title: The effects of Share 35 on the cost of liver transplantation.
abstract: On June 18, 2013, the United Network for Organ Sharing (UNOS) instituted a change in the liver transplant allocation policy known as "Share 35." The goal was to decrease waitlist mortality by increasing regional sharing of livers for patients with a model for end-stage liver disease (MELD) score of 35 or above. Several studies have shown Share 35 successful in reducing waitlist mortality, particularly in patients with high MELD. However, the MELD score at transplant has increased, resulting in sicker patients, more complications, and longer hospital stays. Our study aimed to explore factors, along with Share 35, that may affect the cost of liver transplantation. Our results show Share 35 has come with significantly increased cost to transplant centers across the nation, particularly in regions 2, 5, 10, and 11. Region 5 was the only region with a median MELD above 35 at transplant, and cost was significantly higher than other regions. Several other recipient factors had changes with Share 35 that may significantly affect the cost of liver transplant. While access to transplantation for the sickest patients has improved, it has come at a cost and regional disparities remain. Financial implications with proposed allocation system changes must be considered.
authors.affiliation: Department of Surgery, University of California San Diego, San Diego, CA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Berumen
authors.affiliation: Department of Surgery, University of California San Diego, San Diego, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Misel
authors.affiliation: Department of Hepatology, University of California San Diego, San Diego, CA, USA.
authors.forename: Irine
authors.initials: I
authors.lastname: Vodkin
authors.affiliation: Department of Surgery, University of California San Diego, San Diego, CA, USA.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Halldorson
authors.affiliation: Department of Surgery, University of California San Diego, San Diego, CA, USA.
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Mekeel
authors.affiliation: Department of Surgery, University of California San Diego, San Diego, CA, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Hemming
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017093:Liver Failure / Q000191:economics* / Q000601:surgery; D016031:Liver Transplantation / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000191:economics* / Q000592:standards*; D014850:Waiting Lists
keywords: MELD; Share 35; cost of liver transplant; health economics; regional liver sharing