Liver Transplant Candidate Selection Ethics: Mixed-Methods Study of One Center

Abstract: Determining which patients receive liver transplant is a choice with life-or-death stakes. Bioethicists have long examined allocation among waitlisted patients, yet less research has focused on candidate selection, where teams including hepatologists, surgeons, social workers, nurses, and psychologists determine whether to add a patient to the waitlist. This panel describes liver candidate selection at one academic medical center, through the lens of a central ethical question: should bioethicists study candidate selection by evaluating its outcomes or its procedures?

The first speaker will set out this key question, drawing on political philosophy literature. The next two speakers will share empirical studies of candidate selection at the transplant center. One, a quantitative study of demographic, clinical, and psychosocial factors associated with listing or denial, evaluates candidate selection outcomes. The other, a qualitative study of the candidate selection committee’s deliberation via grounded theory analysis of recorded meetings, describes committee procedures. This research reveals surprising findings: that demographic factors such as religiosity improve psychosocial evaluation scores, that patients are regularly listed or denied with only three minutes of discussion, and that committees grapple with ethical dilemmas through appealing to policy and casuistry. The final speaker will discuss implications of long-standing disease biases on patient evaluation practices, using alcoholic liver disease and obesity-related steatotic liver disease as case studies.

Our panel aims to bring attention to this critical stage in the pathway to organ transplantation, describing the practices and outcomes of candidate selection committees at one institution and drawing out attendant ethical considerations.

Keywords: transplant, candidate selection, mixed-methods