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 23 November 2017

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News

Clinical judgement in liver transplant recipient selection

An allocation process based on the Model for End-Stage Liver Disease rather than clinical judgment would significantly alter organ allocation, and may reduce waiting list mortality, finds the latest issue of Liver Transplantation.

News image

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Minimization of death while waiting for liver transplantation involves accurate prioritization according to clinical status and appropriate allocation of donor livers.

Dr Michael Fink and colleagues from Australia compared clinical judgment in the Liver Transplant Unit Victoria with Model for End-Stage Liver Disease.

Patients who died waiting were 3 times as likely to be prioritized by Model for End-Stage Liver Disease
Liver Transplantation

The research team conducted a retrospective analysis of the Liver Transplant Unit database over a 2-year period from 2002 to 2004.

The team reported that a total of 1118 prioritization decisions and 263 allocation decisions occurred.

The researchers noted that prioritization decisions were concordant in 68%, comparing priorities assigned by clinical judgment with those assigned by Model for End-Stage Liver Disease.

Allocation decisions were concordant in 72% of the cases, comparing donor liver allocation with prioritization by Model for End-Stage Liver Disease.

The investigative team also compared donor liver allocation with prioritization by clinical judgment and noted that allocation decisions were concordant in 77% of the cases.

The team found that of the 52 patients allocated a liver, only 23 would have been allocated on the basis of Model for End-Stage Liver Disease.

The researchers also found that 29 patients were prioritized on the waiting list in the week prior to transplantation according to the Model for End-Stage Liver Disease.

The research team reported that a total of 10 patients died on the waiting list in the 2-year period.

In addition, the researchers observed that patients who subsequently died waiting were 3 times as likely to be prioritized by Model for End-Stage Liver Disease as clinical judgment.

One half of the patients who could have received a donor liver, but who died waiting, would have been allocated the organ on the basis of Model for End-Stage Liver Disease.

Dr Fink's team concludes, “An allocation process based on Model for End-Stage Liver Disease rather than clinical judgment would significantly alter organ allocation in Australia and may reduce waiting list mortality.”

Liver Transpl 2005: 11(6): 621 -26
31 May 2005

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