The sickest first? Disparities with model for end-stage liver disease-based organ allocation: One region’s experience

• DOI: 10.1053/jlts.2003.50192
• Publication Date: 2003-10-29T17:35:56Z
• Authors: Randolph L. Schaffer; Sanjay Kulkarni; Ann Harper; Michael J. Millis; David C. Cronin
• Keywords: Liver disease; Organ procurement

February 27, 2002, allocation of cadaver livers for transplantation changed from a waiting-time-based system to an evidence-based referred as the Model End-Stage Liver Disease (MELD). We reviewed data 1 11 United Network Organ Sharing regions determine impact MELD on in that region. The region interest (study region) consists three distinct geographic areas (referred Transplant Service Areas [TSAs]). Based information obtained Procurement and Transplantation States study region, following observations were made: (1) patients who received liver had higher mean median scores than recipients score, 25.1; median, 26.0; US 23.9; 24.0); (2) within TSAs with competing transplant programs performed at significantly score dominated by single center (TSA-1 27.3; TSA-2 26.6; TSA-3 21.3); this disparity persisted when transplantations hepatocellular carcinoma (HCC) excluded; (3) removed waiting list because death or being too sick have national average 25.4; 23.8). Overall, implementation resulted substantial increase number HCC, exceptions all reasons more common multiple centers. Despite MELD, there remains organ may accurately predict pretransplantation mortality, but it does not ensure equitable distribution. propose intraregional sharing based help limit disparities allocation.