The authors of this article have no conflicts of interest.
Challenges and Controversies in Liver Transplantation
Expedited liver allocation in the United States: A critical analysis
Article first published online: 8 JUL 2013
Copyright © 2013 American Association for the Study of Liver Diseases
Volume 19, Issue 10, pages 1159–1165, October 2013
How to Cite
Kinkhabwala, M., Lindower, J., Reinus, J. F., Principe, A. L. and Gaglio, P. J. (2013), Expedited liver allocation in the United States: A critical analysis. Liver Transpl, 19: 1159–1165. doi: 10.1002/lt.23675
This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.
- Issue published online: 24 SEP 2013
- Article first published online: 8 JUL 2013
- Accepted manuscript online: 21 MAY 2013 03:49AM EST
- Manuscript Accepted: 2 MAY 2013
- Manuscript Received: 15 FEB 2013
The fate of donor livers allocated via an out-of-sequence expedited placement (EP) pathway has not been previously examined. We determined the originating and receiving United Network for Organ Sharing (UNOS) regions of all donor livers procured between January 1, 2010 and October 31, 2012 and placed out of sequence with UNOS bypass code 863 (EP attempt) or 898 (miscellaneous). We reviewed the early function of these liver grafts and assessed the effect of EP allocation on wait-listed patients at our center. Registrants at our center were eligible to receive 1298 liver offers during the interval studied: 218 (16.8%) of these liver offers bypassed our center and were allocated to other centers and used in patients lower on the match-run list. During the study interval, 560 livers were allocated in the United States by EP. Regions 1, 5, 7, 9, and 10 used the greatest number of EP-placed grafts. Region 1 (New England) used the greatest proportion of all EP livers (33% of all imported EP livers in the United States, P < 0.001 versus all other regions). Graft function data were available for 560 livers placed by EP: 491 (88%) of these grafts were functioning at a mean of 399.5 days after transplantation. In conclusion, the transplantation of livers allocated by means of an expedited refusal code is asymmetric across regions and, in some instances, results in the bypassing of patients with higher wait-list priority but without notification of the bypassed center. Short-term graft function after EP allocation is excellent. Policies governing EP allocation should be created in order to improve access to available organs. Liver Transpl 19:1159-1165, 2013. © 2013 AASLD.