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UNOS Board recommends adoption of MELD liver allocation scheme after data shows it will save lives.

Acting with quickness and unanimity impossible in recent years because of the rancorous fight over organ allocation policies with the federal government, the United Network for Organ Sharing (UNOS) has recommended adopting a new liver allocation scheme that data shows will reduce the number of deaths of patients on the waiting list for a donor.

What began as a routine update on the Model for End Stage Liver Disease (MELD), a new liver allocation policy first introduced to the UNOS board last November, changed dramatically in tenor as data overwhelmingly showed that the formula accurately predicts a patient's short term risk of death if they do not receive a transplant. Recommendation for approval was unanimous.

While details for implementing the new system are yet to be worked out, the 18,000 patients currently on the waiting list for a liver are in no danger of having their position changed on the waiting list now. Patients who are status 1 remain the first priority to receive a liver. The new plan, when adopted, will eliminate current system of status 2A and 3, and replace it with the MELD scoring system.

Adoption of the new plan caught board members by surprise. As Richard Freeman, MD, chair of the UNOS Liver/Intestinal Organ Transplantation Committee, was systematically giving a report showing that the MELD score has shown consistently it is a very good predictor of patient mortality and was backed up by UNOS data mortality data, board members began to question the need to wait until the next UNOS board meeting in November to recommend adoption of the plan.

"Can we as a board move ahead more quickly; can we speed it up right now?" Robert Ettenger, MD finally asked. "A delay will cost lives. We may be reneging on our responsibility as a board if we don't adopt it now." Ettenger is director of the Pediatric Renal Transplant Program at the UCLA School of Medicine.

"We don't need more data," echoed Jack Lake, MD. "It has been validated in 7 different data sets and all show it (MELD) to be a superior model, the pediatric patients will not be at a disadvantage, and we'll never know how to list special diagnoses until we start using the system and can make adjustments. So lets do it." Lake is director of the Liver Transplant Program at Fairview-University Medical Center in Minneapolis.

While details for implementing the new system are yet to be worked out, the 18,000 patients currently on the waiting list for a liver are in no danger of having their position changed on the waiting list now. Patients who are status 1 remain the first priority to receive a liver.

Under the new system the standard protocol for allocating livers is modified based on a scoring system that addresses the severity of potential recipients' liver disease. For adult patients, the system uses the prognostic factors of serum creatinine, bilirubin, and prothrombin time/INR which results in the MELD score.

For pediatric patients, the system uses the prognostic factors of bilirubin, INR, albumin, growth failure, and age less than 1 year which results in the Pediatric End-Stage Liver Disease (PELD) score.

In a nutshell, the MELD scoring system will replace the current Statuses 2A, 2B and 3 will be used to prioritize patients for liver allocation following allocation for Status 1 patients using the existing definition and protocol for Status 1 patients.

A formal proposal based on additional refinements is expected to be presented to the Organ Procurement and Transplantation Network (OPTN)/UNOS board at its November meeting and is expected to go into effect after receiving final approval.

"We feel the follow-up data presented to the board support a decision to move ahead with this life-giving approach," said Patricia Adams, MD, UNOS president. "At the same, there are some additional medical and technical issues to be resolved."

Adams emphasized that the UNOS board may authorize the new policy to take effect on a voluntary basis prior to final government approval, which is expected to happen following the November meeting.

For information patients, family, transplant professionals are encouraged to call Doug Heiney, Director of UNOS Membership and Policy Office - (804) 330-8800
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Comment:UNOS Board recommends adoption of MELD liver allocation scheme after data shows it will save lives.
Author:Warren, Jim
Publication:Transplant News
Article Type:Brief Article
Geographic Code:1USA
Date:Jun 30, 2001
Words:699
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