Kalra Avash, Biggins Scott W
Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
UW Liver Clinical and Translational Research Center.
Curr Opin Gastroenterol. 2018 May;34(3):123-131. doi: 10.1097/MOG.0000000000000434.
The 'Final Rule,' issued by the Health Resources and Service Administration in 2000, mandated that liver allocation policy should be based on disease severity and probability of death, and - among other factors - should be independent of a candidate's residence or listing. As a result, the Organ Procurement Transplantation Network/United Network for Organ Sharing (UNOS) has explored policy changes addressing geographic disparities without compromising outcomes.
Major paradigm shifts are underway in U.S. liver allocation policy. New hepatocellular carcinoma exception policy incorporates tumor characteristics associated with posttransplantation outcomes, whereas a National Liver Review Board will promote a standardized process for awarding exception points. Meanwhile, following extensive debate, new allocation policy aims to reduce geographic disparity by broadening sharing to the UNOS region and 150-mile circle around the donor hospital for liver transplant candidates with a calculated model for end-stage liver disease score at least 32. Unnecessary organ travel will be reduced by granting 3 'proximity points' to candidates within the same donation service area (DSA) as a liver donor or within 150 nautical miles of the donor hospital, regardless of DSA or UNOS region.
This review provides an evaluation of major policy changes in liver allocation from 2016 to 2018.
卫生资源与服务管理局于2000年发布的“最终规则”规定，肝脏分配政策应基于疾病严重程度和死亡概率，并且——在其他因素中——应独立于候选人的居住地或登记情况。因此，器官获取与移植网络/器官共享联合网络（UNOS）一直在探索政策变化，以解决地理差异问题，同时不影响治疗效果。
美国肝脏分配政策正在发生重大范式转变。新的肝细胞癌例外政策纳入了与移植后结果相关的肿瘤特征，而国家肝脏审查委员会将推动授予例外积分的标准化流程。与此同时，经过广泛辩论，新的分配政策旨在通过将共享范围扩大到UNOS地区以及供体医院周围150英里的区域，来减少地理差异，适用于终末期肝病评分计算模型至少为32分的肝脏移植候选人。对于与肝脏供体在同一捐赠服务区（DSA）内或距离供体医院150海里以内的候选人，无论其DSA或UNOS地区如何，都将给予3个“接近积分”，从而减少不必要的器官运输。
本综述对2016年至2018年肝脏分配的主要政策变化进行了评估。
