Model for end-stage liver disease exceptions committee activity in Argentina: does it provide justice and equity among adult patients waiting for a liver transplant?
BACKGROUND
In 2005, the model of end-stage liver disease (MELD)-based allocation system was adopted to assess potential liver transplant (LT) recipients in Argentina. The aim of the present study was to revise the activity of the MELD Exception Experts Committee.


METHODS
Between 2005 and 2009, 1623 patients were listed for LT. Regulation provides extra-MELD points for amyloidosis, hepatopulmonary syndrome (HPS) and T(2) hepatocellular carcinoma (T(2) HCC). Centres could also request priority for other situations. Using a prospective database, we identified patients in whom priority points were requested. Pathology reports of explanted livers were analysed for patients with T(2) HCC.


RESULTS
From 234 out of 1623 (14.4%) requests, the overall approval rate was 60.2% including: 2 amyloidosis, 6 HPS, 111 T(2) HCC and 22 non-regulated situations. Of the 111 patients with T(2) HCC, 6 died (5.4%), 8 had tumour progression (7.2%), 94 were transplanted (84.2%) and 3 are still waiting. An explants correlation showed that presumed diagnosis of T(2) HCC was incorrect in 20/94 (22%) and was correct in only 41/94 (43%) cases being T(1) HCC in 9 and T(3) HCC in 23.


CONCLUSIONS
MELD exceptions are frequently requested in Argentina. Unfortunately, most receiving priority points for T(2) HCC benefited by medical error or imaging limitations. An intense review process is urgently needed to maintain equity and justice in the allocation system.
McCormack
Lucas
L
Liver Transplant Unit, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina. lmccormack@hospitalaleman.com
Gadano
Adrián
A
Lendoire
Javrer
J
Quiñonez
Emilio
E
Imventarza
Oscar
O
Andriani
Oscar
O
Toselli
Lorenzo
L
Gil
Octavio
O
Gondolesi
Gabriel
G
Bisigniano
Liliana
L
De Santibañes
Eduardo
E
D000293:Adolescent; D000328:Adult; D026683:Advisory Committees; D000368:Aged; D001118:Argentina; D016009:Chi-Square Distribution; D003951:Diagnostic Errors; D005260:Female; D015276:Health Care Rationing; D006305:Health Status Indicators; D054625:Healthcare Disparities; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult