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New liver transplant rules found to cut waiting list deaths

The United Network for Organ Sharing tweaked the system for livers and revised tissue-matching policy for kidneys, which will likely increase transplants among minorities.

By Susan J. Landers, amednews staff. Dec. 2, 2002.

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Washington -- A new system to prioritize liver transplant candidates more objectively has worked well during its first six months, although some refinements were called for, according to United Network for Organ Sharing, which operates the national Organ Procurement and Transplantation Network for the federal government.

The OPTN/UNOS board met in November to approve those refinements and to ease the way for more minority patients to receive kidneys.

Since the new liver allocation system was implemented, the number of patients who either died while on the waiting list for a liver or were removed from the list because they were too sick to undergo a transplant dropped by 23%, said UNOS.

The early data also suggest that under the new system there was either no change or a slight improvement in patient survival rate after transplantation. If that trend continues it would put to rest a fear held by some that since sicker patients would be receiving the organs, their outcomes were less likely to be positive.

"While these results are preliminary, they are encouraging," said Richard Freeman, MD, chair of OPTN/UNOS Liver and Intestinal Organ Transplantation Committee. "These early results suggest that the policy is meeting the key goal of reducing wait list deaths," he said.

The group examined data available from Feb. 27, when the updated system was implemented, until Aug. 27.

Under the new allocation system, called the Model for End-Stage Liver Disease, or MELD, and Pediatric End- Stage Liver Disease, or PELD, common, objective laboratory tests are used to rank patients on a continuous scale of severity of illness. [...]