Comparative Analysis of Liver Organ Offers Pre- and Post- Acuity Circle Policy Change in the US

V. Reddy¹, R. Ruiz², H. Fernandez³, J. Bayer³, E. Martinez³, A. Gupta³, G. McKenna⁴, N. Onaca³, S. Lee³, T. Ma³, G. Testa³, A. Wall³

¹Baylor Scott and White Research Institute, Allen, TX, ²Baylor University Medical Center, Fort Worth, TX, ³Baylor University Medical Center, Dallas, TX, ⁴Baylor Simmons Transplant Inst, Dallas, TX

Meeting: 2022 American Transplant Congress

Abstract number: 268

Keywords: Allocation, Liver grafts

Topic: Clinical Science » Public Policy » 21 - Non-Organ Specific: Public Policy & Allocation

Session Information

Session Name: Non-Organ Specific: Public Policy & Allocation

Session Type: Rapid Fire Oral Abstract

Date: Monday, June 6, 2022

Session Time: 3:30pm-5:00pm

Presentation Time: 4:40pm-4:50pm

Location: Hynes Room 311

*Purpose: With the intended goal of reducing geographic inequities, the United Network for Organ Sharing (UNOS) and Organ Procurement and Transplantation Network (OPTN) transitioned to an Acuity Circles model (AC) of organ allocation for liver transplantation. The consequences are a more complex system of organ allocation and distribution that will especially increase the number of connections between different OPOs and transplant centers. At our center, we have found an increase in the number of liver offers per month without an increase in liver transplants. Given the increase in complexity of network connections for liver allocation and increased pressure on OPOs to allocate organs, we hypothesized that the total number of liver offers have increased post-AC policy change in the US.

*Methods: We collected 3,503,163 UNOS liver donor offer records from 74,636 donors between 1/1/2015 and 6/30/2021. We looked at liver offer characteristics such as volume of accepted and declined livers before and after the change to Acuity Circles. We compared organ offer characteristics before and after AC allocation policy change.

*Results: There were increases in the average annual number of donors (10,927 to 13,631, 22%), average annual accepted liver offers (7,480 to 9,098, 22%), average monthly number of offers (911 to 1,136, 25%), and average monthly accepted liver offers (623 to 758, 22%). There was an increase in median time between first and last notification (17.5 min to 81.8 min, p<0.001). The average monthly liver offers increased by 125%, but the average accepted monthly liver transplant offers only increased by 122%.

*Conclusions: We found an higher increase in the number of liver offers per year versus liver offers accepted per year following AC policy change. The increase in liver offers results in an increased workload for transplant personnel and may be a source of inefficiency, especially given that the number of offers for livers that are never transplanted.

To cite this abstract in AMA style:

Reddy V, Ruiz R, Fernandez H, Bayer J, Martinez E, Gupta A, McKenna G, Onaca N, Lee S, Ma T, Testa G, Wall A. Comparative Analysis of Liver Organ Offers Pre- and Post- Acuity Circle Policy Change in the US [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/comparative-analysis-of-liver-organ-offers-pre-and-post-acuity-circle-policy-change-in-the-us/. Accessed May 17, 2025.

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