PHYSICIAN-PATIENT RELATIONSHIPS IN ORGAN TRANSPLANTATION FROM MARGINAL DONORS

Purpose:

In order to increase the organ donor pool, different strategies including expanding the criteria of donation to marginal donor were developed in some countries. However, the concept of marginal donor is not used for every type of organ and if used not clearly defined.

The French national health authority in charge of transplantation supports transplantation from living and non-heart beating donors. In France, physicians are not enforced to provide information to recipients about marginal donors except for hepatitis C or B and non-heart beating donation. Therefore, we hypothesized that information proposed to patients concerning this type of donors was not harmonized between transplant teams and that shared-decision making was seldom.

Our objectives were to: 1) estimate the number of transplant teams rejecting marginal grafts without asking patient; 2) evaluate the kind of information proposed to patients before using a marginal graft. 

Method:

A cross sectional survey using an electronic questionnaire was realized from January to February 2014 among the medical and surgical responsible in all kidney, liver, heart and lung transplant center in France. 

Result:

Among 208 physicians who were addressed our questionnaire, 117 (56.3%) responded. Almost all (89.5%) physicians used marginal grafts: 55.6% informed patients about this type of graft, mainly on its advantages and risks; 50% talked to patients about the possibility of being transplanted by these organs. They preferred informing patients orally during outpatient visit (90.5%) giving preferably not detailed information regarding each risk and benefits but general information (76.6%). Only 17% of physicians involved their patients in a shared-decision.

Conclusion:

Ethically and legally, physicians should inform patients about uncertainty of treatment results and involve patients in decision making. However, nearly ten percent reject marginal organs without talking to patients about their existence. Among those who accept marginal organs, only half inform patients about this possibility. Indeed, most are afraid of patients’ rejection of marginal organs leading to worsen organ shortage. Despite the large number of physicians using marginal organs, shared decision making is not a current practice.