Development and outcomes of the French liver allocation system

Although most countries adopted the Model for End Stage Liver Disease (MELD) score for prioritization in liver transplantation, differences exist from country to country. The purpose of the review is to present the specificity of the French allocation policy.

Organ allocation in France is typically based on the MELD score and the distance between the donor and the recipient at a national level. Organs are offered to patients on a national basis, not to centers. Patients with hepatocellular carcinoma and α-fetoprotein score 2 or less receive extra points to have access to transplantation similar to that of patients with cirrhosis. A third category is represented by MELD exceptions where MELD score is inaccurate at predicting outcome. MELD exceptions include complications of cirrhosis such as refractory ascites and other conditions such as polycystic liver disease. The objective is to guarantee similar waiting list mortality and similar posttransplant outcomes for each of these categories.

The French allocation system has been created with MELD as reference for prioritization, but it also takes into account distance between the donor and the recipient. Patients with hepatocellular carcinoma and patients with MELD exceptions are prioritized to have a similar access to transplantation.