New Tiered Sharing Policy Suggested for Liver Transplants

Public forum recommends that changes be implemented in small steps to prevent disruption

THURSDAY, Sept. 15 (HealthDay News) -- An algorithm incorporating a national sharing policy with a tiered policy, such as the model for end-stage liver disease (MELD), may reduce the number of wait-list deaths and organ travel distances, according to a study published in the September issue of Liver Transplantation.

Kenneth Washburn, M.D., from the University of Texas Health Science Center in San Antonio, and colleagues addressed issues related to extending the broader and regional distribution of cadaveric liver allografts to all patients with a MELD score. Extensive evaluations, modeling, and discussions, including a public forum, were undertaken to produce a concept document.

The investigators found that modeling demonstrated several general findings for potential changes in the distribution system concerning travel distance and the number of organs used or shared outside the local area, and addressing geographic inequities. It was suggested that changes are implemented in small steps to prevent disruption of the current system. One suggested change is to use a tiered MELD sharing system, in which livers are shared regionally over a certain MELD score cut-off, rather than the concentric circle approach. This may result in reductions in the number of total deaths and shorter travel distances.

"We suggest that an algorithm incorporating a national 15 sharing policy and a tiered sharing policy (e.g., a MELD score of 35, 32, or 29) with a sharing threshold, would reduce the number of wait-list deaths with the least amount of additional sharing and with minimized travel distances for organs," the authors write.

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