Liver allocation rules changed nearly one year ago on February 27, 2002. On that date UNOS initiated a new scoring system for patients needing a transplant.
The United Network for Organ Sharing (UNOS) runs the nation’s organ waiting list and sets policies for transplantation and allocation of organs.
Last November, after examining six months of Model End-Stage Liver Disease (MELD) data, the organization announced that the system is working well; UNOS estimated a 23 percent decrease in liver patient deaths in the first six months of the system. In addition, the number of people who were too sick to transplant or who died while waiting decreased, according to UNOS calculations.
“Here at Hopkins, as at other transplant centers, the sickest patients are being transplanted. The average regional MELD score is in the low 20s,” said Andrew Klein, M.D., Director of the Hopkins Comprehensive Transplant Center. “But outcomes still depend upon how sick a person is upon transplant,” he added.
Dr. Klein pointed out that Hopkins has been successful in using an “extended criteria” approach for livers in which previously unacceptable organs are now used.
He noted, “Regional differences in transplantation criteria are becoming more balanced. Still, geography is an important factor. Our small region has a large patient population and a great need for organs.”
Dr. Klein, who serves as Chairman, Ad Hoc Living Donor Committee and Region 2 Councilor for the UNOS Board, is leading an effort to strengthen guidelines on living liver donations. This procedure can shorten wait time for a liver.
The UNOS system, termed MELD (adult) and PELD (pediatric), gives each individual a score based upon how urgently he or she needs a liver transplant within the next three months. Laboratory blood tests based upon creatinine, bilirubin and prothrombin time are calculated into a standard formula, which tallies a score for an individual. The PELD system uses additional criteria to determine a score. Adult scores can range from 6-40.
Scores are recalculated frequently, as a person waits on the list and as the individual’s condition changes. Certain liver conditions, such as cancer, rely upon additional technical criteria. Waivers are requested from special review boards within a transplant center’s region.
Patient scores may go up or down depending on laboratory results. Under MELD persons with high scores have an increased priority for an organ. The new scoring system was designed to improve equity in allocating livers, ranking patients by their short-term risk of death without a transplant. The sickest patients would move to the top of the waiting list.
In November UNOS announced a modification to the rules, by adjusting the score for hepatocellular cancer patients. It was felt that the scoring adjustment would, “improve the fairness” of the system for all patients on the list, according to Richard Freeman, M.D., chairman of the OPTN/UNOS Liver and Intestinal Organ Transplantation Committee.
During the first six months of the MELD scoring system, about one- fifth of transplants went to liver cancer patients.
Hopkins transplant recipient Ernie Clayton is a Patient Representative to the Liver and Intestinal Organ Transplant Committee.
Bridges Winter 2002-2003
