The Evolution of Organ Allocation for Liver Transplantation: Tackling Geographic Disparity Through Broader Sharing.

The liver transplant allocation system has evolved to a ranking system of “sickest-first” system based on objective criteria. Yet, organs continue to be distributed first within OPOs and regions that are largely based on historical practice patterns related to kidney transplantation and were never designed to minimize waitlist death or equalize opportunity for liver transplant. The current proposal is a move to enhance survival though the application of modern mathematical techniques to optimize liver distribution. Like MELDbased allocation, it will never be perfect and should be continually evaluated and revised. However, the disparity in access, which favors those residing in or able to travel to privileged areas, to the detriment of the patients dying on the list in underserved areas, is simply not defensible in 2015.

[1]  J. Trotter,et al.  Development of the allocation system for deceased donor liver transplantation. , 2005, Clinical medicine & research.

[2]  T. Starzl.  History of Clinical Transplantation , 2000, World Journal of Surgery.

[3]  A. Israni,et al.  OPTN/SRTR 2013 Annual Data Report: Liver , 2015, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[4]  R. Wiesner,et al.  Summary report of a national conference: Evolving concepts in liver allocation in the MELD and PELD era , 2004, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[5]  R. Wolfe,et al.  The Survival Benefit of Liver Transplantation , 2005, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[6]  Kara E MacLeod,et al.  The interaction among donor characteristics, severity of liver disease, and the cost of liver transplantation , 2011, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[7]  M. Schnitzler,et al.  Addressing Geographic Disparities in Liver Transplantation Through Redistricting , 2013, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[8]  J. Kalbfleisch,et al.  Survival Benefit‐Based Deceased‐Donor Liver Allocation , 2009, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[9]  Parsia A Vagefi,et al.  Multiple listings as a reflection of geographic disparity in liver transplantation. , 2014, Journal of the American College of Surgeons.

[10]  R. Merion,et al.  Rates of solid-organ wait-listing, transplantation, and survival among residents of rural and urban areas. , 2008, JAMA.

[11]  M. Schnitzler,et al.  Following the Organ Supply: Assessing the Benefit of Inter-DSA Travel in Liver Transplantation , 2013, Transplantation.

[12]  J. Roberts,et al.  Decadal analysis of deceased organ donation in Spain and the United States linking an increased donation rate and the utilization of older donors , 2013, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[13]  Parsia A Vagefi,et al.  Use of living donor liver transplantation varies with the availability of deceased donor liver transplantation , 2012, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[14]  J. Markmann,et al.  Geographic Inequity in Access to Livers for Transplantation , 2010, Transplantation.

[15]  Harry J. Paarsch,et al.  Center competition and outcomes following liver transplantation , 2013, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[16]  B. Caffo,et al.  MELD Exceptions and Rates of Waiting List Outcomes , 2011, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.