Regional review boards improve liver transplant allocation

The United Network for Organ Sharing (UNOS) currently utilizes scores based on the Model for End-Stage Liver Disease (MELD) or Pediatric End-Stage Liver Disease (PELD) to prioritize patients waiting for liver transplants. The MPS (MELD/PELD score) is a well-validated measure of short-term mortality from liver disease, however, referring physicians who believe a patient faces a greater mortality risk than predicted by the MPS can request accelerated listing.

Regional review boards can approve or deny these requests, and a new study published in the May 2004 issue of Liver Transplantation the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS) shows that these boards fairly and accurately distinguish between high and low risk patients. Their denials of physicians' requests for accelerated listings do not increase mortality for those patients. Liver Transplantation is published on behalf of the societies by John Wiley & Sons, Inc., and is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/livertransplantation.

To determine the effect of regional review board decisions on the mortality of physician-referred patients, researchers led by Michael D. Voigt of the University of Iowa, analyzed 1,965 nationwide referrals to UNOS regional review boards. They noted which cases were approved and which were denied, and gathered information about patient deaths while awaiting transplantation. They found that there was no significant difference in survival to transplantation whether accelerated listing was approved or denied for adult or pediatric cases.

Secondly, the researchers examined whether or not referring physicians predicted death better than the MPS. They found that the physicians had poor predictive capacity and added no additional information to

Contact: David Greenberg
John Wiley & Sons, Inc.

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