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Donor livers not consistently allocated according to medical need

A new study suggests that donor livers are not always distributed according to a patient's need, but may be retained by some organ procurement organizations with smaller waiting lists and transplanted into less sick patients, according to a study in the April 21 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, the Model for Endstage Liver Disease (MELD) score was implemented in February 2002 to serve as the basis for the liver allocation system used by the United Network for Organ Sharing. The MELD score is an objective scoring system of medical characteristics predictive of prognosis, with minimal emphasis on waiting time as a priority for transplantation. However, recommendations to increase and standardize the size of the area of organ allocation has not been implemented. Consequently, there is great disparity in the patient populations served by organ procurement organizations (OPOs) across the country. In some regions of the United States, an OPO may serve as few as 1.2 million people, whereas in other areas, the population covered by the OPO is nearly 18 million. The smallest OPO has fewer than 10 patients listed for liver transplantation, whereas the largest has more than 2000.

James F. Trotter, M.D., and Michael J. Osgood, B.S., of the University of Colorado Health Sciences Center, Denver, conducted a study to determine whether there is a difference in MELD scores for liver transplant recipients receiving transplants in small vs. large OPOs. The researchers reviewed data from the U.S. Scientific Registry of Transplant Recipients between February 28, 2002, and March 31, 2003. Transplant recipients (n=4,798) had end-stage liver disease and received deceased-donor (DD) livers. The authors examined MELD score distribution (range, 6-40), graft survival, and patient survival for liver transplant recipients in small (less than 100) and large (100 or greater on the waiting list) O
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Contact: Dana Berry
303-315-5571
JAMA and Archives Journals
20-Apr-2004


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