Family-centered decision making in living liver transplantation: Analyzing the tripartite physician-patient-family model in Taiwan.

Abstract

Introduction: Living donor liver transplantation (LDLT) necessitates effective shared decision making (SDM) to ensure optimal outcomes. Traditional models focus on the physician-patient dyad; however, in Taiwan, family involvement is integral to the decision-making process. This study addresses the gap by proposing a tripartite model that incorporates physicians, patients, and family members to capture the cultural nuances influencing LDLT decisions.

Method: A retrospective chart review was conducted on 105 LDLT cases from the Transplant Surgery Department at National Cheng Kung University Hospital (2015-2022). The study employed thematic analysis to examine qualitative data extracted from medical records, including medical, psychiatric, and social evaluations, thereby identifying key themes in the decision-making process.

Results: Analysis revealed that LDLT decision making in Taiwan is predominantly family-centered. Three main themes emerged: the initiation of SDM by physicians and primary caregivers, a comprehensive risk assessment process integrating both clinical and psychosocial perspectives, and a final decision-making stage driven by collective family consensus. These findings highlight the complex interplay between medical factors and familial dynamics in donor selection and transplant outcomes.

Discussion: The study extends traditional binary decision-making models by highlighting the critical role of family involvement in LDLT. The tripartite framework not only reflects Taiwan's cultural context but also offers valuable insights for improving clinical practices and health care policies. Integrating family-centered approaches into SDM processes may enhance patient safety, promote ethical practices, and ultimately lead to better transplant outcomes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).