Strategies to Improve Liver Allocation, Distribution, and Utilization in a Broader Sharing Climate

摘要

Purpose of the Review In an attempt to eliminate geographic disparities in median MELD at transplant, the allocation of deceased donor liver allografts has transitioned to the use of acuity-based circles. This has provided new obstacles for both organ procurement organizations and transplant centers to accommodate the implications of a broader sharing climate. Recent Findings With changes to allocation, OPOs and transplant centers have experienced new challenges in donor organ evaluation and logistics. However, these changes present an opportunity to refocus on the deceased liver donation process. Opportunities exist to develop strategies to optimize collaborations between OPOs and transplant centers, facilitate informed donor organ evaluation and acceptance, and create efficiency in donation logistics. By standardizing the evaluation of deceased donors and providing the necessary tools to ensure informed transplant center decisions regarding organ acceptance, improved efficiency in the new allocation system can be attained. Similarly, with anticipated changes in organ recovery travel and logistics, increasing reliance on local surgeon recovery and improved communication tools have the potential to facilitate adaptation to geographic changes in allocation and reduce costs.