Faculty Collaboration Database

Failure to fully disclose during pretransplant psychological evaluation in alcoholic liver disease: a driving under the influence corroboration study. Liver Transpl 2008 Nov;14(11):1632-6

Date

11/01/2008

Pubmed ID

18975271

DOI

10.1002/lt.21574

Scopus ID

2-s2.0-57849123691 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

The prevention of recidivism in alcoholic liver disease is one of the aims of pretransplant psychological evaluation (PE). Failure to fully disclose the extent of alcohol use is evidence of ongoing alcoholism. Driving under the influence (DUI) represents objective evidence of alcohol abuse, but verifying DUIs through official records is not standard during PE. The aim of this study was to determine whether there was failure to fully disclose alcohol abuse on the part of patients on the basis of the Wisconsin Department of Transportation (DOT) DUI rate. Demographics, alcohol abuse/abstinence history, and DUIs admitted by the patient on PE were collected for 82 alcoholic patients with cirrhosis. The DOT was queried for DUIs before PE for all patients. Discrepancies between PE and DOT DUI numbers were evaluated and re-presented to the psychologist without identifiers. Psychosocial recommendation was then evaluated in light of DOT/PE DUI discrepancies. Six patients did not drive. The remaining 76 had 29 +/- 8 years of alcohol abuse and reported sobriety for 55 +/- 64 months before PE. Eighteen DUIs that were not originally admitted were discovered; 63% of DUIs occurred in the period during which patients claimed to be sober. Two patients had been rejected for transplant for other causes. Re-presenting the case to the psychologist with the new knowledge of DUIs would have prevented transplant clearance for the remaining 16 (21%, P = 0.000005 versus prior PE). In conclusion, official DUI records in prospective transplant candidates may identify patients who do not fully disclose the extent of their alcohol abuse and may be at risk for adverse outcomes.

Author List

Bajaj JS, Saeian K, Hafeezullah M, Franco J, Thompson A, Anderson R

Author

Kia Saeian MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Accidents, Traffic
Aged
Alcohol Drinking
Alcoholic Intoxication
Alcoholism
Female
Humans
Liver Diseases, Alcoholic
Liver Transplantation
Male
Middle Aged
Retrospective Studies
Tissue and Organ Procurement
Treatment Outcome
Truth Disclosure