Retrospective Cohort Study
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World J Transplant. Sep 18, 2025; 15(3): 101865
Published online Sep 18, 2025. doi: 10.5500/wjt.v15.i3.101865
Death after psychiatric contraindications to urgent liver transplant for paracetamol overdose
Olivia R E Impey, Jennifer D Baker, Roger S Smyth, Stephen G Potts
Olivia R E Impey, Hammersmith and Fulham Mental Health Unit, West London NHS Trust, London W6 8LN United Kingdom
Jennifer D Baker, Roger S Smyth, Stephen G Potts, Department of Psychological Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, United Kingdom
Co-first authors: Olivia R E Impey and Jennifer D Baker.
Author contributions: Impey ORE and Baker JD took part in data acquisition, analysis and interpretation, as well as critical appraisal and revision of each other's work throughout the writing period.They contributed equally to this article, and are the co-first authors of this manuscript. Impey ORE recorded results and discussed study findings; Baker JD led the introduction, methodology, and administrative requirements for submission, including ethics committee approval; Smyth RS and Potts SG led study conception and design, alongside acquisition of departmental data and calculation of results, and retained general oversight of the study and offered critical input throughout. All authors thoroughly reviewed and endorsed the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of NHS Lothian’s Caldicott office, approval No. CG/DF/2476.
Informed consent statement: Consent was not obtained from participants due to the retrospective nature of the study, however the presented data are anonymized and risk of identification is low.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Data sharing consent was not obtained from participants due to the retrospective nature of the study, however the presented data are aggregated and anonymised and the risk of identification is low.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Stephen G Potts, FRCPsych FRCPE, FRCSEd, Department of Psychological Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, United Kingdom. stephen.potts@nhs.scot
Received: September 28, 2024
Revised: February 20, 2025
Accepted: February 25, 2025
Published online: September 18, 2025
Processing time: 201 Days and 10.7 Hours
Core Tip

Core Tip: This is the first United Kingdom study to report the frequency of death in patients presenting with paracetamol overdose-related acute hepatic failure, who are declined urgent liver transplant because of psychiatric contraindications, despite their being otherwise medically suitable for transplant. We found that this occurs in almost 9% of patients assessed. Our results highlight the impact of psychiatric decision-making in this context, as well as the potential for inter-unit variability of patient outcomes that arises from the lack of standardised guidelines in this area.