Among the limited supply of organs available for liver transplantation, a wide spectrum of quality exists. Some organs carry higher risks of disease transmission, and others carry higher risks of graft failure ranging from 20% to 40% at 3 years. Each time an organ offer is made, the patient and physician must decide whether to accept this offer, or wait for a better one to come along. Very little is known about how this decision is made. Although consensus recommendations suggest that higher risk organs should be given to patients with higher Model for End-stage Liver Disease (MELD) scores due to their risk of death while waiting, we recently published a study demonstrating that in current practice patients with lower MELD scores tend to receive the higher risk organs. Furthermore, significant variation exists between transplant centers in the use of high risk organs. Finally, although physicians are ethically and legally obligated to inform patients about the quality of organ they will receive, communicating the complex risk/benefit tradeoffs is difficult. The immediate goals of this proposal are to improve decision making about organ quality by 1) developing a model of transplant center organ quality utilization, 2) conducting a web-based survey of patients on the waiting list for liver transplantation to determine factors influencing acceptance of high risk organs, and 3) facilitating shared patient-physician decision making by developing and pilot testing a patient decision aid about organ quality. In order to conduct these studies, I will receive focused didactic coursework and mentoring in survey design and quantitative methodology, decision psychology and decision aids, and patient-oriented research and career development. My long-term goal is to become an independent clinical investigator and health services researcher in hepatology and liver transplantation, with a methodologic focus in decision sciences. The K23 award will provide me the protected time and advanced research training needed to achieve my goals and contribute to improved quality of care for patients with liver disease.

Public Health Relevance

The overarching goal of this proposal is to improve decision making about organ quality in liver transplantation, specifically by increasing transparency, improving patient knowledge and satisfaction, and maintaining patient and public trust in the transplant system. In addition, this research may improve patient outcomes by ensuring that high risk organs go to patients who are most likely to benefit from them.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23DK085204-04
Application #
8399643
Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Podskalny, Judith M,
Project Start
2010-02-10
Project End
2014-12-31
Budget Start
2013-01-01
Budget End
2013-12-31
Support Year
4
Fiscal Year
2013
Total Cost
$175,600
Indirect Cost
$13,007
Name
University of Michigan Ann Arbor
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Thomson, Mary; Volk, Michael; Kim, Hyungjin Myra et al. (2015) An Automated Telephone Monitoring System to Identify Patients with Cirrhosis at Risk of Re-hospitalization. Dig Dis Sci 60:3563-9
Mellinger, Jessica L; Richardson, Caroline R; Mathur, Amit K et al. (2015) Variation among United States hospitals in inpatient mortality for cirrhosis. Clin Gastroenterol Hepatol 13:577-84; quiz e30
Volk, Michael L; Goodrich, Nathan; Lai, Jennifer C et al. (2015) Decision support for organ offers in liver transplantation. Liver Transpl 21:784-91
Vaughn-Sandler, Valerie; Sherman, Carey; Aronsohn, Andrew et al. (2014) Consequences of perceived stigma among patients with cirrhosis. Dig Dis Sci 59:681-6
Volk, Michael L (2014) Identifying cirrhosis patients for intensive disease management. Dig Dis Sci 59:22-3
Volk, Michael L; Roney, Meghan; Fagerlin, Angela (2014) Pilot test of a patient decision aid about liver transplant organ quality. Liver Transpl 20:850-5
Kanwal, Fasiha; Volk, Michael; Singal, Amit et al. (2014) Improving quality of health care for patients with cirrhosis. Gastroenterology 147:1204-7
Volk, Michael L; Fisher, Natalie; Fontana, Robert J (2013) Patient knowledge about disease self-management in cirrhosis. Am J Gastroenterol 108:302-5
Mellinger, Jessica L; Volk, Michael L (2013) Multidisciplinary management of patients with cirrhosis: a need for care coordination. Clin Gastroenterol Hepatol 11:217-23
Volk, Michael L; Roney, Meghan; Merion, Robert M (2013) Systematic bias in surgeons' predictions of the donor-specific risk of liver transplant graft failure. Liver Transpl 19:987-90

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