title: Liver Graft Allocation by Means of a New, Regionally Shared "Mixed" Model: The Experience in Lazio.
abstract: BACKGROUND
  Since 2013, the regional network of transplantation centers "LAZIO TRANSPLANT" have adopted a new, mixed system for the allocation of liver grafts.
  
  
  METHODS
  The organs from donors aged <65 are assigned to patients with higher Model for End-stage Liver Disease (MELD) scores on a common regional waiting list, whereas those from donors aged >65 are allocated to patients with higher MELD scores on a specific local waiting list (LWL) at each center, on a rotational basis.
  
  
  RESULTS
  The new mixed allocation model grants a more rational allocation of the "standard" organs to the patients with the actual worst MELD score in the entire region, avoiding the possibility that a patient in relatively better clinical condition might be transplanted before a more severely ill patient on another center's waiting list. Nonstandard organs, presenting slightly increased transplant risks, are still allocated on a rotational basis among the different transplant centers, ensuring them the possibility to select, on the basis of a global clinical risk evaluation, those patients in their LWL whose MELD score would not grant any possibility to compete for the "standard" organ allocation.
  
  
  CONCLUSIONS
  The application of the new model had no negative impact on the overall number of transplants performed or on the global list-satisfaction percentages, but has slightly improved the cumulative mortality of the patients in the waiting list, granting to the clinically worst patients a prompt graft allocation, independent of the local center belonging.
authors.affiliation: Centro Regionale Trapianti Lazio, Università "Tor Vergata", Rome, Italy. Electronic address: rafzac81@libero.it.
authors.forename: R
authors.initials: R
authors.lastname: Zaccaria
authors.affiliation: Centro Regionale Trapianti Lazio, Università "Tor Vergata", Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Teti
authors.affiliation: Centro Regionale Trapianti Lazio, Università "Tor Vergata", Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Mecule
authors.affiliation: Centro Regionale Trapianti Lazio, Università "Tor Vergata", Rome, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Torlone
authors.affiliation: Centro Regionale Trapianti Lazio, Università "Tor Vergata", Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Valeri
authors.affiliation: Centro Regionale Trapianti Lazio, Università "Tor Vergata", Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Adorno
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007558:Italy; D016031:Liver Transplantation / Q000592:standards / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D040841:Resource Allocation / Q000379:methods*; D012720:Severity of Illness Index; D009927:Tissue and Organ Procurement / Q000379:methods* / Q000592:standards; D014850:Waiting Lists