Transplant scoring system called more fair

Physicians say the new approach to liver allocation is a step in the right direction, but there is still much room for improvement.

By Victoria Stagg Elliott, AMNews staff. May 13, 2002.

The topics of organ donation, allocation and transplantation are certainly no strangers to controversy.

But a new set of liver allocation rules has received positive reviews from doctors with patients waiting for cadaveric liver transplants. And if it continues to prove workable, the liver rules may pave the way for similar changes in the determination of need for other donated organs.

Specifically, these physicians are saying that, based on the first months of operation, the United Network for Organ Sharing allocation system, which kicked in on Feb. 27, seems to be more equitable.

But it is also far from perfect.

"It's fairer in concept, but it's definitely a work in progress," said Saul Karpen, MD, PhD, director of the Texas Children's Liver Center in Houston.

Under the updated system, the Model for End Stage Liver Disease -- MELD -- and Pediatric End Stage Liver Disease -- PELD -- replaced three of the four broad categories of transplant status with a continuous scoring system. Only status one remains.

The new approach instead is based on laboratory values for creatinine, bilirubin and other test results indicating that a patient might die from liver-related causes within the next three months.

The ultimate goal is to reduce the number of people who die waiting. Previously, patients' chances for a liver were based on a combination of laboratory factors and physician judgment. The length of time a patient spent on the waiting list was a common tie-breaker. Though it will now still be a consideration, it will be given less emphasis. Whether the patient is already in ICU is also less of a factor. [...]