BACKGROUND: Liver Allocation policy in the United States is in dynamic flux, with revisions in policy reflecting designs to optimize access to and outcomes for available organs. MELD was introduced in 2002 to allow transplantation of the “sickest first”. Share 35 was introduced later to improve regional access for those most desperate. These policies potentially leave an organ void for those with lower MELD scores (MELD disadvantaged) {MD} still in desperate need of transplant.

AIM: The purpose of this study was to assess indicators of organ access for these desperate MD patients and the impact on their ultimate outcomes.

METHODS: A single center retrospective review of waitlisted patients and liver transplants performed between 2012-2014 (n=331). The study was designed to assess the impact not of absolute MELD score, but rather position on the transplant list at time of organ offer correlated with type of organ available (DRI, DBD vs DCD, split) and ultimately outcomes (1 year patient and graft survival; wait list mortality if organ passed over).

RESULTS: High MELD (mean 33(31-40)) patients (n= 132) received offers while in position 1-6 (mean 3.2) on the regional list with low DRI organs (mean 1.43 (1.17-1.77)). A second tier of lower MELD patients {MD} (mean 23.6(18-29)]) (n= 199) received offers at position 11-26 (average 16) with high DRI organs (mean 2.6(1.7-5.04). The percentage of DCD organs transplanted in the high MELD group was significantly lower (<5%) than the MD group where > 66% of organs offered were DCDs (p<0.005). Overall 1 year patient and graft survival were similar between the groups (92.3 vs 89.66%, NS).

CONCLUSIONS: Liver allocation policies are expertly designed to ensure that the objectively sickest patients are transplanted first. There are patients with lower MELD scores, however, who are disadvantaged by the system {MD}. To serve these patients, center specific practices of high DRI organ allocation have emerged within the confines of MELD. Data driven guidelines, however, should be developed using predictive models to allocate higher DRI organs to liver transplant candidates who are at the lower end of the spectrum of MELD scores {MD} but have a predicted, risk adjusted optimal post transplant survival.

CITATION INFORMATION: Baker T, Siarris A, Accoh P, Ladner D. A Call for a New Paradigm of Organ Allocation within the Confines of MELD for Those Who Are Not “the Sickest”. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress