AI Article Synopsis
- A liver allocation policy change in February 2020 aimed to reduce differences in median MELD scores at transplant by introducing "acuity circles" for donor organ distribution.
- The study categorized donors into ideal (I), standard (S), and non-ideal (NI) groups, with NI donors being older or having certain health issues, and analyzed how the policy change affected donor utilization across different transplant centers.
- After the policy change, national transplant volume increased, especially at low MELD (LM) centers which began using more non-ideal donors, while high MELD (HM) centers utilized more ideal and standard donors, highlighting variability in donor utilization that could impact the policy's effectiveness.
Article Abstract
Liver allocation policy was changed to reduce variance in median MELD scores at transplant (MMaT) in February 2020. "Acuity circles" replaced local allocation. Understanding the impact of policy change on donor utilization is important. Ideal (I), standard (S), and non-ideal (NI) donors were defined. NI donors include older, higher BMI donors with elevated transaminases or bilirubin, history of hepatitis B or C, and all DCD donors. Utilization of I, S, and NI donors was established before and after allocation change and compared between low MELD (LM) centers (MMaT ≤ 28 before allocation change) and high MELD (HM) centers (MMaT > 28). Following reallocation, transplant volume increased nationally (67 transplants/center/year pre, 74 post, p .0006) and increased for both HM and LM centers. LM centers significantly increased use of NI donors and HM centers significantly increased use of I and S donors. Centers further stratify based on donor utilization phenotype. A subset of centers increased transplant volume despite rising MMaT by broadening organ acceptance criteria, increasing use of all donor types including DCD donors (98% increase), increasing living donation, and transplanting more frequently for alcohol associated liver disease. Variance in donor utilization can undermine intended effects of allocation policy change.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9544006 | PMC |
| http://dx.doi.org/10.1111/ajt.17006 | DOI Listing |
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