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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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Changing Dynamics in Liver Allocation: Donor and Recipient Traits Pre- and Post Acuity Circle Implementation.

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Summary

The Acuity Circle (AC) liver transplant policy improved equity and reduced waitlist times by prioritizing disease severity. However, it also increased organ travel distances and cold ischemic times, indicating logistical challenges remain.

Keywords:
health disparitiesliverliver transplantmeld scoreorgan allocation

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Area of Science:

  • Organ transplantation research
  • Health policy analysis
  • Surgical outcomes research

Background:

  • The Acuity Circle (AC) allocation model was introduced in 2020 to mitigate geographic disparities in liver transplant access.
  • This policy aims to enhance equity and improve waitlist outcomes by prioritizing patients based on disease severity and reducing regional boundaries.

Purpose of the Study:

  • To evaluate the impact of the Acuity Circle (AC) allocation model on liver transplant metrics.
  • To compare donor and recipient characteristics before and after AC implementation.
  • To assess changes in geographic allocation patterns and transplant volumes.

Main Methods:

  • Analysis of liver transplant data from the National Standard Transplant Analysis and Research (STAR) file (February 2017 - February 2023).
  • Assessment of donor and recipient variables using chi-squared and t-tests.
  • Evaluation of geographic trends and transplant volume changes pre- and post-AC implementation.

Main Results:

  • Liver transplant volume increased by 10% post-AC implementation, with a significant shift towards national allocation.
  • Average donor-to-transplant center distance and cold ischemic time increased, while average waitlist time decreased.
  • Transplants for high-severity patients increased, reflected by a rise in MELD scores.

Conclusions:

  • The AC policy has altered transplant allocation, improved matching for medical urgency, and reduced waitlist times.
  • Increased cold ischemic times and travel distances present logistical challenges that require attention.
  • While early indicators suggest progress toward transplant equity, long-term effects and persistent geographic disparities warrant further investigation.