Abstract
This article reviews the historical evolution of the current deceased donor liver allocation and distribution policy in the USA and describes the continued efforts to address limitations within our current allocation system. Due to the finding that hyponatremia is an independent predictor of mortality, since January 2016, the Model for End-stage Liver Disease (MELD)-Na score incorporating serum sodium is now used for patients with MELD score <11. MELD exception points allocation continues to be a challenging prospect in hepatocellular carcinoma (HCC); new changes include a “delay and cap” policy implemented in 2015 but consideration of other HCC-specific MELD scores are being explored. In order to address the significant differences in non-standardized MELD exception points being granted from different regional review boards, a national review board is being proposed. Despite efforts to address limitations in our current liver allocation system through policy changes targeted at reducing waitlist mortality and disparities, there continues to be significant differences on how these policies are implemented on a regional level, prompting the proposal for a national review board.
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