Dr Jennifer Lai and colleagues previously reported that national liver distribution is highly concentrated in 6 US centers.
This raises the possibility of expedited placement.
The research team evaluated all national offers of nationally placed livers to adult wait-list candidates from 2005 to 2010.
The team 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 placed 1 or more livers nationally, but the percentage per donation service areas ranged from 1% to 36%.
The researchers reported that of 2830 possible national donation service areas center pathways, 87% were used.
The team accepted 520 livers on the first national offer.
|4 donation service areas accounted for 47% of first-national-offer livers|
|Liver Transplantation |
The team of doctors examined that 4 donation service areas 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 and had lower median Model for End-Stage Liver Disease scores.
Dr Lai's team commented, "Donation service areas placement patterns of national livers vary widely, with 4 donation service areas exporting a high proportion of national livers on the first national offer to non–status 1 candidates with Model for End-Stage Liver Disease scores less than their local transplant Model for End-Stage Liver Disease 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."