Early changes in liver distribution following implementation of Share 35

Area of Science:

• Transplantation Science
• Organ Allocation Policy
• Hepatology

Background:

• The liver waitlist priority algorithm underwent a significant change in June 2013 with the implementation of Share 35.
• Share 35 prioritizes regional candidates with a Model for End-Stage Liver Disease (MELD) score ≥ 35 over local candidates with MELD < 35.

Purpose of the Study:

• To evaluate the impact of the Share 35 policy on liver distribution and patient mortality.
• To compare outcomes in the first 12 months post-implementation against an equivalent pre-Share 35 period.

Main Methods:

• Comparative analysis of liver transplant data before and after the Share 35 policy implementation.
• Assessment of changes in deceased-donor liver transplants (DDLTs) allocation, regional sharing, cold ischemia time (CIT), discard rates, and waitlist mortality.
• Statistical analysis to determine the significance of observed changes.

Main Results:

• The proportion of DDLTs allocated to recipients with MELD ≥ 35 increased significantly (23.1% to 30.1%).
• Regional sharing of livers increased, and sharing became less concentrated among specific centers.
• Waitlist mortality decreased by 30% for patients with MELD > 30, while discard rates decreased by 14%.
• No significant changes were observed in cold ischemia time or early post-transplant outcomes.

Conclusions:

• The Share 35 policy led to more liver transplants, reduced discards, and decreased waitlist mortality, particularly for critically ill patients.
• The policy improved organ distribution efficiency without compromising transplant quality or immediate post-transplant results.