TY - JOUR
T1 - Patient selection in an era of donor liver shortage
T2 - Current US policy
AU - Wiesner, Russell H.
PY - 2005/1/1
Y1 - 2005/1/1
N2 - In the past, organ allocation in the US was based on anecdotal experience, self-interest and the opinions of single centers, with little support in the way of scientific evidence, mathematical survival modeling or validation. As organ transplantation became more successful, and as disparity between the number of patients on the waiting list and available organs became larger, a more justifiable donor allocation scheme became necessary. The current allocation scheme for donor livers is based on the model for end-stage liver disease/pediatric end-stage liver disease, which was introduced in 2002 by the United Network for Organ Sharing. This new allocation system has improved accuracy for predicting pretransplant mortality. In addition, the number of liver transplantations has risen for almost all etiologic categories, most noticeably for patients with hepatocellular carcinoma. Fewer patients have been registered on the liver transplant waiting list and fewer have been removed from the list because they have died or become too sick for transplantation. So far, this new allocation system has been a success, but it does have its shortcomings, and even with improvements to the system, the use of the donor organ pool still needs to be optimized.
AB - In the past, organ allocation in the US was based on anecdotal experience, self-interest and the opinions of single centers, with little support in the way of scientific evidence, mathematical survival modeling or validation. As organ transplantation became more successful, and as disparity between the number of patients on the waiting list and available organs became larger, a more justifiable donor allocation scheme became necessary. The current allocation scheme for donor livers is based on the model for end-stage liver disease/pediatric end-stage liver disease, which was introduced in 2002 by the United Network for Organ Sharing. This new allocation system has improved accuracy for predicting pretransplant mortality. In addition, the number of liver transplantations has risen for almost all etiologic categories, most noticeably for patients with hepatocellular carcinoma. Fewer patients have been registered on the liver transplant waiting list and fewer have been removed from the list because they have died or become too sick for transplantation. So far, this new allocation system has been a success, but it does have its shortcomings, and even with improvements to the system, the use of the donor organ pool still needs to be optimized.
KW - Allocation
KW - Liver
KW - MELD
KW - PELD
KW - Transplant
UR - http://www.scopus.com/inward/record.url?scp=20444471977&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=20444471977&partnerID=8YFLogxK
U2 - 10.1038/ncpgasthep0070
DO - 10.1038/ncpgasthep0070
M3 - Review article
C2 - 16265097
AN - SCOPUS:20444471977
VL - 2
SP - 24
EP - 30
JO - Nature Reviews Gastroenterology and Hepatology
JF - Nature Reviews Gastroenterology and Hepatology
SN - 1759-5045
IS - 1
ER -