Selection of patients for liver transplantation and allocation of donated livers in the UK

• Published in: Gut Vol. 57; no. 2; pp. 252 - 257
• Main Authors: Neuberger, J, Gimson, A, Davies, M, Akyol, M, O’Grady, J, Burroughs, A, Hudson, M
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.02.2008; BMJ; BMJ Publishing Group LTD
• Subjects: Biological and medical sciences; Blood groups; Equity; Health Care Rationing - ethics; Health Care Rationing - standards; Humans; Liver; Liver Failure - surgery; Liver Transplantation - ethics; Liver Transplantation - standards; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Patient Selection - ethics; Patients; Prognosis; Quality of life; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Transplants & implants; United Kingdom; United Kingdom > UK; Human; Liver; Liver transplantation
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gut.2007.131730

Background:The increasing shortfall between the number of patients who would benefit from liver transplantation and the availability of donor livers means that rationing has to occur. The processes of selection of patients for transplantation and for allocation of donor livers should be done according to ethical and, where possible, evidence-based criteria so that there is clarity and that the competing requirements of equity, justice, utility and benefit can be balanced.Methods:To achieve these goals for patients in the United Kingdom in need of transplantation, we have developed guidelines for the selection of patients to the national waiting list based on the risk of death without a transplant and the ability of the procedure to improve the recipient’s quality of life. Guidelines have been developed for both those with acute liver failure and chronic liver disease. Allocation will depend on matching of the donor liver to the recipient.Results:The proposed system, to be introduced into the UK compares with some other systems, where different models for selection and allocation have been introduced.