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Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion

Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion

Published on: April 27, 2015

Liver sharing and organ procurement organization performance.

Sommer E Gentry¹, Eric K H Chow, Allan Massie

¹Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Mathematics, US Naval Academy, Baltimore, MD.

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

|January 6, 2015

Summary

The liver allocation system does not shift organs based on organ procurement organization (OPO) performance. Instead, liver distribution is driven by transplant demand, not OPO efficiency.

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Area of Science:

Transplantation research
Organ allocation systems
Public health policy

Background:

Debate exists regarding whether the liver allocation system favors certain organ procurement organizations (OPOs).
Previous models of OPO performance have not definitively addressed organ flow dynamics.
Understanding organ distribution is crucial for equitable and efficient transplantation.

Purpose of the Study:

To investigate the relationship between OPO performance metrics and net liver import.
To determine if the liver allocation system redistributes organs from high-performing to low-performing OPOs.
To identify factors influencing liver organ flow within the allocation system.

Main Methods:

Analysis of organ procurement organization (OPO) performance data from the Scientific Registry of Transplant Recipients.
Correlation analysis between net liver import and OPO performance metrics (observed to expected liver yield, liver donor conversion ratio).
Assessment of the association between net liver import and eligible deaths and incident listings (MELD score > 15).

Main Results:

No evidence found supporting the hypothesis that livers are transferred from better to poorer performing OPOs.
Eligible deaths were not significantly associated with net liver import.
Incident listings above a Model for End-Stage Liver Disease (MELD) score of 15 strongly correlated with net liver import, indicating demand drives distribution.

Conclusions:

Liver organ flow is primarily determined by transplant demand, specifically the number of patients with high MELD scores, rather than OPO performance.
The variation in OPO performance is considerably less than the variation in patient demand.
Efforts to improve OPO performance are important, but the current allocation system's organ flow is demand-driven.