Dynamic impact of liver allocation policy change on donor utilization

Area of Science:

• Hepatology
• Transplant Surgery
• Public Health Policy

Background:

• Liver allocation policy was revised in February 2020 to decrease MELD score variance.
• The new policy replaced local allocation with "acuity circles."
• Understanding donor utilization shifts post-policy change is crucial.

Purpose of the Study:

• To assess the impact of the 2020 liver allocation policy change on donor utilization.
• To compare donor utilization patterns between low MELD (LM) and high MELD (HM) transplant centers before and after the policy revision.

Main Methods:

• Donors categorized as Ideal (I), Standard (S), and Non-Ideal (NI) based on characteristics like age, BMI, liver function, and DCD status.
• Donor utilization rates for I, S, and NI donors were analyzed pre- and post-policy change.
• Comparisons were made between LM centers (MMaT ≤ 28) and HM centers (MMaT > 28).

Main Results:

• National transplant volume increased post-policy change (67 to 74 transplants/center/year).
• LM centers significantly increased utilization of NI donors.
• HM centers significantly increased utilization of I and S donors.

Conclusions:

• The policy change led to increased transplant volumes nationally, with differential effects on donor type utilization between LM and HM centers.
• Some centers successfully increased transplant volume by broadening organ acceptance criteria and increasing use of all donor types, including DCD donors.
• Variations in donor utilization among centers can potentially counteract the intended effects of liver allocation policy reforms.