A Share 21 model in liver transplantation: Impact on waitlist outcomes

Abstract

Services Final Rule stated that patients on organ transplant waitlists should be ranked by "medical urgency."1 The Model for End-Stage Liver Disease (MELD) score-based liver allocation was introduced in the United States in 2002.2-4 A major change was introduced to the liver allocation system, in 2016, with adoption of the MELD-Na score in response to the findings in a study by Kim et al.5 The study found that incorporation of serum sodium into the MELD formula allowed better discrimination of waitlist mortality than the MELD score. Allocation rules for higher-score patients have been modified with "Share 35," but the share rule for lower score patients has remained unchanged for over a decade. In 2005, Merion et al6 demonstrated

Are MELD and MELDNa Still Reliable Tools to Predict Mortality on the Liver Transplant Waiting List?

“…42 More recently, a "Share 21" model has been proposed to replace "Share 15" in the United States to offer organs nationally, provided there are no local candidates with MELD >21. 43 Indeed, with the generalization of MELDNa, the score distributions have shifted from low to mid values, both at registration and transplant, and the survival benefit has been shown to be definitive for patients with MELDNa scores of ≥21. 38 Most European countries use MELD as the preferred allocation system.…”