title: The Evolution of Organ Allocation for Liver Transplantation: Tackling Geographic Disparity Through Broader Sharing.
abstract: The liver transplant allocation system has evolved to a ranking system of “sickest-first” system based on objective criteria. Yet, organs continue to be distributed first within OPOs and regions that are largely based on historical practice patterns related to kidney transplantation and were never designed to minimize waitlist death or equalize opportunity for liver transplant. The current proposal is a move to enhance survival though the application of modern mathematical techniques to optimize liver distribution. Like MELDbased allocation, it will never be perfect and should be continually evaluated and revised. However, the disparity in access, which favors those residing in or able to travel to privileged areas, to the detriment of the patients dying on the list in underserved areas, is simply not defensible in 2015.
authors.affiliation: *Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH †Department of Surgery, Massachusetts General Hospital, Boston, MA ‡Department of Surgery, University of California, San Francisco, CA.
authors.forename: David A
authors.initials: DA
authors.lastname: Axelrod
authors.forename: Parsia A
authors.initials: PA
authors.lastname: Vagefi
authors.forename: John P
authors.initials: JP
authors.lastname: Roberts
mesh_terms: D064591:Allografts / Q000600:supply & distribution*; D058625:End Stage Liver Disease / Q000453:epidemiology / Q000601:surgery*; D015276:Health Care Rationing / Q000458:organization & administration*; D054625:Healthcare Disparities / Q000458:organization & administration*; D006801:Humans; D016031:Liver Transplantation; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D014481:United States / Q000453:epidemiology