Allocation of liver grafts worldwide - Is there a best system?
End Stage Liver Disease
/ surgery
Global Health
/ statistics & numerical data
Graft Survival
Humans
Liver Transplantation
/ methods
Needs Assessment
Patient Selection
Procedures and Techniques Utilization
/ standards
Resource Allocation
/ ethics
Tissue Donors
/ supply & distribution
Tissue and Organ Procurement
/ methods
Allocation
ELTR
Liver transplantation
MELD
Organ donation
UNOS
Journal
Journal of hepatology
ISSN: 1600-0641
Titre abrégé: J Hepatol
Pays: Netherlands
ID NLM: 8503886
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
11
01
2019
revised:
23
05
2019
accepted:
27
05
2019
pubmed:
15
6
2019
medline:
15
12
2020
entrez:
15
6
2019
Statut:
ppublish
Résumé
An optimal allocation system for scarce resources should simultaneously ensure maximal utility, but also equity. The most frequent principles for allocation policies in liver transplantation are therefore criteria that rely on pre-transplant survival (sickest first policy), post-transplant survival (utility), or on their combination (benefit). However, large differences exist between centers and countries for ethical and legislative reasons. The aim of this study was to report the current worldwide practice of liver graft allocation and discuss respective advantages and disadvantages. Countries around the world that perform 95 or more deceased donor liver transplantations per year were analyzed for donation and allocation policies, as well as recipient characteristics. Most countries use the model for end-stage liver disease (MELD) score, or variations of it, for organ allocation, while some countries opt for center-based allocation systems based on their specific requirements, and some countries combine both a MELD and center-based approach. Both the MELD and center-specific allocation systems have inherent limitations. For example, most countries or allocation systems address the limitations of the MELD system by adding extra points to recipient's laboratory scores based on clinical information. It is also clear from this study that cancer, as an indication for liver transplantation, requires special attention. The sickest first policy is the most reasonable basis for the allocation of liver grafts. While MELD is currently the standard for this model, many adjustments were implemented in most countries. A future globally applicable strategy should combine donor and recipient factors, predicting probability of death on the waiting list, post-transplant survival and morbidity, and perhaps costs. An optimal allocation system for scarce resources should simultaneously ensure maximal utility, but also equity. While the model for end-stage liver disease is currently the standard for this model, many adjustments were implemented in most countries. A future globally applicable strategy should combine donor and recipient factors predicting probability of death on the waiting list, post-transplant survival and morbidity, and perhaps costs.
Sections du résumé
BACKGROUND & AIMS
An optimal allocation system for scarce resources should simultaneously ensure maximal utility, but also equity. The most frequent principles for allocation policies in liver transplantation are therefore criteria that rely on pre-transplant survival (sickest first policy), post-transplant survival (utility), or on their combination (benefit). However, large differences exist between centers and countries for ethical and legislative reasons. The aim of this study was to report the current worldwide practice of liver graft allocation and discuss respective advantages and disadvantages.
METHODS
Countries around the world that perform 95 or more deceased donor liver transplantations per year were analyzed for donation and allocation policies, as well as recipient characteristics.
RESULTS
Most countries use the model for end-stage liver disease (MELD) score, or variations of it, for organ allocation, while some countries opt for center-based allocation systems based on their specific requirements, and some countries combine both a MELD and center-based approach. Both the MELD and center-specific allocation systems have inherent limitations. For example, most countries or allocation systems address the limitations of the MELD system by adding extra points to recipient's laboratory scores based on clinical information. It is also clear from this study that cancer, as an indication for liver transplantation, requires special attention.
CONCLUSION
The sickest first policy is the most reasonable basis for the allocation of liver grafts. While MELD is currently the standard for this model, many adjustments were implemented in most countries. A future globally applicable strategy should combine donor and recipient factors, predicting probability of death on the waiting list, post-transplant survival and morbidity, and perhaps costs.
LAY SUMMARY
An optimal allocation system for scarce resources should simultaneously ensure maximal utility, but also equity. While the model for end-stage liver disease is currently the standard for this model, many adjustments were implemented in most countries. A future globally applicable strategy should combine donor and recipient factors predicting probability of death on the waiting list, post-transplant survival and morbidity, and perhaps costs.
Identifiants
pubmed: 31199941
pii: S0168-8278(19)30339-3
doi: 10.1016/j.jhep.2019.05.025
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
707-718Investigateurs
Javier Lendoire
(J)
Oscar Imventarza
(O)
Michael Crawford
(M)
Wellington Andraus
(W)
Luiz Augusto Carneiro D'Albuquerque
(LAC)
Roberto Hernandez-Alejandro
(R)
M Katherine Dokus
(MK)
Koji Tomiyama
(K)
Shusen Zheng
(S)
Gabriel Jaime Echeverri
(GJ)
Pavel Taimr
(P)
Jiri Fronek
(J)
Marieke de Rosner-van Rosmalen
(M)
Serge Vogelaar
(S)
Mickael Lesurtel
(M)
Jean-Yves Mabrut
(JY)
Sanjay Nagral
(S)
Farzad Kakaei
(F)
Seyed Ali Malek-Hosseini
(SA)
Hiroto Egawa
(H)
Alan Contreras
(A)
Jaroslaw Czerwinski
(J)
Teresa Danek
(T)
Hugo Pinto-Marques
(H)
Sergey V Gautier
(SV)
Artem Monakhov
(A)
Espen Melum
(E)
Bo-Göran Ericzon
(BG)
Koo Jeong Kang
(KJ)
Myoung Soo Kim
(MS)
Patricia Sanchez-Velazquez
(P)
Christian Eugen Oberkofler
(CE)
Beat Müllhaupt
(B)
Michael Linecker
(M)
Dilmurodjon Eshmuminov
(D)
Lukasz Filip Grochola
(LF)
Zhoulon Song
(Z)
Patryk Kambakamba
(P)
Chao-Long Chen
(CL)
Mehmet Haberal
(M)
Sezai Yilmaz
(S)
Ian A C Rowe
(IAC)
Philipp Kron
(P)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.