An opposing view to United States liver allocation problems with broader sharing

Area of Science:

• Transplantation Medicine
• Organ Allocation Policy
• Public Health

Background:

• The liver transplant community has debated broader organ sharing since 2014.
• Lung and heart transplantation have adopted broader sharing policies using "zones" or circles.
• The Organ Procurement and Transplantation Network (OPTN) approved broader kidney sharing in 2019.

Purpose of the Study:

• To address concerns regarding broader sharing in liver allocation.
• To examine the basis for broader sharing policies.
• To explore potential implications for liver transplantation outcomes and access.

Main Methods:

• Review of the Final Rule governing organ allocation.
• Analysis of concerns related to variability in organ donation rates.
• Examination of access to the liver transplant waiting list under new policies.

Main Results:

• Liver transplantation moved towards broader sharing, initially beyond the donor service area (DSA).
• A circle-based sharing policy, 'Acuity Circles,' replaced the initial proposal due to litigation.
• Implementation of the 'Acuity Circles' policy faced delays from April 2019 to February 2020.

Conclusions:

• Broader sharing in liver allocation presents complex challenges and requires careful consideration.
• Policies must address concerns about organ donation variability and equitable waiting list access.
• Ongoing evaluation is crucial to understand the impact of new sharing policies on liver transplantation.