MELD Scores of Liver Transplant Recipients According to Size of Waiting List

Abstract

Context The Model for Endstage Liver Disease (MELD) score serves as the basis for the distribution of deceased-donor (DD) livers and was developed in response to "the final rule" mandate, whose stated principle is to allocate livers according to a patient's medical need, with less emphasis on keeping organs in the local procurement area. However, in selected areas of the United States, organs are kept in organ procurement organizations (OPOs) with small waiting lists and transplanted into less-sick patients instead of being allocated to sicker patients in nearby transplant centers in OPOs with large waiting lists. Objective To determine whether there is a difference in MELD scores for liver transplant recipients receiving transplants in small vs large OPOs. Design and Setting Retrospective review of the US Scientific Registry of Transplant Recipients between February 28, 2002, and March 31, 2003. Transplant recipients (N=4798) had end-stage liver disease and received DD livers.

Greater travel time to a liver transplant center does not adversely affect clinical outcomes

“…Smaller programs in less populated regions tend to transplant at lower Model for End-Stage Liver Disease (MELD) scores, which has raised calls for organ procurement organizations to include larger populations. 7 However, such reorganization may have unwanted consequences and may not provide the outcomes desired. 8,9 Consolidation of transplant services to fewer but larger transplant cen-ters could occur.…”

Is waiting time a measure of access to liver transplantation? Is shorter necessarily better?†

“…[1][2][3][4] In addition, there is ample evidence that outcomes for complex surgical procedures, including liver transplantation, are to some degree dependent on the volume of procedures done either by an institution or by an individual surgeon. [5][6][7][8] Until recently however, there has not been an attempt to examine the effects of center volume on access to liver transplantation.…”

Geography, transplant centers, and recipients: What can we learn?

“…At times, this has led some to call for broader allocation units to make distribution more equitable and not based so tightly on geography. 1,2 This then leads to discussions about increased costs of distributing organs and the potential negative impact on smaller transplant programs. Likewise, some feel that patients should be able to seek out transplant centers that meet their specific needs or desires even if this requires going to a center not near their home or even in a different DSA or region.…”