Book Review
1
American Journal of Transplantation 2007; 7: 1872 Blackwell Munksgaard C 2007 The Authors Journal compilation C 2007 The American Society of Transplantation and the American Society of Transplant Surgeons doi: 10.1111/j.1600-6143.2007.01854.x Book Review 100 Questions and Answers About Liver Transplantation Frederic Gordon, Jones and Bartlett, 2007; 180p. Educating patients about the complex world of liver trans- plantation remains one of the most important and difficult obligations transplant centers and care givers face today. In the first place, patients with chronic end-stage liver dis- ease are confronted with a progressively debilitating, uni- versally fatal disease. This alone is extremely difficult for patients and their families to understand, cope with, and treat. Complicating this already complicated situation, the liver transplantation treatment, also involves many unique problems in its execution and in obtaining an organ. Navi- gating the organ allocation system, the potential for living liver donation and its risks and benefits, along with the in- tensive and complex medical/surgical treatment involved during and after the liver transplant, requires a tremendous amount of education, self-study, and research on the part of the patient. It is because of this difficult, multifaceted, educational task that Dr. Fred Gordon has written 100 Questions and An- swers about Liver Transplantation. The volume is very well laid out and written in a question and answer style that is of- ten most helpful for patients seeking answers to their spe- cific questions. The information is also supplemented by an individual patient’s perspective who relates his own ex- periences along the liver transplantation process that lends additional ‘user friendliness’ to the piece. The book covers a wide array of issues and areas related to liver transplantation that commonly surface for patients during the referral and evaluation process, and while wait- ing for their transplant. The manuscript is organized into 10 sections covering ‘The Basics’, before liver transplanta- tion, organ allocation, the transplant surgery and afterward, among other topics. In addition, there is a section at the end reviewing living donor liver transplantation. This layout makes it easy for a patient to find specific information about a topic, but also allows the reader to get a sense for the process from beginning through the post transplant care period in a real time sense. Along the way many terms are introduced and defined in the margin of the text for easy reference for the reader. This is a very welcome and helpful feature since the medical jargon is often overwhelming by itself in this field, although some terms are defined in the margin and others are only present in the glossary which may be somewhat confusing to the reader. The section on waiting for liver transplantation is most well done and of- fers helpful and encouraging information for patients during this difficult part of the liver transplant process. There are some specific statements that imply absolute conclusions that are more often only relative considera- tions that may be somewhat misleading for patients man- aged at centers other than Dr. Gordon’s. For example, in addressing patients with hepatocelluar cancer, the text implies that only patients meeting Milan Criteria can re- ceive a transplant. This is not exactly true since, in many areas, centers apply for organ allocation exceptions for pa- tients outside of Milan Criteria. There is another specific important misstatement regarding the MELD system on page 51 where it is stated that, ‘A person with a MELD score of 29 is ranked ahead of a person with a MELD score of 30’. In fact, the opposite is true; patients with MELD score of 30 are ranked ahead of patients with a MELD score of 29. In another area, the author states that living donor transplants are equal to, or even superior to, deceased donor transplantation. This may be true at the author’s center but this may not be the case for adult liv- ing donor liver recipients at all centers across the country. There are numerous other examples where the specifics described in this book may be different in other centers or areas, and clinicians may face questions from patients who have read this book where the descriptions within are different than what the individual center has described to the patient. In addition, pediatric liver transplantation is not addressed. These deficiencies notwithstanding, the scope, clear writ- ing and patient oriented approach make this a valuable con- tribution. There are very few patient-oriented texts that so concisely and thoroughly address the complexities of liver transplantation, including the waiting, organ allocation and specific surgical issues. Clinicians and centers that rec- ommend this text to their patients can temper their rec- ommendation by indicating that not everything described within is specific to their own practice, but the general in- formation is accurate and useful. Richard Freeman Tufts-New England Medical Center, Division of Transplantation, Box 40 750 Washington St. Boston, MA 02111 1872
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Transcript of Book Review
American Journal of Transplantation 2007; 7: 1872Blackwell Munksgaard
C© 2007 The AuthorsJournal compilation C© 2007 The American Society of
Transplantation and the American Society of Transplant Surgeons
doi: 10.1111/j.1600-6143.2007.01854.x
Book Review
100 Questions and Answers About Liver Transplantation
Frederic Gordon, Jones and Bartlett, 2007; 180p.
Educating patients about the complex world of liver trans-plantation remains one of the most important and difficultobligations transplant centers and care givers face today.In the first place, patients with chronic end-stage liver dis-ease are confronted with a progressively debilitating, uni-versally fatal disease. This alone is extremely difficult forpatients and their families to understand, cope with, andtreat. Complicating this already complicated situation, theliver transplantation treatment, also involves many uniqueproblems in its execution and in obtaining an organ. Navi-gating the organ allocation system, the potential for livingliver donation and its risks and benefits, along with the in-tensive and complex medical/surgical treatment involvedduring and after the liver transplant, requires a tremendousamount of education, self-study, and research on the partof the patient.
It is because of this difficult, multifaceted, educational taskthat Dr. Fred Gordon has written 100 Questions and An-swers about Liver Transplantation. The volume is very welllaid out and written in a question and answer style that is of-ten most helpful for patients seeking answers to their spe-cific questions. The information is also supplemented byan individual patient’s perspective who relates his own ex-periences along the liver transplantation process that lendsadditional ‘user friendliness’ to the piece.
The book covers a wide array of issues and areas relatedto liver transplantation that commonly surface for patientsduring the referral and evaluation process, and while wait-ing for their transplant. The manuscript is organized into10 sections covering ‘The Basics’, before liver transplanta-tion, organ allocation, the transplant surgery and afterward,among other topics. In addition, there is a section at theend reviewing living donor liver transplantation. This layoutmakes it easy for a patient to find specific information abouta topic, but also allows the reader to get a sense for theprocess from beginning through the post transplant careperiod in a real time sense. Along the way many terms areintroduced and defined in the margin of the text for easyreference for the reader. This is a very welcome and helpfulfeature since the medical jargon is often overwhelming byitself in this field, although some terms are defined in themargin and others are only present in the glossary which
may be somewhat confusing to the reader. The section onwaiting for liver transplantation is most well done and of-fers helpful and encouraging information for patients duringthis difficult part of the liver transplant process.
There are some specific statements that imply absoluteconclusions that are more often only relative considera-tions that may be somewhat misleading for patients man-aged at centers other than Dr. Gordon’s. For example, inaddressing patients with hepatocelluar cancer, the textimplies that only patients meeting Milan Criteria can re-ceive a transplant. This is not exactly true since, in manyareas, centers apply for organ allocation exceptions for pa-tients outside of Milan Criteria. There is another specificimportant misstatement regarding the MELD system onpage 51 where it is stated that, ‘A person with a MELDscore of 29 is ranked ahead of a person with a MELDscore of 30’. In fact, the opposite is true; patients withMELD score of 30 are ranked ahead of patients with aMELD score of 29. In another area, the author states thatliving donor transplants are equal to, or even superior to,deceased donor transplantation. This may be true at theauthor’s center but this may not be the case for adult liv-ing donor liver recipients at all centers across the country.There are numerous other examples where the specificsdescribed in this book may be different in other centersor areas, and clinicians may face questions from patientswho have read this book where the descriptions within aredifferent than what the individual center has described tothe patient. In addition, pediatric liver transplantation is notaddressed.
These deficiencies notwithstanding, the scope, clear writ-ing and patient oriented approach make this a valuable con-tribution. There are very few patient-oriented texts that soconcisely and thoroughly address the complexities of livertransplantation, including the waiting, organ allocation andspecific surgical issues. Clinicians and centers that rec-ommend this text to their patients can temper their rec-ommendation by indicating that not everything describedwithin is specific to their own practice, but the general in-formation is accurate and useful.
Richard FreemanTufts-New England Medical Center,Division of Transplantation, Box 40
750 Washington St.Boston, MA 02111
1872
