Abstract
Purpose: In Model for End-stage Liver Disease (MELD)-based allocation systems patients with cancer and some other diseases are assigned a special score. The goal of this study was to assess the fairness of organ distribution by the MELD system among different groups of diseases. Methods: Retrospective study with adult patients between 2009 and 2013. Demographics and MELD scores were compared with the incidence of transplant or death, patient origin and disease groups. Results: 260 selected patients were submitted to transplant or died before the transplant. Their median age was 54.9 years (12.1 -73.9 years); 70.4% were men; 63.3% had chronic liver diseases (alcoholic cirrhosis 33.1%, C-virus cirrhosis 24.2%). Exception score was assigned to 26.5% of listed patients. These patients received 31% of transplanted organs and had lower pre-transplant mortality or dropout (14.2 times less) rates than the other patients (p <0.001). Receiving exception points resulted in a higher likelihood of being transplanted. Conclusion: The authors propose the use of a regional variable score for transplantation in special situations, which should be based on the median MELD score of the latest transplants for chronic liver diseases, to refrain from harming patients who have access to transplant according to the calculated MELD score.
Highlights
Relative organ scarcity is the main reason for mortality on waiting lists for liver transplants
Patients with cancer and patients with metabolic diseases, whose need for transplantation cannot be measured by the calculated Model for End-stage Liver Disease (MELD) score, are assigned a special score according to the legislation of Brazil and that of other countries
We studied 301 patients with liver disease referred to transplant during a period exceeding four years
Summary
Relative organ scarcity is the main reason for mortality on waiting lists for liver transplants. Most countries have a real deficit between the demand for a liver and the availability of grafts. This difference is variable and inversely related to local organ procurement capabilities. One solution to this scarcity problem is to prioritize severely ill patients - in an attempt to reduce the death rate before transplantation. In 2001, a new model based on liver disease severity was introduced to guide the allocation of grafts. Known as MELD, short for: Model for End-stage Liver Disease, this model was quickly adopted by many countries and adapted to their
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