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The Distribution of Organs for Liver Transplantation-Reply

Oscar Bronsther, MD; John J. Fung, MD, PhD; Andreas Tzakis, MD; Thomas E. Starzl, MD, PhD; David Van Thiel, MD
JAMA. 1994;272(11):849. doi:10.1001/jama.1994.03520110026014.
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In Reply.  —It is true that one of the authors (T.E.S.) endorsed the original organ distribution plans and in fact wrote them in May 1987 in order to prevent a UNOS default of contract obligation. One plan was for kidneys and the other for extrarenal organs. Disputes within the appointed organ distribution committee had prevented development of the required document. What was used was taken verbatim from two impending publications describing the distribution systems already in place in Pittsburgh.1,2 The existence of these manuscripts had been made known to UNOS by two colleagues, resulting in the last-minute recruitment of Dr Starzl.The principles of both plans are still embraced by UNOS, but with a changed meaning. Originally, overwhelming weight for liver distribution was given to urgency of need because there is no treatment option comparable with the artificial kidney. "Boutique" liver recipients called in for operation from the 19th


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