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 And misperceptions among the general public about liver disease,
liver transplants in general and the people who need them may be
keeping some Americans from registering to become organ donors after
death, according to survey results released June 14 by WebMD and the
University of Pittsburgh Medical Center at the Living-Donor Liver
Transplant Summit at the National Press Club in Washington DC.
Despite advances in transplantation, more than 120,000 people are
awaiting new organs, including 14,000 who need livers. About 20% of
those on the liver waiting list will die for lack of donor organs,
Dr. John Whyte, chief medical officer at WebMD and Dr. Abhinav Humar,
chief of the Division of Transplantation at UPMC say in the preface
to a report of the findings.
WebMD and UPMC collaborated on two surveys to assess perceptions and
misperceptions regarding liver donation - one with 4,600
participants from the general public and the other with responses
from 660 physicians, including primary care providers,
gastroenterologists, and hepatologists.
Members of the public incorrectly believe 43% of liver transplants
are due to drug or alcohol abuse, survey results suggest. In fact,
nonalcoholic fatty liver disease is the most common cause of chronic
liver disease (52%), followed by alcoholic liver disease in only 21%
of cases.
Further, 46% of men and 34% of women think that some people are more
deserving of transplants than others, and that those who need one
because of drug or alcohol abuse should have a lower priority. Close
to 20% of respondents overall thought people who are overweight or
have a poor diet should have lower priority.
"We encounter these perceptions on a daily basis when taking care of
patients with liver disease and their families," said Dr. Nabil
Dagher, director of abdominal transplant at NYU Langone's Transplant
Institute in New York City. "Patients, many of whom do not drink or
use drugs, are acutely aware of the stereotypes the public has
regarding liver disease," he told Reuters Health by email.
"People need to be educated that the liver is subject to injury and
failure due to genetic disorders, autoimmune disorders, as well as
infectious and toxic injury from prescribed drugs, and not just due
to alcohol use or illegal substance use ... or from obesity leading
to fatty liver disease," Dr. Michael Schilsky, medical director for
adult liver transplant at Yale New Haven Transplantation Center in
Connecticut, said by email.
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"Perceptions that physicians would shorten lives just to make
individuals donors need to be dispelled, as well," Schilsky added,
referring to the often-expressed fear that if people have indicated
a willingness to donate organs after death, doctors won't work as
hard to save them.
As for living liver donation, Dagher noted, "Misperceptions also
extend to primary care providers, GI doctors, and hepatologists not
directly involved with transplantation. The power and advantages of
living donor transplantation are known to very few, even in the
transplant community in the U.S."
In a living-donor transplant, someone - usually a relative or friend
- donates a piece of his or her liver to the patient. The donor's
liver ultimately regenerates and functions normally. The down-side
of living-donor liver transplantation is that it requires a healthy
person to undergo major surgery, with inevitable risks. But the
advantages, compared to using livers from deceased donors, include
being able to screen the donor more thoroughly, being able to
optimize the timing of the transplant (rather than having to wait on
a list) and better survival odds.
Among primary care providers who participated in the survey, more
than 60% said they are not knowledgeable about living-donor liver
transplantation.
"There are indications that (doctors) who wouldn't recommend
living-donor liver transplant often don't know enough about it
and/or don't discuss liver donation with their patients," according
to the survey report.
Some physicians expressed concern about whether donations are truly
voluntary and had some reservations about whether it is ethically
appropriate to ask strangers to donate. These concerns create a
barrier to effective donor identification, the report acknowledges.
"At Yale, we believe strongly in living donation, and have embraced
creating a 'donor community' and are following our donors closely
over time to assure their health and wellbeing," Schilsky said.
Dagher added, "For those of us who perform living-donor liver
transplantation and see its life-saving potential, it is a
miraculous process. It's up to us to effectively share that with the
broader community and break down these barriers to donation."
SOURCE: https://wb.md/31IfOfX WebMD, online June 14, 2019.
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