"Patients consider quality of life in addition to survival when making healthcare decisions," note the authors. "In liver disease in particular, it is essential to understand the impact of their disease on their quality of life because of the prolonged wait for transplantation." They suggest that liver disease severity should not be assumed to be an accurate marker for quality of life and that future studies in patients awaiting liver transplants should include quality of life measures as well as survival.
An accompanying editorial by Richard B. Freeman, M.D. of the Division of Transplant Surgery at Tufts-New England Medical Center in Boston, MA, notes that while quality of life is an important component of healthcare decision-making, decisions about organ allocation must be considered within the context of the severe organ shortage. "In the current extremely constrained donor supply, the question is not whether an individual patient's HRQL [health-related quality of life] is poor enough to warrant intervention with transplantation but more directly, to whom, among all of the potential recipients of a given donor liver, should that donor liver be offered." He maintains that quality of life should not outweigh mortality risk in organ allocation decisions and that a patient must first be alive in order to measure his or her quality of life.