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Exception point applications for 15 points: An unintended consequence of the Share 15 policy†
Article first published online: 10 OCT 2012
Copyright © 2012 American Association for the Study of Liver Diseases
Volume 18, Issue 11, pages 1302–1309, November 2012
How to Cite
Bittermann, T., Makar, G. and Goldberg, D. (2012), Exception point applications for 15 points: An unintended consequence of the Share 15 policy. Liver Transpl, 18: 1302–1309. doi: 10.1002/lt.23537
The contents of this article are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does the mention of trade names, commercial products, or organizations imply endorsement by the US Government.
- Issue published online: 26 OCT 2012
- Article first published online: 10 OCT 2012
- Accepted manuscript online: 16 AUG 2012 01:16AM EST
- Manuscript Accepted: 12 AUG 2012
- Manuscript Received: 22 MAY 2012
- National Institutes of Health through the National Institute of Diabetes and Digestive and Kidney Diseases. Grant Number: 1-F32-DK-089694-01
- Health Resources and Services Administration. Grant Number: 234-2005-370011C
In 2005, the United Network for Organ Sharing (UNOS) adopted the Share 15 policy to improve organ allocation by facilitating transplantation for local and regional patients with Model for End-Stage Liver Disease (MELD) scores of 15 or higher. There has been concern that the lack of standardization in the use of exception points is potentially diminishing the benefits of this policy. We reviewed all applications for 15 exception points submitted through UNOS from January 1, 2005 through March 14, 2011 (notably, there were only 5 applications for 15 MELD exception points submitted before the initiation of the Share 15 policy). Four hundred fifty-two applications were submitted for 301 patients. There was significant regional variability, with regions 3 and 10 submitting 72.1% of all applications. More than one-quarter of the applications (32.7%) specifically requested exception points to make a patient eligible for a local, regional, or higher risk organ. All applications were accepted for 74.1% of the patients, and 72.2% of these patients ultimately underwent transplantation; however, when all applications were denied, only 54.0% underwent transplantation (P = 0.006). Overall, 197 applicants (65.4%) underwent transplantation with a deceased donor organ, and 80.2% of these patients had a native MELD score at transplantation less than 15. In conclusion, these analyses demonstrate several important changes in practice that have occurred as a result of the implementation of the Share 15 policy. Since 2005, there has been a marked increase in the number of applications for 15 exception points, with significant regional variability in their use and a lack of standardization in their approval. Liver Transpl, 2012. © 2012 AASLD.