Advances in liver transplantation allocation systems.
With the growing number of patients in need of liver transplantation, there is a need for adopting new and modifying existing allocation policies that prioritize patients for liver transplantation. Policy should ensure fair allocation that is reproducible and strongly predictive of best pre and post transplant outcomes while taking into account the natural history of the potential recipients liver disease and its complications. There is wide acceptance for allocation policies based on urgency in which the sickest patients on the waiting list with the highest risk of mortality receive priority. Model for end-stage liver disease and Child-Turcotte-Pugh scoring system, the two most universally applicable systems are used in urgency-based prioritization. However, other factors must be considered to achieve optimal allocation. Factors affecting pre-transplant patient survival and the quality of the donor organ also affect outcome. The optimal system should have allocation prioritization that accounts for both urgency and transplant outcome. We reviewed past and current liver allocation systems with the aim of generating further discussion about improvement of current policies.
['Schilsky|Michael L|ML|', 'Moini|Maryam|M|']
D003661:Decision Support Techniques D003695:Delivery of Health Care D046148:Donor Selection D058625:End Stage Liver Disease D054625:Healthcare Disparities D006801:Humans D016031:Liver Transplantation D017146:Models, Organizational D018579:Patient Selection D011237:Predictive Value of Tests D018570:Risk Assessment D012307:Risk Factors D014019:Tissue Donors D009927:Tissue and Organ Procurement D016896:Treatment Outcome D014850:Waiting Lists
Liver Transplantation Allocation Model for end-stage liver disease