Organ allocation for liver-intestine candidates

1. Patients listed for combined liver and intestine transplantation have the highest waitlist mortality of any transplant candidates. 2. Liver-intestine candidates have higher mortality rates than other patients listed for liver transplantation at all model for end-stage liver disease (MELD) and pediatric end-stage liver disease (PELD) scores, sepsis rather than liver failure being the major cause of death in this group. 3. Increasing PELD scores appear to correlate with increasing waitlist mortality in patients awaiting combined liver and intestinal transplantation. 4. Present policy to increase MELD / PELD scores for liver-intestine patients by an additional estimated 10% mortality risk is an attempt to bridge the difference in waitlist mortality while maintaining the principle of allocating organs on the basis of disease severity. 5. Scheduled reevaluation of present allocation practices is essential to refine Organ Procurement and Transplantation Network United Network for Organ Sharing policy as it relates to patients in need of combined liver and intestinal transplantation.