Context The Model for Endstage Liver Disease (MELD) score serves as the basis
for the distribution of deceased-donor (DD) livers and was developed in response
to "the final rule" mandate, whose stated principle is to allocate livers
according to a patient's medical need, with less emphasis on keeping organs
in the local procurement area. However, in selected areas of the United States,
organs are kept in organ procurement organizations (OPOs) with small waiting
lists and transplanted into less-sick patients instead of being allocated
to sicker patients in nearby transplant centers in OPOs with large waiting
Objective To determine whether there is a difference in MELD scores for liver
transplant recipients receiving transplants in small vs large OPOs.
Design and Setting Retrospective review of the US Scientific Registry of Transplant Recipients
between February 28, 2002, and March 31, 2003. Transplant recipients (N =
4798) had end-stage liver disease and received DD livers.
Main Outcome Measures MELD score distribution (range, 6-40), graft survival, and patient survival
for liver transplant recipients in small (<100) and large (≥100 on the
waiting list) OPOs.
Results The distribution of MELD scores was the same in large and small OPOs;
92% had a MELD score of 18 or less, 7% had a MELD score between 19 and 24,
and only 2% of listed patients had a MELD score higher than 24 (P = .85). The proportion of patients receiving transplants in small
OPOs and with a MELD score higher than 24 was significantly lower than that
in large OPOs (19% vs 49%; P<.001). Patient survival
rates at 1 year after transplantation for small OPOs (86.4%) and large OPOs
(86.6%) were not statistically different (P = .59),
and neither were graft survival rates in small OPOs (80.1%) and large OPOs
(81.3%) (P = .80).
Conclusions There is a significant disparity in MELD scores in liver transplant
recipients in small vs large OPOs; fewer transplant recipients in small OPOs
have severe liver disease (MELD score >24). This disparity does not reflect
the stated goals of the current allocation policy, which is to distribute
livers according to a patient's medical need, with less emphasis on keeping
organs in the local procurement area.