The sickest first? Disparities with model for end-stage liver disease-based organ allocation: One region[apos ]s experience

Regional Variation and Use of Exception Letters for Cadaveric Liver Allocation in Children with Chronic Liver Disease

“…These children are still utilizing relatively subjective parameters for organ allocation. Regional variation observed in the mean PELD scores at allocation and the percentage of exception cases show the system is not utilized uniformly across the country (18,19). Although some of the variability observed in mean PELD scores at allocation may be due to regional differences in severity of illness, these data suggest that the frequent use of exceptions plays a role as well.…”

Disease Targeted Measures of Health Related Quality of Life (HRQOL) in Patients with Advanced Liver Disease Before and After Liver Transplantation

“…MELD score allows prioritizing patients on the waiting list, putting the "sickest first" (Schaffer, 2003). However, we have to take into account that the MELD score does not always adequately reflect disease severity and prognosis (Frost, 2002).…”

“…In patients with fulminant hepatic failure, metabolic disease, hepatocellular carcinoma, refractory ascites, hepato pulmonary syndrome etc. MELD does not apply (Schaffer, 2003).…”

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.…”