Utility of Liver Transplantation Within the Bounds of Non-futility
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LIVER TRANSPLANTATION (D MULLIGAN AND RAMESH BATRA, SECTION EDITORS)
Utility of Liver Transplantation Within the Bounds of Non-futility Ramesh K. Batra 1 Published online: 10 August 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review To evaluate the measures of utility of liver transplant within the bounds of non-futility for controversial and high-risk scenarios associated with greatest transplant benefit and also possibilities of high futility. Recent Findings Liver organ allocation policies are routinely adjusted to be in line with the Final Rule, maximizing transplant opportunities and minimizing futile transplants. Transplanting patients with high survival benefit is the construct of the liver allocation models with “sickest first” approach, but such policies have unintended consequences of futile transplants which raise ethical controversies and moral burdens on transplant physicians. Summary Various adjustments are proposed to make the liver organ allocation models effective in high-risk scenarios which yield greatest transplant benefit for patients and satisfaction for the transplant physicians while minimizing disappointment among them from reduced futile efforts. They also offer ethical and effective allocation strategies of scare medical resource, i.e., liver. Keywords Liver transplant . Transplant futility . Utilitarianism . Transplant utility . Frailty . Ethics of liver transplant . Acute liver failure
Introduction Utility and Utilitarianism Jeremy Bentham (1748–1832), an English philosopher, and the founder of modern Utilitarianism is known for his moral philosophy of utilitarianism in his book Introduction to the Principles of Morals and Legislation (1789), is described the philosophical theory that defines the principles of Utility [1••]. The principles of utility according to Bentham’s moral philosophy were based on “the greatest happiness principle”, whereby greatest amount of aggregate happiness was the ultimate goal. Besides the aggregate happiness, he expanded utilitarianism to include principles, what modern day economists know as the law of “diminishing marginal utility,” whereby adding pleasure to the stockpile of happiness of a person who has reached a saturation point, will lose its utility and instead is best served to the one in greater need [2]. This article is part of the Topical Collection on Liver Transplantation * Ramesh K. Batra [email protected] 1
Department of Surgery (Transplant), Yale University School of Medicine, Yale New Haven Transplant Center, 330 Cedar Street, New Haven, CT 06520, USA
Final Rule and Utilitarianism On March 16, 2000, U.S. Department of Health and Human Services (HHS) implemented the Final Rule, for functioning of Organ Procurement and Transplantation Network, (OPTN) [3, 4]. Per the §121.8 [3] of the Final Rule, organ allocation needs to follow a medical urgency based approach. The urgency or need-based allocation of organs appears in line with the aforementioned utilitarian principles of Bentham, i.e., “the greatest happiness princ
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