Abstract
Under the current liver organ allocation system organs are on a sickest first policy as prioritized by MELD score within one of the 11 multi-state UNOS regions for MELD scores greater than 35. In the unusual circumstance in which no patient has a MELD score above 35, the organ is offered within a local area, again prioritized by the MELD score. Both UNOS regions and local distribution areas called DSAs (Donor Service Areas) may be served by several transplant centers creating a competitive environment for organ placement primarily between transplant centers acting as proxy for their listed patients. Although donor livers are offered for recipients based solely on urgency as defined by the MELD score, centers and patients are free to accept or reject offers based on their personal estimate for successful transplantation.
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