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World J Gastroenterol. Mar 14, 2016; 22(10): 2922-2930
Published online Mar 14, 2016. doi: 10.3748/wjg.v22.i10.2922
Advances in liver transplantation allocation systems
Michael L Schilsky, Maryam Moini
Michael L Schilsky, Departments of Medicine (Digestive Diseases) and Surgery (Transplantation and Immunology), Yale University Medical Center, New Haven, CT 06520, United States
Maryam Moini, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Nemazee Hospital, Shiraz 71935-1311, Iran
Author contributions: Schilsky ML designed the work, collected data and revised the paper; and Moini M designed the work, collected data and wrote the paper.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Maryam Moini, MD, Associate Professor, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Nemazee Hospital, Zand Street, Shiraz 71935-1311, Iran. dornam@hotmail.com
Telephone: +98-713-6281442 Fax: +98-713-6281442
Received: October 31, 2015
Peer-review started: October 31, 2015
First decision: December 11, 2015
Revised: December 26, 2015
Accepted: January 17, 2016
Article in press: January 18, 2016
Published online: March 14, 2016
Processing time: 125 Days and 17.4 Hours
Abstract

With the growing number of patients in need of liver transplantation, there is a need for adopting new and modifying existing allocation policies that prioritize patients for liver transplantation. Policy should ensure fair allocation that is reproducible and strongly predictive of best pre and post transplant outcomes while taking into account the natural history of the potential recipients liver disease and its complications. There is wide acceptance for allocation policies based on urgency in which the sickest patients on the waiting list with the highest risk of mortality receive priority. Model for end-stage liver disease and Child-Turcotte-Pugh scoring system, the two most universally applicable systems are used in urgency-based prioritization. However, other factors must be considered to achieve optimal allocation. Factors affecting pre-transplant patient survival and the quality of the donor organ also affect outcome. The optimal system should have allocation prioritization that accounts for both urgency and transplant outcome. We reviewed past and current liver allocation systems with the aim of generating further discussion about improvement of current policies.

Keywords: Liver; Transplantation; Allocation; Model for end-stage liver disease

Core tip: This manuscript is a review on the different allocation systems developed in the field of liver transplantation. The review includes an overview of the past and current policies with critical discussion. It also reviews specific studies and suggested allocation models developed with the aim of improving current systems.