Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Mar;12(3):166-70.

Current Status of Liver Allocation in the United States

Saleh Elwir  1 , John Lake  1
Affiliations

Current Status of Liver Allocation in the United States

Saleh Elwir et al. Gastroenterol Hepatol (N Y). 2016 Mar.

Abstract

The liver transplant allocation system is currently based upon the Model for End-Stage Liver Disease (MELD) score and allocates organs preferentially to patients with the highest scores (ie, the sickest patients) within a defined geographic unit. In addition, certain patient populations, such as patients with hepatocellular carcinoma and portopulmonary hypertension, receive MELD exception points to account for their increased waitlist mortality, which is not reflected by their MELD score. Significant geographic variation in the access to liver transplantation exists throughout the United States. Both the Organ Procurement and Transplant Network Board of Directors and the Health Resources and Services Administration have determined these geographic disparities to be unacceptable. The liver transplant community has worked to develop methods to reduce these geographic disparities and to reexamine how MELD exception points are granted to certain patient populations. As a result, numerous policy changes have been adopted throughout the years that have broadened the sharing of organs through wider geographic sharing. Despite all of these changes, variation in access to liver transplantation continues to exist, and, thus, the liver transplant community continues to examine new ways to address geographic disparities. This paper reviews several of the key changes to the liver allocation system that have occurred since the implementation of MELD allocation in 2002 and provides an overview of potential changes to the system.

Keywords: Liver transplantation; Model for End-Stage Liver Disease; allocation; geographic discrepancy; hepatocellular carcinoma.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Proposed 4-district distribution model for liver allocation.
Figure 2.
Figure 2.
Proposed 8-district distribution model for liver allocation.
See this image and copyright information in PMC

References

    1. Institute of Medicine (US) Committee on Organ Procurement and Transplantation Policy. Organ Procurement and Transplantation: Assessing Current Policies and the Potential Impact of the DHHS Final Rule. Washington, DC: National Academies Press; 1999. - PubMed
    1. Freeman RB, Jr, Wiesner RH, Harper A, et al. UNOS/OPTN Liver Disease Severity Score, UNOS/OPTN Liver and Intestine, and UNOS/OPTN Pediatric Transplantation Committees. The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transpl. 2002;8(9):851–858. - PubMed
    1. Washburn K, Pomfret E, Roberts J. Liver allocation and distribution: possible next steps. Liver Transpl. 2011;17(9):1005–1012. - PubMed
    1. OPTN/UNOS Liver and Intestinal Organ Transplantation Committee. Redesigning liver distribution to reduce variation in access to liver transplantation. [February 8, 2016]. https://optn.transplant.hrsa.gov/contentdocuments/liver_concepts_20l4.pdf
    1. Yeh H, Smoot E, Schoenfeld DA, Markmann JF. Geographic inequity in access to livers for transplantation. Transplantation. 2011;91(4):479–486. - PMC - PubMed

LinkOut - more resources