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New paradigms for organ allocation and distribution in liver transplantation

Kalra, Avasha; Biggins, Scott, W.b,c

Current Opinion in Gastroenterology: May 2018 - Volume 34 - Issue 3 - p 123–131
doi: 10.1097/MOG.0000000000000434
LIVER: Edited by Don C. Rockey
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Purpose of review The ‘Final Rule,’ issued by the Health Resources and Service Administration in 2000, mandated that liver allocation policy should be based on disease severity and probability of death, and – among other factors – should be independent of a candidate's residence or listing. As a result, the Organ Procurement Transplantation Network/United Network for Organ Sharing (UNOS) has explored policy changes addressing geographic disparities without compromising outcomes.

Recent findings Major paradigm shifts are underway in U.S. liver allocation policy. New hepatocellular carcinoma exception policy incorporates tumor characteristics associated with posttransplantation outcomes, whereas a National Liver Review Board will promote a standardized process for awarding exception points. Meanwhile, following extensive debate, new allocation policy aims to reduce geographic disparity by broadening sharing to the UNOS region and 150-mile circle around the donor hospital for liver transplant candidates with a calculated model for end-stage liver disease score at least 32. Unnecessary organ travel will be reduced by granting 3 ‘proximity points’ to candidates within the same donation service area (DSA) as a liver donor or within 150 nautical miles of the donor hospital, regardless of DSA or UNOS region.

Summary This review provides an evaluation of major policy changes in liver allocation from 2016 to 2018.

aDivision of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado

bUW Liver Clinical and Translational Research Center

cDivision of Gastroenterology and Hepatology, University of Washington, Seattle, Washington, USA

Correspondence to Scott W. Biggins, Division of Gastroenterology and Hepatology, University of Washington, 1959 NE Pacific Street, Box 356175, Seattle, WA 98195, USA. Tel: +1 206 598 4908; fax: +1 206 598 3884; e-mail:

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