Achilles A Demetriou Frederick D Watanabe

As we have repeatedly emphasized throughout this monograph, severe acute liver failure (SALF) is associated with very high morbidity and mortality and represents one of the most challenging problems in clinical medicine. Historically, when faced with complex clinical problems, the medical community responded by developing specialized, multidisciplinary, focused programs to manage them. This has resulted in the development of Burn Units for managing major burns, Trauma Centers for treating severely injured patients and other such specialized Units. The rationale behind this strategy has been that managing these challenging problems requires a team approach crossing multiple discipline boundaries, commitment of substantial institutional resources, availability of a wide patient referral base and recognition that it will result in improved clinical outcomes.

Team approach is essential due to the complexity of the underlying medical problem. Commitment of resources is needed because of the high level of severity of illness, need for specialized intensive care and sophisticated invasive monitoring, utilization of multiple diagnostic procedures and a variety of major surgical interventions. A wide patient referral base is essential to provide adequate numbers of patients so that a high level of expertise can be achieved. Positive impact of the specialized Unit on disease outcome will make possible continuing commitment of resources.

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