title: Model for end-stage liver disease: did the new liver allocation policy affect waiting list mortality?
abstract: 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.
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Austin
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Poulose
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Ray
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Arbogast
authors.forename: Irene D
authors.initials: ID
authors.lastname: Feurer
authors.forename: C Wright
authors.initials: CW
authors.lastname: Pinson
mesh_terms: 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