2021 Clinical Update in Liver Transplantation

Beating Heart Transplants-Overview and Implications for Anesthesiologists

As the demand for heart allografts for transplantation continues to rise, ex vivo organ perfusion strategies are playing an increasingly important role in the preservation of organs from donation after circulatory death and extended-criteria donors. One such method uses the Organ Care System (TransMedics, Andover, MA). Traditionally, this technique of preservation requires 2 periods of warm ischemia and subsequent cardioplegic arrest. In a novel surgical technique pioneered at the authors' institution, heart allograft implantation no longer requires a second cardioplegic arrest. This article discusses the surgical approach for this procedure, the advantages and disadvantages of this approach, and analogs to current clinical practice to theorize what impact this may have on cardiac transplantation volumes in the future.

Publisher Accreditation Fails to Reflect Higher Content Quality in Liver Transplant YouTube Videos

INTRODUCTION

In 2021, the National Academy of Medicine began collaborating with YouTube to highlight high-quality channels for patients seeking medical information. This study evaluates whether YouTube videos from accredited publishers are useful for patients searching for information regarding liver transplantation.

METHODS

After searching "Liver Transplant" on YouTube, the first 100 results under 10 min long with English text or audio were transcribed. The Flesch-Kincaid grade level was used to quantify reading grade level. Viewership metrics and the accreditation status of the video publisher were identified. The DISCERN score was used to grade the quality of medical information. We adapted an informed consent curriculum for surgical interns to create an eight-point content metric that we coined the "Anderson-Lau score". Higher scores indicated higher content quality. Statistical significance was calculated using Wilcoxon rank-sum and chi-squared tests with a significance level of P = 0.05.

RESULTS

Of the 100 videos assessed, 37 met the average American reading level (8th grade) and none met the reading level of the average Medicare patient (5th grade). The median Flesch-Kincaid grade level was 9th grade. The median content ("Anderson-Lau") and quality (DISCERN) scores were 2/8 and 1/5, respectively. While 56% of videos mentioned operative indications and benefits, under 25% mentioned operative steps, risks, alternatives, and postoperative expectations. A total of 75 videos were from accredited publishers, and there was no significant difference between the quality of videos from accredited and unaccredited publishers.

CONCLUSIONS

Videos made by accredited sources regarding liver transplantation were not of higher educational quality or content. More informative educational materials are needed to advise patients about liver transplantation, help them understand the procedure, and to supplement discussions with their transplant team.