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 MELD score. While the policy was extensively modelled prior to implementation, one organ procurement organization (OPO) sought to study the impact of Share 35 on its donation service area (DSA), which is a single state, 3.81 million population, and includes 3 established liver transplant centers (2 adult, 1 peds).

Method: A review of all deceased donors (DBD and DCD) was conducted for local and import donors 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 data from within the DSA, import/export activity, and utilization data were compared.

Results: Pre-Share 35 (Pre), 167 deceased donors were recovered in the DSA (7.77 per month or 7.77/mo). Post-Share 35 (Post) donors increased dramatically to 12.0/mo (342 total; +54.6%). Transplanted livers (TXL) increased 49.6%; 115 donors or 5.4/mo (68.9% of total deceased donors) yielded a TXL Pre versus 228 or 8.0/mo (66.7%) TXL Post. DCD TXL remained constant (0.23/mo Pre, 0.25/mo Post). TXL exported outside the DSA regionally increased 311.1% (0.93 to 3.82/mo); TXL exported nationally increased 214.3% (0.28 to 0.88/mo). TXL imported from outside the DSA and transplanted in the DSA increased 212.5% (0.33 to 1.02/mo). Total TXL (local plus import) transplanted at centers within the OPO DSA were 96 or 4.47/mo Pre to 123 or 4.32/mo Post, a decline in local liver transplants of 3.3%. OPO donor acceptance criteria were unchanged by Share 35.

Discussion/Conclusions: While the DSA significantly increased both total deceased donors recovered and total TXL from the DSA, a number of less favorable trends were noted. Overall, the percentage of local donors yielding a TXL decreased slightly after institution of broader sharing. Export and import activity were both dramatically increased to achieve a net decrease in livers transplanted within the DSA. The sum of these trends is that more transportation expense is being incurred to transplant fewer livers overall and within a DSA that has dramatically increased donation. We recommend careful study of Share 35's impact on overall utilization of TXL and costs associated with broader sharing on a DSA level before further broadening liver allocation.

CITATION INFORMATION: Orlowski J, Muse C, Whaley J, Squires R. The Impact of Share 35 on Liver Allocation and Utilization: One DSA's Experience. Am J Transplant. 2016;16 (suppl 3).

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