title: A decade of model for end-stage liver disease:  lessons learned and need for re-evaluation of allocation policies.
abstract: OBJECTIVE
  The model for end-stage liver disease (MELD) driven liver allocation system has been in place for 10 years now. Understanding what the driving forces were, what principles were developed and employed, and assessing how these have stood the test of time will help future policy makers further refine the system.
  
  
  RESULTS
  Prior to development of the MELD system, policymakers had limited data and organ allocation policy development was rarely systematic or evidence-based and was not necessarily centered on the patient. The MELD process focused on patient-specific variables and validation of the risk prediction models to be sure the system would function reasonably well across the spectrum of potential candidates and that it did not impose artificial categorizations of patients. In addition, the transplant community focused on assessing the effects of this policy change which was also something new.
  
  
  CONCLUSIONS
  Numerous publications since have reported outcomes for MELD-based liver allocation here in the United States and in many other areas around the world. Some of these reports have suggested changes to the MELD equation or other ways to adapt the system to more accurately reflect the need for transplant. The transparency that this type of system brings allows for much more rigorous assessment of results and for highlighting areas for improvement toward a more fair, equitable, and utilitarian system.
authors.affiliation: Department of Surgery, Dartmouth Hitchcock Medical Center, Dartmouth Medical School, Lebanon, New Hampshire, USA. Richard.b.freeman.jr@dartmouth.edu
authors.forename: Richard B
authors.initials: RB
authors.lastname: Freeman
mesh_terms: D058625:End Stage Liver Disease / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation; D008962:Models, Theoretical; D018579:Patient Selection; D011050:Policy Making; D012720:Severity of Illness Index; D009927:Tissue and Organ Procurement; D014481:United States