Chapter 6.C (or 4.C) Allocation of Organs

UNOS Liver Allocation Policy

Although the use of MELD scores for liver allocation was designed to bring more objectivity to the allocation process, disparities exist between patients on the wait lists of organ procurement organizations (OPOs) with short waiting lists and patients on the wait lists of OPOs with long waiting lists.  Patients in small OPOs are 2.5 times more likely than patients in large OPOs to receive a transplant, and they are much more likely to have a MELD score below 25 (the maximum score is 40).  James F. Trotter and Michael J. Osgood, "MELD Scores of Liver Transplant Recipients According to Size of Waiting List," 291 JAMA 1871 (2004).

Use of the MELD scores has resulted in elimination of an association between race and the receipt of a liver transplant, but disparities based on the sex of the patient remain, with women less likely than men to receive a transplant.  Cynthia A. Moylan, et al., "Disparities in Liver Transplantation Before and After Introduction of the MELD Score," 300 JAMA 2371 (2008).

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