The Secret World of Liver Transplant Candidate Assessment

Abstract

Organ transplantation is a field entangled with ethical complexities. One of the major controversies subject to debate is resource allocation. The UK's organ procurement agency, NHS Blood and Transplant, must ensure that the limited number of human organs are allocated to the most efficient, yet the most deserving, transplant candidates. NHSBT have published numerous organ allocation protocols to this end, but little of known of the transplant candidate assessment process, which not only plays a pivotal role in selecting suitable transplant candidates for the waiting list, but also plays host to some of the most difficult ethical decisions in medicine. This piece will examine the UK liver transplant candidate assessment process in detail, paying particular attention to the composition of transplant teams, the diverse candidate criteria under examination, and the controversial grounds upon which a candidate can be excluded from transplantation. The limited regulations surrounding transplant teams and the opportunities to discriminate against particularly vulnerable candidates—such as alcoholics and illicit drug users—will also be discussed, and it will be asked if a fair assessment process for all liver transplant candidates can be guaranteed by NHSBT when transplant teams are subject to such a wealth of discretion.