Systematic bias in surgeons' predictions of the donor-specific risk of liver transplant graft failure

The decision to accept or decline a liver allograft for a patient on the transplant waiting list is complex. We hypothesized that surgeons are not accurate at predicting donor-specific risks. Surgeon members of the American Society of Transplant Surgeons were invited to complete a survey in which they predicted the 3-year risk of graft failure for a 53-year-old man with alcoholic cirrhosis and a Model for End-Stage Liver Disease score of 21 with a liver from (1) a 30-year-old local donor with traumatic brain death or (2) a 64-year-old regional donor with brain death from a stroke. Complete responses were obtained from 201 surgeons, whose self-reported case volume represents the majority of liver transplants in the United States. The surgeon-predicted 3-year risk of graft failure varied widely (more than 10-fold). In scenario 1, 90% of the respondents provided lower estimates of the graft failure risk than the literature-derived estimate of 21% (P < 0.001). In scenario 2, 96% of the responses were lower than the literature-derived estimate of 40% (P < 0.001). In conclusion, transplant surgeons vary widely in their predictions of the donor-specific risk of graft failure, and they demonstrate a systematic bias toward inaccurately low estimates of graft failure, particularly for higher risk organs.