New System Improves Distribution of Donated Livers

Nov. 26 -- TUESDAY, Nov. 25 (HealthDay News) -- Thanks to a new liver transplant allocation system that gives preference to patients with the greatest need, rather than time spent on a waiting list, racial disparities among those waiting for new livers are narrowing.

Blacks are no longer much more likely to die or become too sick for a transplant while on the waiting list, although there are still noticeable gender gaps, according to the study published in the Nov. 26 issue of the Journal of the American Medical Association.

The new MELD (Model for End-Stage Liver Disease) scoring system was introduced in 2002.

"Post-MELD, the disparity between blacks and whites went away," said Dr. Cynthia A. Moylan, lead author of the study and a transplant hepatology fellow at Duke University Medical Center in Durham, N.C. "The sickest patients get" the organs, she said.

The study is the first comprehensive look at the success of the new system.

Currently, there are more than 16,000 people in the United States waiting for a new liver, according to the United Network for Organ Sharing (UNOS). And according to an accompanying editorial in the journal, overall survival rates for liver transplantations normally exceed 90 percent one year after the surgery. A liver transplant is the only hope for long-term survival for people with end-stage liver disease.

Prior to 2002, allocation of livers from deceased donors was based on time spent on the waiting list, as well as subjective measures by a physician, Moylan said.

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"The system had multiple problems, and one was racial disparity," she said. 'They [blacks] were underrepresented on the waiting list and less likely to receive a transplant."

People who were able to wait for long periods of time were less likely to need a transplant, explained Dr. Richard Freeman, professor of surgery at Tufts University School of Medicine, in Boston, and chairman of the committee that put the MELD system into place.

Also, the old system could be manipulated. For instance, patients in intensive care were given preferential status, so doctors sometimes put patients in the ICU to bump them up on the list. "Doctors were trying to do the best thing for their patient, but it was disadvantaging those who really did need a transplant," Freeman said.