Does the United States Do It Better? A Comparative Analysis of Liver Allocation Protocols in the United Kingdom and the United States

Cherkassky, Lisa

doi:10.1017/s0963180111000107

Cited by 5 publications

(6 citation statements)

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“…Recent literature on the ethics of alternative allocation models often argues for a greater emphasis on the effective and efficient use of donor organs . In response to the growing demand for donor organs, the 1984 National Organ Transplant Act and the UNOS final rule have both called for the reduction of futile and wasteful transplants . To describe concerns of efficiency and economic responsibility, we will use the term utility , which is often used in transplant ethics to describe an effort to maximize the greatest benefit for the greatest number of patients.…”

Section: Ethical Concerns Shaping Liver Allocationmentioning

confidence: 99%

“…Even those authors who have agreed that the MELD score is well designed for predicting wait‐list mortality have also criticized it for giving little priority to prognosis . Without the ability to predict potential benefit, it fails to answer calls for efficiency and reduction of probable futility …”

Section: Model For End‐stage Liver Disease/pediatric End‐stage Liver mentioning

confidence: 99%

“…23,24,31 In response to the growing demand for donor organs, the 1984 National Organ Transplant Act and the UNOS final rule have both called for the reduction of futile and wasteful transplants. 32 To describe concerns of efficiency and economic responsibility, we will use the term utility, which is often used in transplant ethics to describe an effort to maximize the greatest benefit for the greatest number of patients. Utility is commonly used to support efforts to maximize life years gained: if patient A would live 10 years after he or she received a given treatment and patient B would live 8 years, patient A should receive the treatment before patient B.…”

Section: Utilitymentioning

confidence: 99%

“…19,20,27,38 Without the ability to predict potential benefit, it fails to answer calls for efficiency and reduction of probable futility. 22,24,31,32 The MELD system is also not well equipped to regulate the use of ECD for expanding the supply of donor livers. The allocation of high-risk livers only to patients who can achieve a significant medical benefit saves lower risk livers for other candidates.…”

Section: Model For End-stage Liver Disease/pediatric End-stage Liver mentioning

confidence: 99%

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Ethical considerations surrounding survival benefit-based liver allocation

Keller¹,

Kwo

Helft³

2013

Liver Transpl

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The disparity between the demand for and supply of donor livers has continued to grow over the last 2 decades, and this has placed greater weight on the need for efficient and effective liver allocation. Although the use of extended criteria donors has shown great potential, it remains unregulated. A survival benefit-based model was recently proposed to answer calls to increase efficiency and reduce futile transplants. However, it was previously determined that the current allocation system was not in need of modification and that instead geographic disparities should be addressed. In contrast, we believe that there is a significant need to replace the current allocation system and complement efforts to improve donor liver distribution. We illustrate this need first by identifying major ethical concerns shaping liver allocation and then by using these concerns to identify strengths and shortcomings of the Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease system and a survival benefit-based model. The latter model is a promising means of improving liver allocation: it incorporates a greater number of ethical principles, uses a sophisticated statistical model to increase efficiency and reduce waste, minimizes bias, and parallels developments in the allocation of other organs. However, it remains limited in its posttransplant predictive accuracy and may raise potential issues regarding informed consent. In addition, the proposed model fails to include quality-of-life concerns and prioritize younger patients. We feel that it is time to take the next steps toward better liver allocation not only through reductions in geographic disparities but also through the adoption of a model better equipped to balance the many ethical concerns shaping organ allocation. and concluded that the current allocation system is not in need of modification. Rather, the committee has focused on addressing disparities in geographic distribution with the hope that these efforts will help to optimize the utilization of donor livers.2,3 In contrast, we will argue that the model proposed by Schaubel et al., with modifications, better balances a more comprehensive list of ethical concerns. It, therefore, represents a justifiable alternative to the current MELD/PELD system and complements current efforts to improve distribution. We will illustrate this need by analyzing the ways in which this survival benefitbased model better comprehends the ethical concerns shaping liver allocation.

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Section: Ethical Concerns Shaping Liver Allocationmentioning

confidence: 99%

Section: Model For End‐stage Liver Disease/pediatric End‐stage Liver mentioning

confidence: 99%

Section: Utilitymentioning

confidence: 99%

Section: Model For End-stage Liver Disease/pediatric End-stage Liver mentioning

confidence: 99%

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Ethical considerations surrounding survival benefit-based liver allocation

Keller¹,

Kwo

Helft³

2013

Liver Transpl

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“…Deceased donor organ transplantation commenced at the end of the 20th century, and in the intervening 4 decades there has not been a global survey of deceased donor allocation practices to children across all organs. Previous publications have surveyed global pediatric liver allocation practices, 1 as well as comprehensive descriptions of national allocation practices 2–5 . This is the first attempt to provide an overview of deceased donor allocation practices to children across the world.…”

Section: Introductionmentioning

confidence: 99%

Allocation to pediatric recipients around the world: An IPTA global survey of current pediatric solid organ transplantation deceased donation allocation practices

Benabe

Batsis

Dipchand

et al. 2022

Pediatric Transplantation

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Background There has not been a comprehensive global survey of pediatric‐deceased donor allocation practices across all organs since the advent of deceased donor transplantation at the end of the 20th century. As an international community that is responsible for transplanting children, we set out to survey the existing landscape of allocation. We aimed to summarize current practices and provide a snapshot overview of deceased donor allocation practices to children across the world. Methods The International Registry in Organ Donation and Transplantation (IRODAT, http://www.irodat.org) was utilized to generate a list of all countries in the world, divided by continent, that performed transplantation. We reviewed the published literature, published allocation policy, individual website references and associated links to publicly available listed allocation policies. Following this, we utilized tools of communication, relationships, and international fellowship to confirm deceased donation pediatric centers and survey pediatric allocation practices for liver, kidney, heart, and lung across the world. We summarize pediatric allocation practices by organ when available using source documents, and personal communication when no source documents were available. Results The majority of countries had either formal or informal policies directed toward minimizing organ distribution disparity among pediatric patients. Conclusion Children have long‐term life to gain from organ donation yet continue to die while awaiting transplantation. We summarize global strategies that have been employed to provide meaningful and sustained benefit to children on the waitlist.

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Lebertransplantation mit postmortalen Organen

Seehofer

Schöning

Neuhaus

2013

Chirurg

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Deceased donor liver transplantation is nowadays a routine procedure for the treatment of terminal liver failure and often represents the only chance of a cure. Under given optimal conditions excellent long-term results can be obtained with 15-year survival rates of well above 60 %.In Germany the outcome after liver transplantation has deteriorated since the introduction of an allocation policy, which is based on the medical urgency. At present 25 % of liver graft recipients die within the first year after transplantation. In contrast 1-year survival in most other countries, e.g. in the USA or the United Kingdom is around 90 % and therefore significantly better. Reasons for the inferior results in Germany are on the one hand an increasing number of critically ill recipients and on the other hand an unfavorable situation for organ donation. In comparison with other countries the organ donation rate is low and moreover the risk profile of these donors is above average. This combination of organ shortage and organ allocation represents a big challenge for the future orientation of liver transplantation and creates the potential for conflict. These cannot be solved on a medical basis but require a social consensus.Because of the present inferior results and because of the high expenses of the present system we suggest a discussion on future allocation policies as well as on future centre structures in Germany. In addition to the medical urgency the maximum benefit should also be considered for organ allocation.

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Does the United States Do It Better? A Comparative Analysis of Liver Allocation Protocols in the United Kingdom and the United States

Cited by 5 publications

References 0 publications

Ethical considerations surrounding survival benefit-based liver allocation

Ethical considerations surrounding survival benefit-based liver allocation

Allocation to pediatric recipients around the world: An IPTA global survey of current pediatric solid organ transplantation deceased donation allocation practices

Lebertransplantation mit postmortalen Organen

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