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Liver transplantation: evolving patient selection criteria.
1Department of Medicine, Stanford University Medical Center, Stanford, CA 94304-1509, USA.
Summary
Liver transplant waiting lists are growing due to organ shortages. A new scoring system, the Model for End-stage Liver Disease (MELD), will prioritize the sickest patients for organ allocation.
Area of Science:
- Hepatology
- Transplantation Medicine
- Public Health Policy
Background:
- Liver transplantation is a successful treatment for liver failure.
- Increasing referrals and a fixed organ supply have lengthened transplant waiting times.
- This disparity leads to increased deaths and sicker patients undergoing transplantation.
Purpose of the Study:
- To address the growing disparity between liver transplant candidates and donor organs.
- To reassess liver transplant selection and listing criteria.
- To revise organ allocation and distribution policies.
Main Methods:
- Development of minimal listing criteria for chronic liver disease based on cirrhosis decompensation.
- Continuous revision of allocation and distribution policies by the United Network for Organ Sharing.
- Likely implementation of the Model for End-stage Liver Disease (MELD) score.
Main Results:
- Nearly 5000 liver transplantations performed in the US in 2000, with over 17,000 on the waiting list.
- Reassessment of selection criteria and revision of organ allocation policies.
- Shift towards prioritizing the sickest patients using the MELD score.
Conclusions:
- The Model for End-stage Liver Disease (MELD) score will be implemented to determine disease severity.
- Donor organs will be directed to the sickest patients, not solely based on waiting time.
- This policy aims to optimize the utility of limited donor organs based on ethical principles.