The purpose of this study is to critically analyze the distribution patterns and fate of donor livers that were allocated using an expedited placement (EP) pathway.
Methods: We determined the originating and receiving UNOS Regions of all donor livers procured between 1/1/2010 and 10/31/2012 that were placed using UNOS bypass codes 863 (offer not made due to expedited placement attempt) or 898 (miscellaneous), which are commonly used to justify EP. We assessed the effect of EP on patients at our center by evaluating the number of listed patients bypassed for each liver that was allocated by the EP pathway during the study interval. Early function of liver grafts that were transplanted via an EP pathway was reviewed.
Results: Patients at our center were eligible to receive 1,402 donor liver offers during the interval studied; 228 (15.8%) liver offers bypassed patients at our center and were allocated to patients at other centers who were lower on the match-run list. A mean of 10.7 (range 1-52) patients on our center's waiting list were bypassed for each organ allocated by EP. 84% of patients who died on out wait list during the period of analysis were bypassed at least once with a liver that was placed elsewhere via the EP pathway. Nationally, 560 livers were transplanted in the US by EP during the interval studied: centers that used the greatest number of liver grafts allocated by EP (codes 863 and 898 combined) were clustered in Regions 1, 5, 9, 7, and 10. 20% of all EP livers and 33% of all exported EP livers were utilized by Region 1, more than any other Region (p = .0002 compared to all other Regions). Graft function data was available for 560 livers placed by EP; 491 (88%) of these grafts were functioning a mean of 399.49 days post-transplantation.
Conclusions: Transplantation of livers allocated by means of an expedited refusal code is asymmetric across regions and in some instances results in bypass of patients with higher waitlist priority. EP placement occurs without notification of the bypassed center. Short-term graft function after EP allocation was excellent. Policies governing EP allocation should be created in order to ensure equal patient access to available organs.
To cite this abstract in AMA style:Gaglio P, Lindower J, Principe A, John R, Kinkhabwala M. Expedited Liver Allocation in the U.S.: A Critical Analysis [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/expedited-liver-allocation-in-the-u-s-a-critical-analysis/. Accessed March 31, 2020.
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