Article

Offer patterns of nationally placed livers by donation service area

Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA.
Liver Transplantation (Impact Factor: 3.79). 04/2013; 19(4). DOI: 10.1002/lt.23604
Source: PubMed

ABSTRACT We previously reported that national liver distribution is highly concentrated among 6 U.S. centers, raising the possibility of expedited placement. Therefore, we evaluated all national offers of nationally placed livers (n=1625) to adult wait-list candidates from 2/05-1/10. We developed a model to predict national utilization pathways; pathways exceeding expected by ≥3 standard errors of the best-fit linear unbiased predictions were defined as "preferred". All 51 donation service areas (DSAs) placed ≥1 liver nationally, but the %/DSA ranged from 1-36%. Of 2830 possible national DSA→center pathways, 87% were utilized. 580(36%) livers were accepted on the first national offer. Four DSAs accounted for 47% of first national offer livers, of which 44% were accepted by a single center. Compared to first offer livers utilizing non-preferred pathways, first offers along a preferred pathway were offered to fewer Status 1 candidates (19 vs. 61%) and had lower median MELD scores (22 vs. 36) [p<0.001]. In conclusion, DSA placement patterns of national livers vary widely, with four DSAs exporting a high proportion of national livers on the first national offer to non-Status 1 candidates with MELD scores less than their local transplant MELD. While this practice may have facilitated liver placement, it raises the possibility of expedience trumping patient need. Here, we propose changes to the national liver distribution system that help balance equity, efficiency, and transparency. © 2013 American Association for the Study of Liver Diseases.

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