Model for end-stage liver disease: did the new liver allocation policy affect waiting list mortality?
OBJECTIVE
To examine the impact of the Model for End-stage Liver Disease (MELD) on waiting list mortality.


METHODS
Interrupted time series with a nominal inception point of the intervention on February 27, 2002.


METHODS
United Network for Organ Sharing Standard Transplant Analysis and Research file data from March 1, 1999, to July 30, 2004.


METHODS
All adult candidates on the waiting list for liver transplantation in the United States during the study period.


METHODS
Implementation of the MELD policy.


METHODS
Waiting list mortality, waiting time to transplantation, number of new registrants, and posttransplantation survival.


RESULTS
Although no preintervention trend was identified, the policy change was associated with an immediate effect of increasing waiting list mortality by 2.2 deaths per 1000 registrants per month (from approximately 11 to 13 deaths per 1000 registrants per month; 95% confidence interval [CI], 1.1 to 3.4; P = .001) followed by a postintervention decline in waiting list mortality over time (-0.09 death per 1000 registrants per month; 95% CI, -0.16 to -0.03; P <.001). An immediate effect of decreased waiting time was also noted (from approximately 294 to 250 days; -44.4 days; 95% CI, -77.1 to -11.7 days; P <.001), which reached a new, lower postintervention steady state. The intervention had no effect on the number of new registrants listed per month or on 3- and 6-month posttransplantation survival.


CONCLUSIONS
After an initial increase in waiting list mortality, the implementation of the MELD-based allocation policy was associated with an overall decline in waiting list mortality and time to transplantation.
Austin
Mary T
MT
Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Poulose
Benjamin K
BK
Ray
Wayne A
WA
Arbogast
Patrick G
PG
Feurer
Irene D
ID
Pinson
C Wright
CW
D000328:Adult; D005260:Female; D015276:Health Care Rationing / Q000331:legislation & jurisprudence*; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006297:Health Services Accessibility; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery*; D016031:Liver Transplantation / Q000331:legislation & jurisprudence*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D018579:Patient Selection; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000331:legislation & jurisprudence*; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists