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Updated: Apr 12, 2026
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Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
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Liver sharing and organ procurement organization performance under redistricted allocation
Sommer E Gentry1,2, Eric K H Chow1, Allan Massie1,3
1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Summary
Optimized redistricting of liver allocation areas will not shift livers from high- to low-performing organ procurement organizations (OPOs). Simulations show redistribution aligns supply and demand, improving equity without compromising performance.
Area of Science:
- Transplantation science
- Health services research
- Organ allocation policy
Background:
- Geographic disparities exist in liver transplantation.
- Optimized redistricting aims to improve liver allocation equity.
- Concerns about performance shifts between organ procurement organizations (OPOs) exist.
Purpose of the Study:
- To evaluate the impact of optimized liver allocation redistricting on OPO performance.
- To determine if redistricting would cause a shift of livers from better- to poorer-performing OPOs.
- To assess the correlation between OPO net liver import and performance metrics under redistricting.
Main Methods:
- Liver simulated allocation modeling was used.
- Simulations covered a 5-year period of liver sharing.
- Scenarios included 4 or 8 optimized districts.
- OPO net liver import was correlated with performance metrics (observed to expected liver yield, donor conversion ratio), eligible deaths, and incident listings.
Main Results:
- No evidence suggested livers would flow from better- to poorer-performing OPOs.
- Simulations indicated a flow of livers from OPOs with excess eligible deaths to those with fewer.
- Livers would flow from OPOs with fewer incident listings to those with more, a pattern consistent with the current system.
Conclusions:
- Optimized redistricting is unlikely to negatively impact OPO performance.
- Redistricting is expected to align liver allocation with national supply and demand.
- The primary outcome of redistricting is reduced geographic inequity in liver distribution.
