Development of an Interactive Bioethics Training Module for Healthcare Providers Treating Patients Who Need Liver Transplant for Alcohol-associated Liver Disease

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PROJECT SUMMARY Alcohol-associated liver disease (ALD) accounts for nearly half of liver-related deaths in the United States and is the leading indication for liver transplant (LT). Historically, many transplant centers have required a 6-month alcohol abstinence period to qualify for a liver transplant. However, the subset of patients with ALD who have severe alcoholic hepatitis (SAH) are unlikely to survive 6 months, with 70-80% mortality in 3 months. A 6- month abstinence requirement limits access to LT for patients with SAH. Early liver transplantation (ELT), or the practice of proceeding with a transplant without waiting for a 6-month abstinence period, is the only life- saving treatment available for most patients with SAH. Since its introduction a decade ago, ELT for SAH has sparked debate on issues of fair and responsible allocation of scarce donor organs. Healthcare providers who treat patients with ALD have expressed conflicting feelings and moral distress about center-level ELT practices, particularly related to the selection process and post-transplant clinical care. Recent research data providing evidence of successful patient outcomes after ELT have not resolved healthcare providers’ moral distress, especially related to stigmatization of patients with alcohol use disorder and concerns about trustworthiness or deservingness. Healthcare providers’ perceptual schemas and unconscious biases are persistent barriers to the expansion and sustainment of ELT. To aid in the expansion of ELT nationally, ethics training for healthcare providers and research collaborators is needed. Bioethics educational interventions have been shown to alleviate moral distress, increase resilience, and empower healthcare workers to exercise moral agency. We will develop a novel, interactive training module that situates key bioethics concepts within real clinical practice and teaches foundations of ethical reasoning to help healthcare providers navigate moral distress related to ELT. We will use design-based research methodology to create an online training module that will include a) foundations of bioethics and ethical reasoning and their application to clinical scenarios in ELT b) self-reflexive exercises to examine unconscious biases and c) selectable instructional pathways tailored to the learner’s moral distress. The training module will be part of a larger endeavor to share resources, including an ethical framework (as outlined in the parent award) and educational materials, for transplant centers nationally. We envision this module to be the first in a series, culminating in a comprehensive and customizable online bioethics curriculum.