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In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
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Updated: Dec 26, 2025

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United States liver allocation.

Julie K Heimbach1

  • 1Division of Transplantation Surgery William J von Liebig Transplant Center, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Current Opinion in Organ Transplantation
|March 7, 2020
PubMed
Summary
This summary is machine-generated.

The US liver allocation system uses the Model for End-Stage Liver Disease (MELD) score. Recent changes, including the National Liver Review Board (NLRB), aim to improve fairness and reduce geographic disparities in liver transplants.

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Area of Science:

  • Organ transplantation
  • Medical policy
  • Public health

Background:

  • The United States liver allocation system has historically faced challenges with geographic disparities in access to transplants.
  • The Model for End-Stage Liver Disease (MELD) score is the primary metric for prioritizing liver transplant candidates.
  • Modifications to MELD and distribution policies are continually evaluated to optimize outcomes.

Purpose of the Study:

  • To review the current liver allocation system in the United States.
  • To discuss the implementation and impact of the National Liver Review Board (NLRB).
  • To examine the upcoming changes in liver allograft distribution, including the acuity circle model.

Main Methods:

  • Review of existing literature and policy documents related to liver allocation.
  • Analysis of the MELD score and its modifications.
  • Description of the NLRB's role and the acuity circle model for distribution.

Main Results:

  • The MELD score prioritizes patients based on their likelihood of death without a transplant.
  • The NLRB was implemented in May 2019, replacing the prior system.
  • The acuity circle model aims to broaden geographic sharing of donor livers to reduce disparities.

Conclusions:

  • The liver allocation system is undergoing significant optimization to improve equity.
  • The NLRB and the acuity circle model represent major shifts in liver distribution policy.
  • These changes are expected to reduce geographic disparities and improve access to liver transplantation.