Goldberg David
Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA.
Curr Opin Organ Transplant. 2020 Apr;25(2):110-114. doi: 10.1097/MOT.0000000000000739.
Since 2014, the liver transplant community has been debating the pros and cons of broader sharing. Over the last 6 years, lung and heart transplantation have moved to broader sharing based on 'zones' or circles around a donor hospital, with the Organ Procurement and Transplantation Network (OPTN) approving a broader kidney sharing proposal in December of 2019 (set to be implemented in December 2020).
In 2017, the OPTN Board of Directors approved a broader sharing policy in liver transplantation that was rooted in expanding the first-line of liver sharing beyond the donor service area (DSA). Faced with the threat of litigation, this proposal was replaced with a circle-based sharing policy titled 'Acuity Circles'. After a long legal challenge, the implementation of this new policy was delayed from April 2019 until February 2020.
In this review, concerns related to broader sharing in liver allocation will be addressed, in terms of the basis for broader sharing and the potential implications to liver transplantation, rooted in the Final Rule and concerns around variability in organ donation rates and access to the waiting list.
自2014年以来，肝移植界一直在讨论扩大共享范围的利弊。在过去6年里，肺移植和心脏移植已转向基于供体医院周围的“区域”或圈子进行更广泛的共享，器官获取与移植网络（OPTN）于2019年12月批准了一项更广泛的肾脏共享提议（定于2020年12月实施）。
2017年，OPTN董事会批准了一项肝移植更广泛共享政策，该政策的基础是将肝共享的一线范围扩大到供体服务区域（DSA）之外。面对诉讼威胁，该提议被一项名为“急性病圈子”的基于圈子的共享政策取代。经过长期法律挑战，这项新政策的实施从2019年4月推迟到2020年2月。
在本综述中，将根据扩大共享的基础以及对肝移植的潜在影响，从最终规则以及器官捐献率的变异性和进入等待名单的机会等方面，探讨与肝分配中扩大共享相关的问题。
