10 November 2022: Manas - B
Questions from core participants:
On not prioritising people when their liver transplant need is due to infected blood; he said there were many reasons for a liver transplant. There is a 9% mortality after one year. Acute liver issues result in 33% non-survival, in fact such people often never leave the hospital. A lot of people are stable with their diseases, and it may be in their best interests not to risk a transplant, particularly due to the risks for bleeding. There are other treatments that might be more appropriate. Once a patient, including an infected blood patient, becomes in need of a liver transplant, they will be prioritised accordingly.
On the cohort for modelling the process; he said he could not remember exactly but thinks it was based on conversations with statisticians.
On the monitoring committee meeting frequency; he said they originally met three-monthly but now meet six-monthly. If there is a change to be made, they will meet three-monthly.
On the issue of “marginal livers”; he said it can be confusing for patients to understand the terminology, but there is information including videos on the website to explain the issues. Patients will also have lead clinicians and specialist nurses who will meet several times with patients before a transplant becomes likely. Consent is obtained much earlier in the process and can be reversed at any time.
On the possibility of a recipient developing HCV as a result of receiving a liver transplant; he said it could happen to anyone. Such livers could be classified as marginal. There would be automatic prophylaxis with DAA treatments and so far it has all worked out.
The Chair asked about mortality rates after transplant and the witnesses’ perhaps off the cuff comment that transplanting a liver “could kill half of the people”. It was confirmed to be an “off the cuff” comment. The next question was about the semantics of giving, taking, or having obtained consent. In some way it is considered consent if the patient turns up for the procedure.
The witness said that if there were enough organs there would be a change in the process of allocating organs, but until that is achieved, if it ever is, then the prioritisation process is necessary. It is considered the fairest system and is being replicated by other countries. It was created out of a desire to do the right thing for patients. Prof Manas believes it is the right system.
The Chair thanked the witness for attending and explaining about the transplant system. It would be of great interest to many people listening and helped the Chair to understand this aspect much better.
The witness lived up to his reputation and his name. “Manas” comes from the Sanskrit word for “thought”, and this was both a thoughtful and though-provoking session of evidence.
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