How Do We Determine Futility for Patients in Need of Liver Transplantation?

Futility remains poorly defined in healthcare and entails a large portion of healthcare spending. With limited resources, the field of liver transplantation attempts to minimize cases of futility but struggles to balance the difficulty to provide a life-saving procedure to an increasingly sick patient population as seen with rising Model-for-End-Stage-Liver Disease (MELD) scores. This paper aims to explore the historical context of organ allocation, utilize the medical ethical principles for organ allocation, and review the literature on how to improve transplant outcomes and reduce ‘futile’ cases. In addition, the piece will also delve into the application of palliative care in the management of both listed patients and those who are deemed futile. As transplant centers continue to be challenged with higher expectations and sicker patients, the field needs to develop a consensus statement on how to define futility and determine what measurements should be used to assess centers’ transplant performance. © 2016, Springer International Publishing AG.