Background: In June 2013, U.S. liver allocation changed from a local-regional-national model to “Share 35”, broadening sharing to a regional level based upon recipient listed MELD score. With the inception of Share 35, one organ procurement organization (OPO) perceived an increase in the frequency with which livers were initially accepted only to be declined during the surgical recovery or immediately post recovery, thereby requiring reallocation.

Method: In an effort to better understand the impact of Share 35 on liver reallocation, the OPO performed a retrospective review of all deceased donor livers recovered in two cohorts, one 28.5 month cohort between 6/15/2013 and 10/31/2015 (post-Share 35) and one 21.5 month cohort between 9/1/2011 and 6/14/2013 (pre-Share 35). Liver recovery, allocation, and utilization data were compared.

Results: Pre-Share 35 (Pre), 167 deceased donors or 7.77/month were recovered by the OPO. Post-Share 35 (Post) donors increased dramatically to 342 total or 12.00/month (+54.49%). Transplanted livers (TXL) increased 49.57% from 115 or 5.35/month Pre to 228 TXL or 8.00/month Post. TXL shared regionally increased from 17.39% Pre to 47.81%; national sharing increased from 5.22% Pre to 10.97% Post. TXL turned down by the primary center during or after surgical recovery and subsequently reallocated/transplanted increased from 8 (6.96% of all TXL) to 25 (10.97% of all TXL). The subset of reallocated livers which where “expedited” after primary and backup centers declined increased from 4 (50.00% of reallocations) to 17 (68.00% of reallocated livers). OPO donor acceptance criteria were unchanged by Share 35.

Discussion/Conclusions: Share 35 was implemented to broaden sharing of livers and to increase the frequency with which higher MELD patients are transplanted. In our OPO we have demonstrated that while sharing has been broadened, reallocation intraoperatively has also increased dramatically, especially those livers expedited after multiple declines. As expedited placement often entails open offers to more aggressive centers, these organs are frequently used in lower MELD patients. Study of these variables in regional and national cohorts which can provide both larger numbers and the opportunity to observe regional variation is indicated before further broadening liver allocation.

CITATION INFORMATION: Orlowski J, Muse C, Whaley J, Squires R. Increased Frequency of Post-Recovery Liver Reallocation: The Law of Unintended Consequences? Am J Transplant. 2016;16 (suppl 3).

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