Model for end-stage liver disease: impact of the new deceased donor liver allocation policy in São Paulo, Brazil.
Since 1997, organ transplantation in Brazil has been regulated by a federal law, which was created to guarantee equal access to treatment on a national scale. Centralized deceased donor organ procurement and sharing are controlled by the Health Department of each state of the nation, following a regional allocation policy. In São Paulo, time on the waiting list was the main criterion adopted to allocate deceased donor livers up to July 15, 2006. After that, model for end-stage liver disease/pediatric end-stage liver disease (MELD/PELD) scores were the main criteria. The aim of this study was to investigate the impact of the new criteria on patient survival rates using 895 consecutive liver recipients. The 1-year patient survival rates were compared between recipients transplanted based on the waiting time policy and based on MELD/PELD scores showing similar results (69.79% vs 66.69%; P = NS). Regarding liver allocation based on MELD/PELD scores, worse survival outcomes were observed among recipients transplanted with higher MELD scores. Also, under the new criteria, a high frequency of hepatocellular carcinoma and pediatric recipients underwent transplantation.
Monteiro
F
F
São Paulo Organ Allocation System, Health Secretariat of São Paulo, São Paulo, Brazil. ctrans@saude.sp.gov.br
Coria
S A
SA
Boni
R
R
Pereira
L A
LA
D000328:Adult; D002102:Cadaver; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D002648:Child; D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D040841:Resource Allocation; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors; D014019:Tissue Donors; D014850:Waiting Lists