Liver Allograft Allocation and Distribution: Toward a More Equitable System

Abstract The liver allocation system in the USA has undergone an evolution during the last 25 years from one largely based on waiting time to one based on disease severity. Utilizing the Model for End-stage Liver Disease (MELD) score resulted in objectively ordering the waitlisted candidates in a “sickest first” manner. However, the geographic boundaries that define the 58 donor service areas, which define the area of distribution of organ donors, as well as the MELD exception policies (particularly related to hepatocellular carcinoma) have created inequity in the organ allocation system such that patients that reside in a certain geographic location, or patients with certain diagnoses, experience differential access to liver allografts. Addressing and improving these inequities involve complex and controversial actions and thus remain a difficult charge. The following discussion includes the history of liver allocation, the changes in policies that have been recently implemented, and where distribution policies may be headed in the future.
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research