A Critique of UNOS Liver Allocation Policy

1999 ◽  
Vol 8 (3) ◽  
pp. 311-320 ◽  
Author(s):  
KENNETH EINAR HIMMA
Keyword(s):  
United States ◽  
Liver Disease ◽  
Liver Failure ◽  
Chronic Liver Disease ◽  
The United States ◽  
Acute Illness ◽  
Waiting List ◽  
Allocation Policy ◽  
Liver Allocation ◽  
United Network

The United Network for Organ Sharing (UNOS) recently changed the policy by which donor livers are allocated to liver failure patients in the United States. Formerly, all liver failure patients were characterized as status 1 and placed at the top of the transplant list. Under the new policy, only patients with liver failure due to acute illness (“ALF patients”) are eligible for status 1; patients with liver failure due to chronic liver disease (“CLF patients”) are characterized as status 2. Since donor organs are allocated first to status 1 patients and then to status 2 patients, the new policy moves all CLF patients down on the waiting list relative to all ALF patients. This means that some livers that would have gone to CLF patients under the old policy will now go to ALF patients. Accordingly, while the new policy will likely increase the number of ALF patients saved, it will also increase the number of deaths among CLF patients waiting for a transplant.

Trends in hospitalizations for chronic liver disease‐related liver failure in the United States, 2005‐2014

2019 ◽  
Vol 39 (9) ◽  
pp. 1661-1671 ◽  
Author(s):  
Donghee Kim ◽  
George Cholankeril ◽  
Andrew A. Li ◽  
Won Kim ◽  
Sean P. Tighe ◽  
...  
Keyword(s):  
United States ◽  
Liver Disease ◽  
Liver Failure ◽  
Chronic Liver Disease ◽  
The United States ◽  
Chronic Liver

Reply to Burdick: Constraining Physician Discretion

2000 ◽  
Vol 9 (2) ◽  
pp. 280-283
Author(s):  
Kenneth Einar Himma
Keyword(s):  
Liver Disease ◽  
Brain Death ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Chronic Liver Disease ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Allocation Policy ◽  
Liver Allocation ◽  
Unos Policy

In “A Critique of UNOS Liver Allocation Policy,” I argued that the UNOS policy of placing acute liver failure patients (ALF patients) above chronic liver failure patients (CLF patients) on the transplant list fails to satisfy the principles of utility and justice that ostensibly guide UNOS allocation policy. Further, I argued that physician discretion in evaluating ALF and CLF patients should be expanded—not constrained. In response, Dr. Burdick attempts to justify the policy constraints on physician discretion on the strength of objective differences between ALF and CLF; as he puts it, “the distinction between acute liver failure and progression of chronic liver disease … is clear in the way brain death is.”

Mo1547 Prevalence of Chronic Liver Disease and Dirrhosis by Underlying Cause in Understudied Ethnic groups in the United States: The Multiethnic Cohort (MEC)

2016 ◽  
Vol 150 (4) ◽  
pp. S1141 ◽  
Author(s):  
Veronica W. Setiawan ◽  
Jacqueline Porcel ◽  
Shelly C. Lu ◽  
Mazen Noureddin
Keyword(s):  
United States ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Ethnic Groups ◽  
The United States ◽  
Chronic Liver ◽  
Multiethnic Cohort

scholarly journals Chronic Liver Disease in the Hispanic Population of the United States

2011 ◽  
Vol 9 (10) ◽  
pp. 834-841 ◽  
Author(s):  
Andres F. Carrion ◽  
Ravi Ghanta ◽  
Olveen Carrasquillo ◽  
Paul Martin
Keyword(s):  
United States ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
The United States ◽  
Chronic Liver ◽  
Hispanic Population

Coffee and Tea Consumption Are Associated With a Lower Incidence of Chronic Liver Disease in the United States

2005 ◽  
Vol 129 (6) ◽  
pp. 1928-1936 ◽  
Author(s):  
Constance E. Ruhl ◽  
James E. Everhart
Keyword(s):  
United States ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Lower Incidence ◽  
The United States ◽  
Chronic Liver ◽  
Tea Consumption

scholarly journals Chronic liver disease mortality in the United States, 1990-1998

Hepatology ◽  
2004 ◽  
Vol 39 (2) ◽  
pp. 476-483 ◽  
Author(s):  
Sirenda Vong ◽  
Beth P. Bell
Keyword(s):  
United States ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
The United States ◽  
Chronic Liver ◽  
Disease Mortality

Demographics, Resource Utilization, and Outcomes of Elderly Patients With Chronic Liver Disease Receiving Hospice Care in the United States

2017 ◽  
Vol 112 (11) ◽  
pp. 1700-1708 ◽  
Author(s):  
Natsu Fukui ◽  
Pegah Golabi ◽  
Munkhzul Otgonsuren ◽  
Alita Mishra ◽  
Chapy Venkatesan ◽  
...  
Keyword(s):  
United States ◽  
Liver Disease ◽  
Elderly Patients ◽  
Chronic Liver Disease ◽  
Resource Utilization ◽  
Hospice Care ◽  
The United States ◽  
Chronic Liver

Universal Hepatitis B Immunization

PEDIATRICS ◽  
1992 ◽  
Vol 89 (4) ◽  
pp. 795-800 ◽  
Author(s):  
Keyword(s):  
United States ◽  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Hepatitis B ◽  
Chronic Liver Disease ◽  
The United States ◽  
Chronic Liver ◽  
Hbv Infection ◽  
Primary Hepatocellular Carcinoma ◽  
Childhood And Adolescence

HEPATITIS B DISEASE AND EPIDEMIOLOGY In the United States 200 000 to 300 000 acute infections with hepatitis B virus (HBV) occur each year.1,2 More than one million persons in the United States have chronic HBV infection, and approximately 4000 to 5000 persons die each year from HBV-induced chronic liver disease and hepatocellular carcinoma. Although HBV infections occur during childhood and adolescence, the full impact of these infections is not recognized until many years later when chronic liver disease and hepatocellular carcinoma may develop. The incidence of HBV infection increases rapidly during adolescence, with higher rates among blacks than among whites (Fig 1).3 Although rates vary by region, sex, and race, between 3.3% and 25% of all persons have had HBV infection by 25 to 34 years of age. The likelihood of becoming chronically infected with HBV varies inversely with the age at which infection occurs. HBV transmitted from hepatitis B surface antigen (HBsAg)-positive mothers to their newborns results in HBV carriage for up to 90% of infants. Between 25% and 50% of children infected before 5 years of age become carriers, whereas only 6% to 10% of acutely infected adults become carriers. It is estimated that more than 25% of carrier infants will die from primary hepatocellular carcinoma or cirrhosis of the liver, with most of these deaths occurring during adult life. HBV infection occurs more commonly in certain populations, including Pacific Islanders, Alaskan Natives, immigrants from countries in which infection is highly endemic, persons who require multiple transfusions of blood or blood products, and persons with high-risk lifestyles, including intravenous drug abuse and contact with multiple sexual partners.

scholarly journals Association between serum uric acid level and chronic liver disease in the United States

Hepatology ◽  
2010 ◽  
Vol 52 (2) ◽  
pp. 578-589 ◽  
Author(s):  
Anita Afzali ◽  
Noel S. Weiss ◽  
Edward J. Boyko ◽  
George N. Ioannou
Keyword(s):  
United States ◽  
Uric Acid ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Serum Uric Acid ◽  
Uric Acid Level ◽  
Acid Level ◽  
Serum Uric Acid Level ◽  
The United States ◽  
Chronic Liver
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