UNOS, Organ, Allocation Policy and MELD Score

2010 ◽  
pp. 24-24
Author(s):  
Dilip K ◽  
WC Lee ◽  
YY Jan ◽  
Po-Huang Lee
Keyword(s):  
Meld Score ◽  
Organ Allocation ◽  
Allocation Policy

Abstract 13468: Effect of Listing Criteria on Transplant Rate and Early Outcomes in Adults With Congenital Heart Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Wagih m Zayed ◽  
Neha Bansal ◽  
Snehal R Patel ◽  
Jacqueline M Lamour ◽  
Daniel J GOLDSTEIN ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Primary Diagnosis ◽  
Organ Allocation ◽  
Transplant Recipients ◽  
Allocation Policy ◽  
Kaplan Meier ◽  
Allocation Criteria ◽  
History Of

Introduction: Heart failure (HF) is the leading cause of death in adults with congenital heart disease (ACHD). Heart transplant (HT) is one of the few options for the treatment of advanced HF in this growing population. In October 2018, the United Network for Organ Sharing (UNOS) implemented a change in organ allocation criteria. The effect of this change on outcomes in ACHD patients (pts) after listing and transplant has not been evaluated. Hypothesis: Change in organ allocation criteria negatively impacts outcomes in ACHD patients. Methods: Data from the Scientific Registry of Transplant Recipients in pts age > 18 years old listed for HT between Oct. 2016 and 0ct. 2019 and followed through March 2020 were analyzed. Pts were grouped by diagnosis (ACHD and non-ACHD) and by the time of listing (pre- and post-change in allocation criteria). Differences in comorbidities, outcomes while listed, and 1-year Kaplan Meier survival post-HT were compared among groups. For comparison, post-change criteria (status 1-6) were equated to pre-change criteria (status 1A, 1B, 2). Results: Over 3 years, 11,931 patients were listed for HT; 459 had a primary diagnosis of ACHD. ACHD was present in 279/7942 pts listed in the 2 years pre-change and 180/3989 pts in the year post-change. ACHD pts listed post-change were less likely to have a history of cardiac surgery (88% vs. 79%, p=0.01) and more likely to have an abnormal BMI (p=0.015) than ACHD pts pre-change. Post-change, ACHD pts were listed at a higher priority status compared to pre-change ACHD. (Figure). The proportion of pts transplanted with ACHD increased slightly pre- and post-change (3.7% vs. 4.1%). There was no difference in 1-year survival in ACHD pts transplanted pre- and post-change (Figure). Conclusions: Recent changes to the UNOS organ allocation policy increased the proportion of ACHD patients transplanted with no change in early post-HT survival.

Putting Patients First in Organ Allocation: An Ethical Analysis of the U.S. Debate

2001 ◽  
Vol 10 (4) ◽  
pp. 365-376 ◽  
Author(s):  
JAMES F. CHILDRESS
Keyword(s):  
United States ◽  
The United States ◽  
Ethical Analysis ◽  
Organ Allocation ◽  
Current Debate ◽  
Ethical Considerations ◽  
Political Factors ◽  
Allocation Policy ◽  
Public Hearings ◽  
The U.S

Organ allocation policy involves a mixture of ethical, scientific, medical, legal, and political factors, among others. It is thus hard, and perhaps even impossible, to identify and fully separate ethical considerations from all these other factors. Yet I will focus primarily on the ethical considerations embedded in the current debate in the United States about organ allocation policy. I will argue that it is important to put patients first—in the language of the title of one of the major public hearings—but even then significant ethical questions will remain about exactly how to put patients first.

scholarly journals Mortality and its Determinants in Adult Patients with End-stage Liver Disease on Waiting List for Liver Transplantation: A Preliminary Report on Baseline Data

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Kamran Bagheri Lankarani ◽  
Behnam Honarvar ◽  
Mohammad Reza Rouhezamin ◽  
Hadi Raeisi Shahraki ◽  
Vahid Seifi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Weight Loss ◽  
Liver Disease ◽  
Gallbladder Wall ◽  
Meld Score ◽  
Organ Allocation ◽  
Ca 125 ◽  
End Stage Liver Disease ◽  
History Of ◽  
End Stage

Background: Prevention of death in patients on the waiting list for liver transplantation (LT) is a major concern to prioritize organ allocation. Since the model for the end-stage liver disease (MELD) and its modifications have many shortages, there is a need for further refinement of the allocation strategy. Objectives: The current study aimed at assessing the predictors of mortality in LT candidates in a more comprehensive manner with the possible implications to improve the care of such patients and assist in developing better strategies for organ allocation. Methods: In the current cohort study, 544 adult LT candidates with end-stage liver disease were followed up for a mean of 12 months in three-month intervals. Data analysis was performed in Nutritionist, SPSS, and R software, using Kaplan-Meier, Cox proportional hazard (HRC), and LASSO Cox regression hazard (HRL) tests. Results: The mean age of the patients was 46.7 ± 13.7 years; the majority were male (n = 336, 61.7%). At the end of the study, 414 (76.1%) subjects were still alive and 130 (23.9%) dead. The cumulative percentages of death were 33.1%, 57.7%, and 79.2% after 3, 6, and 12 months of waiting for a donor, respectively. Although there was a strong association between having hepatopulmonary syndrome (HPS) (HRC = 4.7, HRL = 1.8), a history of myocardial infarction (MI) (HRC = 3.3, HRL = 1.6), low-carbohydrate (CHO) diet (HRC = 2.7, HRL = 1.5), and mortality, it was weak for MELD score. Moreover, a serum level of CA 125, high polymorphonuclear (PMN) count, weight loss, a high level of alanine aminotransferase (ALT), positive hepatitis B virus (HBV) markers, high mean corpuscular volume (MCV) of red blood cells, ascites, and edema of gallbladder wall had association with mortality in LT patients. Conclusions: In addition to MELD score, HPS, a history of MI, low CHO intake, weight loss, ascites, PMN, CA 125, ALT, hepatitis B surface antigen, MCV, blood urea nitrogen, and gallbladder wall thickness are predictors of mortality in LT candidates and need to be considered in the LT allocation system.

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