s or for numbers of the transplant center. Stay Tuned!