Allocation of liver grafts worldwide – Is there a best system?

[Display omitted] •An optimal allocation system for scarce resources should simultaneously ensure maximal utility, but also equity.•Large differences exist between centers and countries for ethical and legislative reasons.•A future globally applicable strategy should combine donor and recipient fact...

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Published in:	Journal of hepatology Vol. 71; no. 4; pp. 707 - 718
Main Authors:	Tschuor, Christoph, Ferrarese, Alberto, Kuemmerli, Christoph, Dutkowski, Philipp, Burra, Patrizia, Clavien, Pierre-Alain, Lendoire, Javier, Imventarza, Oscar, Crawford, Michael, Andraus, Wellington, D'Albuquerque, Luiz Augusto Carneiro, Hernandez-Alejandro, Roberto, Dokus, M. Katherine, Tomiyama, Koji, Zheng, Shusen, Echeverri, Gabriel Jaime, Taimr, Pavel, Fronek, Jiri, de Rosner-van Rosmalen, Marieke, Vogelaar, Serge, Lesurtel, Mickael, Mabrut, Jean-Yves, Nagral, Sanjay, Kakaei, Farzad, Malek-Hosseini, Seyed Ali, Egawa, Hiroto, Contreras, Alan, Czerwinski, Jaroslaw, Danek, Teresa, Pinto-Marques, Hugo, Gautier, Sergey V., Monakhov, Artem, Melum, Espen, Ericzon, Bo-Göran, Kang, Koo Jeong, Kim, Myoung Soo, Sanchez-Velazquez, Patricia, Oberkofler, Christian Eugen, Müllhaupt, Beat, Linecker, Michael, Eshmuminov, Dilmurodjon, Grochola, Lukasz Filip, Song, Zhoulon, Kambakamba, Patryk, Chen, Chao-Long, Haberal, Mehmet, Yilmaz, Sezai, Rowe, Ian A.C., Kron, Philipp
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier B.V 01.10.2019 Elsevier Science Ltd
Subjects:	Allocation ELTR End Stage Liver Disease - surgery Global Health - statistics & numerical data Graft Survival Humans Liver Liver diseases Liver transplantation Liver Transplantation - methods Liver Transplantation - standards Liver Transplantation - statistics & numerical data MELD Morbidity Needs Assessment Organ donation Patient Selection Procedures and Techniques Utilization - standards Procedures and Techniques Utilization - statistics & numerical data Resource Allocation - ethics Resource Allocation - legislation & jurisprudence Resource Allocation - organization & administration Survival Tissue and Organ Procurement - methods Tissue and Organ Procurement - organization & administration Tissue and Organ Procurement - supply & distribution Tissue Donors - supply & distribution Transplants & implants UNOS Organ donation UNOS Allocation MELD ELTR Liver transplantation
ISSN:	0168-8278, 1600-0641, 1600-0641
Online Access:	Get full text
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Summary:	[Display omitted] •An optimal allocation system for scarce resources should simultaneously ensure maximal utility, but also equity.•Large differences exist between centers and countries for ethical and legislative reasons.•A future globally applicable strategy should combine donor and recipient factors.•This strategy must predict probability of death on the waiting list, post-transplant survival and morbidity, and costs. An optimal allocation system for scarce resources should simultaneously ensure maximal utility, but also equity. The most frequent principles for allocation policies in liver transplantation are therefore criteria that rely on pre-transplant survival (sickest first policy), post-transplant survival (utility), or on their combination (benefit). However, large differences exist between centers and countries for ethical and legislative reasons. The aim of this study was to report the current worldwide practice of liver graft allocation and discuss respective advantages and disadvantages. Countries around the world that perform 95 or more deceased donor liver transplantations per year were analyzed for donation and allocation policies, as well as recipient characteristics. Most countries use the model for end-stage liver disease (MELD) score, or variations of it, for organ allocation, while some countries opt for center-based allocation systems based on their specific requirements, and some countries combine both a MELD and center-based approach. Both the MELD and center-specific allocation systems have inherent limitations. For example, most countries or allocation systems address the limitations of the MELD system by adding extra points to recipient’s laboratory scores based on clinical information. It is also clear from this study that cancer, as an indication for liver transplantation, requires special attention. The sickest first policy is the most reasonable basis for the allocation of liver grafts. While MELD is currently the standard for this model, many adjustments were implemented in most countries. A future globally applicable strategy should combine donor and recipient factors, predicting probability of death on the waiting list, post-transplant survival and morbidity, and perhaps costs. An optimal allocation system for scarce resources should simultaneously ensure maximal utility, but also equity. While the model for end-stage liver disease is currently the standard for this model, many adjustments were implemented in most countries. A future globally applicable strategy should combine donor and recipient factors predicting probability of death on the waiting list, post-transplant survival and morbidity, and perhaps costs.
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ISSN:	0168-8278 1600-0641 1600-0641
DOI:	10.1016/j.jhep.2019.05.025