title: Advances in liver transplantation allocation systems.
abstract: With the growing number of patients in need of liver transplantation, there is a need for adopting new and modifying existing allocation policies that prioritize patients for liver transplantation. Policy should ensure fair allocation that is reproducible and strongly predictive of best pre and post transplant outcomes while taking into account the natural history of the potential recipients liver disease and its complications. There is wide acceptance for allocation policies based on urgency in which the sickest patients on the waiting list with the highest risk of mortality receive priority. Model for end-stage liver disease and Child-Turcotte-Pugh scoring system, the two most universally applicable systems are used in urgency-based prioritization. However, other factors must be considered to achieve optimal allocation. Factors affecting pre-transplant patient survival and the quality of the donor organ also affect outcome. The optimal system should have allocation prioritization that accounts for both urgency and transplant outcome. We reviewed past and current liver allocation systems with the aim of generating further discussion about improvement of current policies.
authors.affiliation: Michael L Schilsky, Departments of Medicine (Digestive Diseases) and Surgery (Transplantation and Immunology), Yale University Medical Center, New Haven, CT 06520, United States.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Schilsky
authors.affiliation: Michael L Schilsky, Departments of Medicine (Digestive Diseases) and Surgery (Transplantation and Immunology), Yale University Medical Center, New Haven, CT 06520, United States.
authors.forename: Maryam
authors.initials: M
authors.lastname: Moini
mesh_terms: D003661:Decision Support Techniques; D003695:Delivery of Health Care / Q000458:organization & administration*; D046148:Donor Selection; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D054625:Healthcare Disparities; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017146:Models, Organizational; D018579:Patient Selection; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D016896:Treatment Outcome; D014850:Waiting Lists
keywords: Allocation; Liver; Model for end-stage liver disease; Transplantation