Impact of Consideration of Transplantation on End-of-Life Care for Patients During a Terminal Hospitalization

Published in: Transplantation, v. 95, no. 4, Feb. 2013, p. 641-646

Posted on RAND.org on April 29, 2015

by Anne Walling, Steven M. Asch, Karl Lorenz, Neil S. Wenger

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BACKGROUND: Many patients considered for transplantation die before receiving the organ, underlining the importance of providing high-quality symptomatic relief and communication for all transplant patients. METHODS: To study how consideration of transplantation affects the end-of-life care received by patients, care was evaluated by abstracting medical records for 496 adults who died in one high-volume transplant medical center between April 2005 and April 2006. Sixteen quality indicators from the Assessing Care of Vulnerable Elders set that focused on communication and symptom management were measured to calculate an overall patient-level quality score. We evaluated the predictors of quality of end-of-life care, with the main independent variable being whether the patient was being considered for transplantation. Restricting to patients who died an "expected death," we also evaluated the end-of-life treatments received. RESULTS: Twenty-five percent of decedent patients were considered for transplantation. In adjusted models, patients considered for transplantation received lower-quality end-of-life care, had longer hospital stays before death, and were more likely to receive aggressive life-sustaining treatments. CONCLUSIONS: Care models should incorporate an emphasis on symptom relief and communication along with transplant preparation.

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