perceived obstacles to treatment (e.g. antisocial behavior), patientÆs contribution to their medical disorder (e.g. alcoholism), and past use of medical resources (Neuberger and James, 1999). The clinical criteria for medical contraindications are clearly defined. There are differences between states, however, on how these criteria are applied. In North Carolina, for instance, the source and availability of funding has the greatest influence on a patientÆs receipt of a liver transplant. Some transplant units are uneasy about giving liver transplants to patients with alcoholic liver disease and those who use illegal drugs. Age is also a factor in some transplant decisions.
In 2001, UNOS and the Organ Procurement and Transplantation Network (OPTN) endorsed the further development of the Model for End Stage Liver Disease (MELD) and Pediatric End Stage Liver Disease (PELD) for prioritizing patients awaiting liver transplantation according to their short-term risk of death without a transplant (UNOS, 2002). UNOS is a non-profit medical, scientific, and educational organization of volunteers and staff which maintains the nationÆs organ transplant waiting list. OPTN was established by Congress to ôlist all U.S. transplant hospitals and organ procurement organizations and ensure efficient, equitable distribution of donated organs.ö Oversight of OPTN is provided by the Department of Health and Human Services through federal regulation and contract with UNOS.
There are four categories of patients awaiting liver transplants: Status 1, 2A, 2B, and 3 (UNOS, 2002). Status 1 patients are the most critical, and are patients with fulminant liver failure or those whose first transplant did not function, and they have a life expectancy of less than seven days. Status 2A patients are patients with chronic liver disease and a life expectancy of less than seven days without a transplant as determined by both subjective and objec...