The new liver allocation system: Moving toward evidence-based transplantation policy

Richard B. Freeman, Russell H. Wiesner, Ann Harper, Sue V. McDiarmid, Jack Lake, Erick Edwards, Robert Merion, Robert Wolfe, Jeremiah Turcotte, Lewis Teperman

Research output: Contribution to journalArticle

509 Citations (Scopus)

Abstract

In 1999, the Institute of Medicine suggested that instituting a continuous disease severity score that de-emphasizes waiting time could improve the allocation of cadaveric livers for transplantation. This report describes the development and initial implementation of this new plan. The goal was to develop a continuous disease severity scale that uses objective, readily available variables to predict mortality risk in patients with end-stage liver disease and reduce the emphasis on waiting time. Mechanisms were also developed for inclusion of good transplant candidates who do not have high risk of death but for whom transplantation may be urgent. The Model for End-Stage Liver Disease (MELD) and Pediatric End-Stage Liver Disease (PELD) scores were selected as the basis for the new allocation policy because of their high degree of accuracy for predicting death in patients having a variety of liver disease etiologies and across a broad spectrum of liver disease severity. Except for the most urgent patients, all patients will be ranked continuously under the new policy by their MELD/PELD score. Waiting time is used only to prioritize patients with identical MELD/PELD scores. Patients who are not well served by the MELD/PELD scores can be prioritized through a regionalized peer review system. This new liver allocation plan is based on more objective, verifiable measures of disease severity with minimal emphasis on waiting time. Application of such risk models provides an evidenced-based approach on which to base further refinements and improve the model.

Original languageEnglish (US)
Pages (from-to)851-858
Number of pages8
JournalLiver Transplantation
Volume8
Issue number9
DOIs
StatePublished - Sep 2002

Fingerprint

End Stage Liver Disease
Transplantation
Liver
Pediatrics
Liver Diseases
National Academies of Science, Engineering, and Medicine (U.S.) Health and Medicine Division
Peer Review
Liver Transplantation
Transplants
Mortality

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Freeman, R. B., Wiesner, R. H., Harper, A., McDiarmid, S. V., Lake, J., Edwards, E., ... Teperman, L. (2002). The new liver allocation system: Moving toward evidence-based transplantation policy. Liver Transplantation, 8(9), 851-858. https://doi.org/10.1053/jlts.2002.35927

The new liver allocation system : Moving toward evidence-based transplantation policy. / Freeman, Richard B.; Wiesner, Russell H.; Harper, Ann; McDiarmid, Sue V.; Lake, Jack; Edwards, Erick; Merion, Robert; Wolfe, Robert; Turcotte, Jeremiah; Teperman, Lewis.

In: Liver Transplantation, Vol. 8, No. 9, 09.2002, p. 851-858.

Research output: Contribution to journalArticle

Freeman, RB, Wiesner, RH, Harper, A, McDiarmid, SV, Lake, J, Edwards, E, Merion, R, Wolfe, R, Turcotte, J & Teperman, L 2002, 'The new liver allocation system: Moving toward evidence-based transplantation policy', Liver Transplantation, vol. 8, no. 9, pp. 851-858. https://doi.org/10.1053/jlts.2002.35927
Freeman RB, Wiesner RH, Harper A, McDiarmid SV, Lake J, Edwards E et al. The new liver allocation system: Moving toward evidence-based transplantation policy. Liver Transplantation. 2002 Sep;8(9):851-858. https://doi.org/10.1053/jlts.2002.35927
Freeman, Richard B. ; Wiesner, Russell H. ; Harper, Ann ; McDiarmid, Sue V. ; Lake, Jack ; Edwards, Erick ; Merion, Robert ; Wolfe, Robert ; Turcotte, Jeremiah ; Teperman, Lewis. / The new liver allocation system : Moving toward evidence-based transplantation policy. In: Liver Transplantation. 2002 ; Vol. 8, No. 9. pp. 851-858.
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