Liver transplantation: evolving patient selection criteria.

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.