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The Impact of Increased Allocation Priority for Children Awaiting Liver Transplant

A Liver Simulated Allocation Model (LSAM) Analysis

Perito, Emily R.*; Mogul, Douglas B.; VanDerwerken, Douglas; Mazariegos, George§; Bucuvalas, John||; Book, Linda; Horslen, Simon#; Kim, Heung B.**; Miloh, Tamir††; Ng, Vicky‡‡; Reyes, Jorge§§; Rodriguez-Davalos, Manuel I.||||; Valentino, Pamela L.¶¶; Gentry, Sommer; Hsu, Evelyn#

Journal of Pediatric Gastroenterology and Nutrition: April 2019 - Volume 68 - Issue 4 - p 472–479
doi: 10.1097/MPG.0000000000002287
Rapid Communication: Hepatology

Objective: The aim of the study was to investigate the impact of prioritizing infants, children, adolescents, and the sickest adults (Status 1) for deceased donor livers. We compared outcomes under two “SharePeds” allocation schema, which prioritize children and Status 1 adults for national sharing and enhanced access to pediatric donors or all donors younger than 35 years, to outcomes under the allocation plan approved by the Organ Procurement and Transplant Network in December 2017 (Organ Procurement and Transplantation Network [OPTN] 12-2017).

Methods: The 2017 Liver Simulated Allocation Model and Scientific Registry of Transplant Recipients data on all US liver transplant candidates and liver offers 7/2013 to 6/2016 were used to predict waitlist deaths, transplants, and post-transplant deaths under the OPTN 12-2017 and SharePeds schema.

Results: Prioritizing national sharing of pediatric donor livers with children (SharePeds 1) would decrease waitlist deaths for infants (<2 years, P = 0.0003) and children (2–11 years, P = 0.001), with no significant change for adults (P = 0.13). Prioritizing national sharing of all younger than 35-year-old deceased donor livers with children and Status 1A adults (SharePeds 2) would decrease waitlist deaths for infants, children, and all Status 1A/B patients (P < 0.0001 for each). SharePeds 1 and 2 would increase the number of liver transplants done in infants, children, and adolescents compared to the OPTN-2017 schema (P < 0.00005 for all age groups). Both SharePeds schema would increase the percentage of pediatric livers transplanted into pediatric recipients.

Conclusions: Waitlist deaths could be significantly decreased, and liver transplants increased, for children and the sickest adults, by prioritizing children for pediatric livers and with broader national sharing of deceased donor livers.

*Department of Pediatrics, University of California San Francisco, San Francisco, CA

Department of Pediatrics, Johns Hopkins University, Baltimore

Department of Mathematics, United States Naval Academy, Annapolis, MD

§Department of Surgery, University of Pittsburgh, Pittsburgh, PA

||Department of Pediatrics, Recanati Miller Transplantation Institute, Mount Sinai School of Medicine, New York, NY

Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT

#Department of Pediatrics, University of Washington, Seattle, WA

**Department of Surgery, Harvard Medical School, Boston, MA

††Department of Pediatrics, Baylor College of Medicine, Houston, TX

‡‡Department of Pediatrics, University of Toronto, Toronto, Canada

§§Department of Surgery, University of Washington, Seattle, WA

||||Department of Surgery, Primary Children's Hospital, Salt Lake City, UT

¶¶Department of Pediatrics, Yale University School of Medicine, New Haven, CT.

Address correspondence and reprint requests to Emily R. Perito, MD, MAS, Department of Pediatrics, University of California, San Francisco, 550 16th St, 5th Floor, Box 0136, San Francisco, CA 94143 (e-mail:

Received 9 December, 2018

Accepted 16 January, 2019

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

This work was supported by Health Resources and Services Administration contract 234-2005-37011C (United Network for Organ Sharing [UNOS] Data), the Society for Pediatric Liver Transplant, the NIH (E.R.P, K23 DK0990253; D.B.M., K08 HS023876; S.G. R01 DK111233), and the UCSF Department of Pediatrics. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the OPTN or the US Government. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the NIH or the Department of Health and Human Services, nor does mention of trades names, commercial products, or organizations imply endorsement by the US Government.

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,