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.
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.
|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|
|Volk, Michael L (2013) Center differences in model for end-stage liver disease exceptions: fairness, local culture, and norms of practice. Liver Transpl 19:1287-8|
|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|
|Rakoski, Mina O; McCammon, Ryan J; Piette, John D et al. (2012) Burden of cirrhosis on older Americans and their families: analysis of the health and retirement study. Hepatology 55:184-91|
|Bassett, John T; Volk, Michael L (2011) Can quality of care for patients with cirrhosis be measured? Dig Dis Sci 56:3488-91|
|Volk, Michael L; Biggins, Scott W; Huang, Mary Ann et al. (2011) Decision making in liver transplant selection committees: a multicenter study. Ann Intern Med 155:503-8|
|Volk, M L; Reichert, H A; Lok, A S F et al. (2011) Variation in organ quality between liver transplant centers. Am J Transplant 11:958-64|
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