Donor Livers Not Always Allocated to the Sickest Patients

[Guest guest]

Donor Livers Not Always Allocated to the Sickest Patients

By Rauscher

NEW YORK (Reuters Health) Apr 20 - Donor livers are not always distributed

according to patient need, as current US organ allocation policy dictates, a

study released on Tuesday suggests.

Some of these scarce organs are being retained by smaller organ procurement

organizations (OPOs) and transplanted into less-sick patients instead of

being allocated to sicker patients at larger OPOs, two investigators report

in the April 21st issue of the Journal of the American Medical Association.

In an interview with Reuters Health, Dr. F. Trotter emphasized,

however, that the liver allocation system " is not broken. " For the most

part, it is a " fair and equitable " system that has " improved dramatically

over the last 2 to 3 years, " he said. " So in that context, this is a chink

in the armor of organ allocation. "

Dr. Trotter and J. Osgood, from the University of Colorado Health

Sciences Center in Denver, compared the Model for Endstage Liver Disease or

MELD scores for liver transplant recipients transplanted in small (< 100

people on the waiting list) vs. large (100 or more people on the waiting

list) OPOs. Data analysis centered on 4,798 patients who had end-stage liver

disease and received deceased-donor livers between February 2002 and March

2003.

The MELD score is an objective scoring system used by the United Network for

Organ Sharing (UNOS) " whose stated principle is to allocate livers according

to a patient's medical need, " the investigators explain. In general, the

patient with the highest MELD score should get the donor liver.

The investigators found that the distribution of MELD scores was the same in

small and large OPOs. Ninety-two percent had a MELD score of 18 or lower, 7%

had a MELD score between 19 and 24, and 2% had a MELD score higher than 24.

However, there was " significant disparity " in MELD scores among liver

transplant recipients in small vs large OPOs. Fewer transplant recipients in

small OPOs compared with large OPOs had MELD scores > 24 indicating severe

liver disease (19% vs 49%; respectively, p < 0.001).

" The most likely explanation for this disparity is that deceased-donor

livers are preferentially retained for transplantation in the local OPO,

where the number of patients with high MELD scores is smaller than that in

large OPOs, " the authors write.

Dr. Trotter said that the transplant community " has recognized this as a

problem and this study numerically describes it in detail. " It is important

to note, he added, that this is a " relatively small problem representing

just 8% of all transplants in the United States. "

Nonetheless, " transplant professionals should be aware of this disparity and

its implications as they continue to amend regulations for organ

allocation, " the investigators conclude.

JAMA 2004;291:1871-1874.

[Guest guest]

Donor Livers Not Always Allocated to the Sickest Patients

By Rauscher

NEW YORK (Reuters Health) Apr 20 - Donor livers are not always distributed

according to patient need, as current US organ allocation policy dictates, a

study released on Tuesday suggests.

Some of these scarce organs are being retained by smaller organ procurement

organizations (OPOs) and transplanted into less-sick patients instead of

being allocated to sicker patients at larger OPOs, two investigators report

in the April 21st issue of the Journal of the American Medical Association.

In an interview with Reuters Health, Dr. F. Trotter emphasized,

however, that the liver allocation system " is not broken. " For the most

part, it is a " fair and equitable " system that has " improved dramatically

over the last 2 to 3 years, " he said. " So in that context, this is a chink

in the armor of organ allocation. "

Dr. Trotter and J. Osgood, from the University of Colorado Health

Sciences Center in Denver, compared the Model for Endstage Liver Disease or

MELD scores for liver transplant recipients transplanted in small (< 100

people on the waiting list) vs. large (100 or more people on the waiting

list) OPOs. Data analysis centered on 4,798 patients who had end-stage liver

disease and received deceased-donor livers between February 2002 and March

2003.

The MELD score is an objective scoring system used by the United Network for

Organ Sharing (UNOS) " whose stated principle is to allocate livers according

to a patient's medical need, " the investigators explain. In general, the

patient with the highest MELD score should get the donor liver.

The investigators found that the distribution of MELD scores was the same in

small and large OPOs. Ninety-two percent had a MELD score of 18 or lower, 7%

had a MELD score between 19 and 24, and 2% had a MELD score higher than 24.

However, there was " significant disparity " in MELD scores among liver

transplant recipients in small vs large OPOs. Fewer transplant recipients in

small OPOs compared with large OPOs had MELD scores > 24 indicating severe

liver disease (19% vs 49%; respectively, p < 0.001).

" The most likely explanation for this disparity is that deceased-donor

livers are preferentially retained for transplantation in the local OPO,

where the number of patients with high MELD scores is smaller than that in

large OPOs, " the authors write.

Dr. Trotter said that the transplant community " has recognized this as a

problem and this study numerically describes it in detail. " It is important

to note, he added, that this is a " relatively small problem representing

just 8% of all transplants in the United States. "

Nonetheless, " transplant professionals should be aware of this disparity and

its implications as they continue to amend regulations for organ

allocation, " the investigators conclude.

JAMA 2004;291:1871-1874.

[Guest guest]

Donor Livers Not Always Allocated to the Sickest Patients

By Rauscher

NEW YORK (Reuters Health) Apr 20 - Donor livers are not always distributed

according to patient need, as current US organ allocation policy dictates, a

study released on Tuesday suggests.

Some of these scarce organs are being retained by smaller organ procurement

organizations (OPOs) and transplanted into less-sick patients instead of

being allocated to sicker patients at larger OPOs, two investigators report

in the April 21st issue of the Journal of the American Medical Association.

In an interview with Reuters Health, Dr. F. Trotter emphasized,

however, that the liver allocation system " is not broken. " For the most

part, it is a " fair and equitable " system that has " improved dramatically

over the last 2 to 3 years, " he said. " So in that context, this is a chink

in the armor of organ allocation. "

Dr. Trotter and J. Osgood, from the University of Colorado Health

Sciences Center in Denver, compared the Model for Endstage Liver Disease or

MELD scores for liver transplant recipients transplanted in small (< 100

people on the waiting list) vs. large (100 or more people on the waiting

list) OPOs. Data analysis centered on 4,798 patients who had end-stage liver

disease and received deceased-donor livers between February 2002 and March

2003.

The MELD score is an objective scoring system used by the United Network for

Organ Sharing (UNOS) " whose stated principle is to allocate livers according

to a patient's medical need, " the investigators explain. In general, the

patient with the highest MELD score should get the donor liver.

The investigators found that the distribution of MELD scores was the same in

small and large OPOs. Ninety-two percent had a MELD score of 18 or lower, 7%

had a MELD score between 19 and 24, and 2% had a MELD score higher than 24.

However, there was " significant disparity " in MELD scores among liver

transplant recipients in small vs large OPOs. Fewer transplant recipients in

small OPOs compared with large OPOs had MELD scores > 24 indicating severe

liver disease (19% vs 49%; respectively, p < 0.001).

" The most likely explanation for this disparity is that deceased-donor

livers are preferentially retained for transplantation in the local OPO,

where the number of patients with high MELD scores is smaller than that in

large OPOs, " the authors write.

Dr. Trotter said that the transplant community " has recognized this as a

problem and this study numerically describes it in detail. " It is important

to note, he added, that this is a " relatively small problem representing

just 8% of all transplants in the United States. "

Nonetheless, " transplant professionals should be aware of this disparity and

its implications as they continue to amend regulations for organ

allocation, " the investigators conclude.

JAMA 2004;291:1871-1874.

[Guest guest]

Donor Livers Not Always Allocated to the Sickest Patients

By Rauscher

NEW YORK (Reuters Health) Apr 20 - Donor livers are not always distributed

according to patient need, as current US organ allocation policy dictates, a

study released on Tuesday suggests.

Some of these scarce organs are being retained by smaller organ procurement

organizations (OPOs) and transplanted into less-sick patients instead of

being allocated to sicker patients at larger OPOs, two investigators report

in the April 21st issue of the Journal of the American Medical Association.

In an interview with Reuters Health, Dr. F. Trotter emphasized,

however, that the liver allocation system " is not broken. " For the most

part, it is a " fair and equitable " system that has " improved dramatically

over the last 2 to 3 years, " he said. " So in that context, this is a chink

in the armor of organ allocation. "

Dr. Trotter and J. Osgood, from the University of Colorado Health

Sciences Center in Denver, compared the Model for Endstage Liver Disease or

MELD scores for liver transplant recipients transplanted in small (< 100

people on the waiting list) vs. large (100 or more people on the waiting

list) OPOs. Data analysis centered on 4,798 patients who had end-stage liver

disease and received deceased-donor livers between February 2002 and March

2003.

The MELD score is an objective scoring system used by the United Network for

Organ Sharing (UNOS) " whose stated principle is to allocate livers according

to a patient's medical need, " the investigators explain. In general, the

patient with the highest MELD score should get the donor liver.

The investigators found that the distribution of MELD scores was the same in

small and large OPOs. Ninety-two percent had a MELD score of 18 or lower, 7%

had a MELD score between 19 and 24, and 2% had a MELD score higher than 24.

However, there was " significant disparity " in MELD scores among liver

transplant recipients in small vs large OPOs. Fewer transplant recipients in

small OPOs compared with large OPOs had MELD scores > 24 indicating severe

liver disease (19% vs 49%; respectively, p < 0.001).

" The most likely explanation for this disparity is that deceased-donor

livers are preferentially retained for transplantation in the local OPO,

where the number of patients with high MELD scores is smaller than that in

large OPOs, " the authors write.

Dr. Trotter said that the transplant community " has recognized this as a

problem and this study numerically describes it in detail. " It is important

to note, he added, that this is a " relatively small problem representing

just 8% of all transplants in the United States. "

Nonetheless, " transplant professionals should be aware of this disparity and

its implications as they continue to amend regulations for organ

allocation, " the investigators conclude.

JAMA 2004;291:1871-1874.