AST Educational Document on Liver Redistricting

The AST applauds the efforts of UNOS to explore ways of increasing equity in access to transplantation by examining the issue of liver redistricting. In response to these efforts, the AST has created a workgroup to closely follow the work of the UNOS liver committee. This workgroup has produced a document that summarizes the issues and outlines key considerations, so that you can better understand the implications of any proposal that might be put forth.

AST Educational Document on Liver Redistricting

• The AST endorses equitable and timely allocation of donor organs, as well as efforts to increase organ donation.
• Wider geographic sharing is being considered because of the concern that geographic disparity exists in the current liver allocation system.
• The current measures of liver sickness used to prioritize patients for transplant (Model for End-Stage Liver Disease (MELD) and Pediatric End-Stage Liver Disease (PELD) scores) are not comprehensive enough to evaluate all important liver organ allocation policy issues.
• In order to fairly and critically consider changes in liver allocation, there must first be a determination of appropriate alternative metric(s) to evaluate proposed organ allocation strategies. 
• The AST supports the process underway to identify accurate metrics to evaluate alternate liver organ allocation taking into account the following:
  • Recipient illness severity
  • Recipient survival benefit
  • Public attitude & perceptions
  • Donor organ utilization
  • Financial costs
  • OPO performance
  • Transplant center performance
  • Logistical support that ensures:
    • Timely delivery of organs to recipients
    • The quality of all organs during and after transplantation.
• Once metrics have been identified to evaluate novel strategies, the AST supports the use of evidence-based medicine to evaluate the objective, measurable outcomes of interest.
• The AST believes that any new organ allocation policy must be evaluated for its demographic, geographic, and socioeconomic impact on liver transplantation.
• Any systematic changes must give due consideration to effects on pediatric populations.
• Ongoing efforts should be made to minimize and standardize MELD exceptions when possible.
• The AST supports well-defined and accurate data collection that are required to make decisions regarding liver organ allocation.
  • Ensuring the accurate collection of data before and after change implementation is critical.
  • Transparency of analytic methodology, applicability, and limitations is necessary.

The AST would like to thank the following members for their contributions to this document: Jacqueline O’Leary, Yolanda Becker, Simon Horslen, Paul Martin, Luke Preczewski, Thomas Schiano, and Tom Mone.