Abstract
The equitable allocation of deceased donor livers for transplantation is an important and contentious issue. The institution of liver allocation based on the Model for End-Stage Liver Disease (MELD) score has allowed prioritization to be based on an objective measure of illness. In addition, after institution of the MELD system, policy makers were now able to measure differences among patients, institutions, and geographical areas that are much less influenced by the artificial biases that waiting time introduced. A careful analysis of MELD scores <15 showed that patients face a greater mortality risk from the transplant procedure than from their liver disease without surgery. As a result, the organ allocation policy was changed such that regional sharing is now based on offering organs to candidates with MELD score ≥ 15 before local allocation to patients with MELD scores <15. Since the institution of the “Share 15” policy, the number of transplants performed in patients with high MELD score has increased, while the number of deaths on the transplant list has decreased.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Norman DJ. Allocation of livers for liver transplantation: Ethics and politics. Clin Liver Dis 1997; 1: 281–6.
Ellison MD, Edwards LB, Edwards EB, Barker CF. Geographic differences in access to transplantation in the United States. Transplantation 2003; 76:1389–94.
Schaffer RL 3rd, Kulkami S, Harper A, Millis JM, Cronin DC 2nd. The sickest first? Disparities with model for end-stage liver disease-based organ allocation: One region’s experience. Liver Transpl 2003; 9:1211–5.
Freeman RB, Wiesner RH, Roberts JP, McDiarmid SV, Dykstra D, Merion RM. SRTR report on the state of liver transplantation. Improving liver allocation: MELD and PELD. Am J Transpl 2004; 4(Suppl 9):114–31.
Trotter JF, Osgood MJ. MELD scores of liver transplant recipients according to size of waiting list. JAMA 2004; 291:1871–4.
Freeman RB, Edwards EB, Harper AM. Trends in MELD score and transplantation rates under the MELD system. Hepatology 2005; 42(Suppl 1):203A.
Meckler LA. States fight organ donation policy. AP wire service, July 14, 1998.
Organ Procurement and Transplantation: Assessing Current Policies and the Potential Impact of the DHHS Final Rule. 1999; Washington, DC: National Academy Press, p. 7.
Freeman RB, Harper AM, Edwards EB. Redrawing organ distribution boundaries: Results of a computer-simulated analysis for liver transplantation. Liver Transpl 2002; 8:659–66.
Freeman RB, Wiesner RH, Harper A, McDiarmid SV, Lake J, Edwards EB, Merion R, Wolfe R, Turcotte J, Teperman L. The new liver allocation system: Moving toward evidence-based transplantation policy. Liver Transpl 2002; 8:851–8.
Olthoff KM, Brown RS, DelMonico FL, Freeman RB, McDiarmid SV, Merion RM, Millis JM, Roberts JP, Shaked A, Wiesner RH, Lucey MR. Summary report of a national conference: Evolving concepts in liver allocation in the MELD/PELD era. Liver Transpl2004; 10(Suppl 2):A6–A22.
Merion RM. When is a patient too well and when is a patient too sick for a liver transplant? Liver Transpl 2004; 10(Suppl 2):S69–S73.
Merion RM, Schaubel DE, Dykstra DM, Freeman RB, Port FK, Wolfe RA. The survival benefit of liver transplantation. Am J Transpl 2005; 2:307–13.
See www.optn.org, policy 3.6.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2009 Humana Press, a part of Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Freeman, R.B. (2009). The Share 15 Rule. In: Trotter, J., Everson, G. (eds) Liver Transplantation. Clinical Gastroenterology. Humana Press. https://doi.org/10.1007/978-1-60327-028-1_5
Download citation
DOI: https://doi.org/10.1007/978-1-60327-028-1_5
Published:
Publisher Name: Humana Press
Print ISBN: 978-1-58829-793-8
Online ISBN: 978-1-60327-028-1
eBook Packages: MedicineMedicine (R0)