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Perspectives on Care at the Close of Life: CODA
June 14, 2006

Integrating Palliative Care for Liver Transplant Candidates“Too Well for Transplant, Too Sick for Life”

JAMA. 2006;295(22):2655. doi:10.1001/jama.295.22.2655

In the May 10, 2006, issue of JAMA, Drs Larson and Curtis1 discussed the case of Ms F, a 55-year-old woman with chronic hepatitis B viral (HBV) infection, cirrhosis, and eventually hepatic carcinoma localized to the liver. At the time of her interview for the Perspectives series in May 2004, she was in the hospital, awaiting a liver. As the authors discussed, despite significant improvements in the ability to palliate the complications of end-stage liver disease, patients still experience reduced quality of life and the likelihood that their disease will progress. Liver transplantation increases the duration of survival and palliates many symptoms. However, because of the shortage of available organs, between 10% and 15% of these patients die without receiving a transplant.2 In addition, many patients are not candidates for transplantation due to comorbid illness and some succumb to complications of the transplant itself. Patients like Ms F and their families live with the uncertainty of having a potentially treatable, yet often fatal, illness. To maximize these patients' quality and quantity of life, palliative care and life-sustaining therapy must be delivered in concert.

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