Accept or refuse? Factors influencing the decision-making of transplant surgeons who are offered a pancreas: results of a qualitative study

BMC Surgery

Research Article

Martin Loss¹  Hans J Schlitt¹  Julika Loss²  Karl P Drewitz² 

[1] Department of Surgery, University Hospital Regensburg, Regensburg, Germany;Medical Sociology, University of Regensburg, Franz-Josef-Strauss-Allee 11, D-93053, Regensburg, Germany;

关键词: Pancreas transplantation;    Under-utilization;    Allocation process;    Refusal;   

DOI  :  10.1186/1471-2482-13-47

 received in 2013-01-28, accepted in 2013-10-15,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundMost offered pancreases are not transplanted. This study investigates the factors that inform and influence the transplant surgeon’s decision to select an offered pancreas.MethodsSemi-standardized interviews were conducted with 14 highly qualified transplant surgeons from all 14 German transplant centers performing > 5 pancreas transplantations per year. The interviews focused on medical and non-medical criteria on which the individual accept/refuse decision depends. Interviews were recorded, transcribed and underwent content analysis.ResultsThe interviewees agreed upon certain main selection criteria, e.g. donor age, lab results, ICU stay. However, there was no consistency in judging these parameters, and clear cut-offs did not exist. The pancreas macroscopy is a pivotal factor, as well as knowing (and trusting) the donor surgeon. 3/14 surgeons reported that they had occasionally refused a pancreas because of staff shortage. Some interviewees followed a restrictive acceptance policy, whereas others preferred to accept almost any pancreas and inspect it personally before deciding.ConclusionThe assessment of medical donor characteristics is highly inconsistent. Both very cautious as well as very permissive acceptance policies may render the allocation process less efficient. A more standardized policy should be discussed. Finally, better training for donor surgeons seems advisable, in order to increase trust and thus pancreas utilization.

【 授权许可】

CC BY   
© Loss et al.; licensee BioMed Central Ltd. 2013