Document Detail

Offer patterns of nationally placed livers by donation service area.
MedLine Citation:
PMID:  23447450     Owner:  NLM     Status:  MEDLINE    
We previously reported that national liver distribution is highly concentrated in 6 US centers, and this raises the possibility of expedited placement. Therefore, we evaluated all national offers of nationally placed livers (n=1625) to adult wait-list candidates from February 2005 to January 2010. We developed a model to predict national utilization pathways; pathways exceeding the best-fit linear unbiased predictions by ≥3 standard errors were defined as preferred. All 51 donation service areas (DSAs) placed 1 or more livers nationally, but the percentage per DSA ranged from 1% to 36%. Of 2830 possible national DSA-center pathways, 87% were used. Five hundred eighty livers (36%) were accepted on the first national offer. Four DSAs accounted for 47% of first-national-offer livers, and 44% of these were accepted by a single center. In comparison with first-offer livers using nonpreferred pathways, first offers along a preferred pathway were offered to fewer status 1 candidates (19% versus 61%) and had lower median model for end-stage liver disease (MELD) scores (22 versus 36, P<0.001). In conclusion, DSA placement patterns of national livers vary widely, with 4 DSAs exporting a high proportion of national livers on the first national offer to non-status 1 candidates with MELD scores less than their local transplant MELD scores. Although this practice may facilitate liver placement, it raises the possibility of expedience trumping patient need. Here we propose changes to the national liver distribution system that will help to balance equity, efficiency, and transparency.
Jennifer C Lai; Sandy Feng; Eric Vittinghoff; John P Roberts
Publication Detail:
Type:  Journal Article     Date:  2013-03-17
Journal Detail:
Title:  Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society     Volume:  19     ISSN:  1527-6473     ISO Abbreviation:  Liver Transpl.     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-28     Completed Date:  2013-09-13     Revised Date:  2014-04-29    
Medline Journal Info:
Nlm Unique ID:  100909185     Medline TA:  Liver Transpl     Country:  United States    
Other Details:
Languages:  eng     Pagination:  404-10     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 American Association for the Study of Liver Diseases.
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MeSH Terms
Chi-Square Distribution
Graft Survival
Health Services Accessibility / organization & administration*
Healthcare Disparities*
Kaplan-Meier Estimate
Liver Transplantation* / adverse effects
Logistic Models
Middle Aged
Multivariate Analysis
Odds Ratio
Proportional Hazards Models
Residence Characteristics*
Risk Assessment
Risk Factors
Time Factors
Tissue Donors / supply & distribution*
Tissue and Organ Procurement / organization & administration*
Treatment Outcome
United States
Waiting Lists*
Grant Support
Comment In:
Liver Transpl. 2013 Apr;19(4):358-9   [PMID:  23447420 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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