Update on Organ Allocation and Liver Transplantation

Liver transplantation remains a lifesaving intervention for patients with end-stage liver disease; however, organ demand continues to far exceed the supply. The core ethical principles that guide scarce resource allocation include utility, equity, and prioritization of the sickest patients. Implementation of national organ allocation and distribution policy updates over the years have led to several positive changes, including earlier transplant of livers from sicker patients and decreased waitlist mortality rates. Current practices include utilization of the Model for End-Stage Liver Disease score to determine waitlist priority, with distribution protocols involving the use of the acuity circle model. Despite these improvements, geographic and socioeconomic disparities remain. This article reviews the history of liver allocation and distribution practices, the successes and challenges of current policies, and future frameworks aimed at providing equitable approaches to matching donors with candidates.