Introduction: Liver transplantation (LT) is the only curative option for patients with end-stage liver disease (ESLD). Patients with ESLD have high rates of in-hospital mortality and low rates of survival to hospital discharge after in-hospital CPR. As ESLD is one of the few diseases where patients are close to death but also to a total cure, some studies suggest that LT listing and hospice referral should not be mutually exclusive. While many centers require that a patient be “full code” for LT listing or evaluation, this is not a United Network for Organ Sharing (UNOS) mandate.
This study aims to assess LT providers’ awareness of organizational policies and their perspectives on code status requirement, with the eventual goal of providing patients with goal-concordant care while balancing the need of ethical solid organ allocation for transplant.
Methods: Healthcare providers involved in the LT evaluation process at a high-volume transplant center anonymously completed a 13-question survey. Provider specialties are shown in Table 1. Answers were displayed using descriptive statistics.
Results: Out of 83 providers who filled out the survey, 40% reported that they either often or always discussed code status with patients, often in a hospital setting. 62% were unaware of the institutional protocol that patients had to be full code for LT evaluation or listing, and 95% were unaware that UNOS did not have a full code requirement for the LT process.
93% of participants felt that patients undergoing LT evaluation should discuss code status. 15% felt that patients should remain full code throughout, 54% felt that patient should have their choice of code status during LT evaluation and listing, and 31% felt that patients should have their choice during evaluation but become full code once listed.
Discussion: These results show a need for increased educational initiatives among providers involved in the LT process, as there is a lack of knowledge among providers regarding policy on code status. Among the subset who was aware of a protocol, knowledge of the actual requirements varied.
While most providers believe that a discussion regarding code status is necessary for patients who wish to undergo LT, there was a diverse range of opinions on code status requirement throughout the LT evaluation and listing process. Initiatives to further the dialogue of code status and advanced care planning in a high mortality patient population are needed.
