Development of a UK liver transplantation selection and allocation scheme.

Purpose Of Review: Equitable allocation of organs for liver transplantation remains a major area of ongoing study. In United Kingdom, it was agreed that the success of any national donor offering scheme would be judged from the point of registration on a national list for a transplant, and would therefore include outcome while waiting for the procedure.

Recent Findings: Standard minimal criteria for acceptance onto a transplant list have been developed for chronic liver disease, hepatocellular carcinoma and for a number of variant syndromes where current scores do not adequately reflect the risk of death without a transplant or symptom burden. Allocation by need, or on the basis of utility, or by transplant benefit (net life years gained) were compared in a simulation against current unit-based allocation. A transplant benefit model was shown to reduce deaths on the waiting list and maximise population life years.

Summary: Since March 2018, liver donors after brain death in United Kingdom have been offered to a national list prioritised by net life years gained - transplant benefit.