Allocation of liver grafts worldwide – Is there a best system?

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dc.authorscopusid24466914200
dc.authorscopusid56153776000
dc.authorscopusid56989796500
dc.authorscopusid7004433412
dc.authorscopusid7005916237
dc.authorscopusid15818940100
dc.authorscopusid6603370570
dc.contributor.authorTschuor C.
dc.contributor.authorFerrarese A.
dc.contributor.authorKuemmerli C.
dc.contributor.authorDutkowski P.
dc.contributor.authorBurra P.
dc.contributor.authorClavien P.-A.
dc.contributor.authorLendoire J.
dc.date.accessioned2024-08-04T19:59:16Z
dc.date.available2024-08-04T19:59:16Z
dc.date.issued2019
dc.departmentİnönü Üniversitesien_US
dc.description.abstractBackground & Aims: An optimal allocation system for scarce resources should simultaneously ensure maximal utility, but also equity. The most frequent principles for allocation policies in liver transplantation are therefore criteria that rely on pre-transplant survival (sickest first policy), post-transplant survival (utility), or on their combination (benefit). However, large differences exist between centers and countries for ethical and legislative reasons. The aim of this study was to report the current worldwide practice of liver graft allocation and discuss respective advantages and disadvantages. Methods: Countries around the world that perform 95 or more deceased donor liver transplantations per year were analyzed for donation and allocation policies, as well as recipient characteristics. Results: Most countries use the model for end-stage liver disease (MELD) score, or variations of it, for organ allocation, while some countries opt for center-based allocation systems based on their specific requirements, and some countries combine both a MELD and center-based approach. Both the MELD and center-specific allocation systems have inherent limitations. For example, most countries or allocation systems address the limitations of the MELD system by adding extra points to recipient's laboratory scores based on clinical information. It is also clear from this study that cancer, as an indication for liver transplantation, requires special attention. Conclusion: The sickest first policy is the most reasonable basis for the allocation of liver grafts. While MELD is currently the standard for this model, many adjustments were implemented in most countries. A future globally applicable strategy should combine donor and recipient factors, predicting probability of death on the waiting list, post-transplant survival and morbidity, and perhaps costs. Lay summary: An optimal allocation system for scarce resources should simultaneously ensure maximal utility, but also equity. While the model for end-stage liver disease is currently the standard for this model, many adjustments were implemented in most countries. A future globally applicable strategy should combine donor and recipient factors predicting probability of death on the waiting list, post-transplant survival and morbidity, and perhaps costs. © 2019 European Association for the Study of the Liveren_US
dc.identifier.doi10.1016/j.jhep.2019.05.025
dc.identifier.endpage718en_US
dc.identifier.issn0168-8278
dc.identifier.issue4en_US
dc.identifier.pmid31199941en_US
dc.identifier.scopus2-s2.0-85071097269en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.startpage707en_US
dc.identifier.urihttps://doi.org/10.1016/j.jhep.2019.05.025
dc.identifier.urihttps://hdl.handle.net/11616/90521
dc.identifier.volume71en_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherElsevier B.V.en_US
dc.relation.ispartofJournal of Hepatologyen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.subjectAllocationen_US
dc.subjectELTRen_US
dc.subjectLiver transplantationen_US
dc.subjectMELDen_US
dc.subjectOrgan donationen_US
dc.subjectUNOSen_US
dc.titleAllocation of liver grafts worldwide – Is there a best system?en_US
dc.typeArticleen_US

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