Recipient and Donor Selection and Transplant Logistics: The US Perspective
Organ allocation for donor livers in the US follows an algorithm of medical urgency determined by 3-month mortality risk based on objective laboratory values that are included in the MELD score. However, in a significant proportion of waitlist patients (patients with HCC and non-cirrhotic patients) the 3-month mortality risk may not be reflected by standard laboratory tests accurately. Therefore, so called exceptional MELD points based on statistical mortality risk can be granted upon standard or non-standard request. Additionally, based on urgency, the prioritization of organ recipients is embedded in a framework of local and regional distribution, resulting in significant geographical discrepancies in the US with regard to waiting time and severity of disease at the time of transplant. Changes of the current allocation and distribution policies are evaluated but have to balance increased cold ischemia times and cost efficiency with equity. While the number of ‘standard...
KeywordsMELD score Child score Share 35 Waiting time Liver allocation Donor management
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