LIVER TRANSPLANTATION: Edited by James TrotterBasic principles of liver allocation and development over the yearsAby, Elizabeth S.; Lake, John R.Author Information Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA Correspondence to John R. Lake, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, 420 Delaware Street SE, MMC 36, Minneapolis, MN 55455, USA. Tel: +1 612 624 9684; e-mail: firstname.lastname@example.org Current Opinion in Organ Transplantation: April 2020 - Volume 25 - Issue 2 - p 99-103 doi: 10.1097/MOT.0000000000000732 Buy Metrics Abstract Purpose of review Prior to the enactment of the National Organ Transplant Act in 1984, there was no organized system to allocate donor organs in the United States. The process of liver allocation has come a long way since then, including the development and implementation of the Model for End-stage Liver Disease, which is an objective estimate of risk of mortality among candidates awaiting liver transplantation. Recent findings The Liver Transplant Community is constantly working to optimize the distribution and allocation of scare organs, which is essential to promote equitable access to a life-saving procedure in the setting of clinical advances in the treatment of liver disease. Over the past 17 years, many changes have been made. Most recently, liver distribution changed such that deceased donor livers will be distributed based on units established by geographic circles around a donor hospital rather than the current policy, which uses donor service areas as the unit of distribution. In addition, a National Liver Review Board was created to standardize the process of determining liver transplant priority for candidates with exceptional medical conditions. The aim of these changes is to allocate and distribute organs in an efficient and equitable fashion. Summary The current review provides a historical perspective of liver allocation and the changing landscape in the United States. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.