Juan-Ignacio Marín

Is liver transplantation for intractable attacks of porphyria a viable treatment in a developing country

In a recent issue of HEPATOLOGY, Rush et al. reported a large retrospective cohort analysis regarding palliative care access for hospitalized patients. We read with interest the encouraging increase in utilization of palliative care specialist services. It was unsurprising that certain factors were associated with an increased rate of referral, not least among them the presence of hepatocellular carcinoma. In the United Kingdom, there has been a similarly identified need to improve access to palliative care for patients with liver disease. However, effective palliative care does not stop at the front door of the specialist center; it must extend into the community. Community care offers continuity for patients and has had success with simple interventions such as shared electronic patient records documenting an anticipatory care plan. This approach has been shown to improve important outcomes, including preferred place of final care for patients with liver disease. Although referral to specialist palliative care is often necessary, it is equally important to recognize the valuable anticipatory care planning and community palliative care already being delivered by patients’ personal physicians or general practitioners. Michael Patrick Johnston, M.B. Ch.B Iona Campbell, M.B. Ch.B Judith Morris, M.B. Ch.B Fiona Finlay, M.B. Ch.B Queen Elizabeth University Hospital, Glasgow Scotland, National Health Service United Kingdom