Liver Transplantation for Quality as well as Quantity of Life

Implication for health policy/practice/research/medical education: Monitoring of quality of life after liver transplantation is a step toward patient centered care, but unfortunately a comprehensive and scientific instrument for this evaluation is not yet available. Background medical and mental condition of patients as well as social and economic support of the patients should be considered for developing this instrument. When we discuss various modalities of treatment, our aim is to measure the benefits. This benefit is usually defined as the years of saved life or increase the life expectancy in dreadful conditions. But life is not only the quantity. We know that the quality is even more important, but quantification of this outcome is not easy (1). There have been many proposed instruments for this aim. Now we know that as the quality of life is variously affected by the different diseases, we have to develop different quality measures for different diseases. This is especially more true for chronic diseases. Recipients of liver transplanta-tion are at risk of special problems for instance rejection, long term expensive treatments, increased risk of cancer and opportunistic infections, increased rate of cardiovas-cular diseases and renal dysfunction. However without transplantation, they would have died within 12 months when their Model of end stage liver disease (MELD) score have raised to higher than 13. To monitor the quality of life after transplantation we have to consider all of these aspects (2). Rule of culture, values, concerns and expectations from life in different cultures and even different stages of life should not be ignored when one consider the quality of life (3, 4). For instance, the quality of life for a Muslim may include her or his ability to go to mosque and pray which may not even discussed in other cultures. Sometimes expectations are not in line with medical advices and health life. Some people enjoy so much from smoking or other addiction that is considered a high quality of life in their opinion. However many aspects of quality of life is constant between peoples and cultures. Considering these backgrounds we should welcome the efforts of Tayebi and her colleagues in developing an instrument in measuring quality of life after liver transplantation in Iran (5). Their scientific research which is published in this issue of hepatitis monthly provided us with an instrument which could help clinicians as well as other health care providers for better care of …