Navigation Links
New System Improves Distribution of Donated Livers

Gains reported for blacks, but women lagging behind men, study finds

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.

"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.

The MELD score, which predicts the risk of dying within three months, is based on a formula incorporating three laboratory tests.

"MELD is based on pure blood tests, and it's hard to manipulate patients' blood tests," Freeman said. "The waiting time is taken out. It's based on who's sicker."

The authors of the new study looked at patients, black and white, on the Organ Procurement and Transplantation Network waiting list for liver transplantation between Jan. 1, 1996, and Dec. 31, 2000 (pre-MELD), and between Feb. 28, 2002, and March 31, 2006 (post-MELD).

Before MELD, 27 percent of black patients died or became too sick for a transplant within three years of registering for a liver, compared with 21.7 percent of whites. After MELD, that gap narrowed considerably with 26 percent of blacks dying or becoming too sick for a transplant, compared with 22 percent of whites.

And while blacks were less likely than whites to receive a new liver within three years of registering on the pre-MELD list, in the post-MELD era this is no longer the case.

Gender, however, is another story. Women are more likely to die or become too sick for a liver transplant under the post-MELD system. And they are -- and were -- less likely to receive a new liver within three years, regardless of the era.

This likely is the result of several factors, including women's smaller size (meaning they need a smaller liver), higher likelihood of having an autoimmune disease, and the fact that women have less muscle mass, likely affecting some of the MELD calculations.

"Organ allocation in general is evolving all the time," Freeman said. "You learn how to do it better and build on your experiences to figure out what's wrong and what's right about it."

More evidence is emerging that adding a serum sodium test to the MELD calculation might right the gender imbalance.

More information

Visit the United Network for Organ Sharing for more on organ donations and transplantation.

SOURCES: Cynthia A. Moylan, M.D., transplant hepatology fellow, Duke University Medical Center, Durham, N.C.; Robert Freeman, M.D., professor of surgery, Tufts University School of Medicine, Boston; Nov. 26, 2008, Journal of the American Medical Association

Copyright©2008 ScoutNews,LLC.
All rights reserved

Related medicine news :

1. Traxtal Highlights PercuNav Systems Powerful Capabilities for Diagnostic Imaging
2. New Software Streamlines Interface Management, Delivers More System Security and Greater IT Control
3. Ochsner Health System, Surgical Information Systems Partner to Rebuild New Orleans Healthcare Infrastructure
4. ASP Announces Availability of CLEANASCOPE System
5. Lilly Completes Acquisition of ImClone Systems
6. Varian Medical Systems to Exhibit the Latest X-Ray Image Detectors, X-Ray Tubes, and Cancer Treatment Technologies at RSNA This Year
7. Gulf Coast Hospital Chooses Global Med Technologies(R) Blood System
8. Parkland Health & Hospital System Rolls Out Innovations PharmASSIST Technology Platform Across Nine Pharmacy Sites
9. Environmental Tectonics Corporations BioMedical Systems Division Announces Additional Sales of its Baramed Monoplace Chambers
10. Wendy Hoke Joins the Sisters of Charity Health System as Communications Officer
11. SEIUs Andy Stern Renews Call to Fix Nations Broken Health Care System, Ease Financial Strain on Working Families, Economy
Post Your Comments:
(Date:6/27/2016)... (PRWEB) , ... June 27, 2016 , ... ... District , the only authorized OSHA Training Institute Education Center headquartered in Northern ... protecting their workers from extreme heat at their worksites. Employers with workers ...
(Date:6/27/2016)... ... 2016 , ... "FCPX editors can now reveal their media with growing colorful ... Christina Austin - CEO of Pixel Film Studios. , ProSlice Color brings the ... can now reveal the media of their split screens with growing colorful panels. , ...
(Date:6/27/2016)... ... June 27, 2016 , ... ... announced today its affiliation with Tennessee Counseling Association. This new relationship ... of the Tennessee Counseling Association, adding exclusive benefits and promotional offers. , "TCA ...
(Date:6/27/2016)... ... June 27, 2016 , ... ... strategic partnership with Connance, a healthcare industry leader providing predictive analytics to ... technology combine to provide health systems, hospitals and ambulatory surgical centers with ...
(Date:6/27/2016)... ... June 27, 2016 , ... A revolution is ... emergency ambulance transport experience for the millions of people who require these medical ... the taxi industry through the use of technology. Now, SmartEMS has put forth ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... , June 24, 2016 Dehaier Medical ... the "Company"), which develops, markets and sells medical devices ... , signed a strategic cooperation agreement with Hongyuan ... "Hongyuan Supply Chain") on June 20, 2016, to develop ... the strategic cooperation agreement, Dehaier will leverage Hongyuan Supply ...
(Date:6/24/2016)... India , June 24, 2016 ... Needles Market by Type (Standard Pen Needles, Safety Pen ... Therapy (Insulin, GLP-1, Growth Hormone), Mode of Purchase (Retail, ... by MarketsandMarkets, This report studies the market for the ... expected to reach USD 2.81 Billion by 2021 from ...
(Date:6/24/2016)... 2016  Arkis BioSciences, a leading innovator in ... durable cerebrospinal fluid treatments, today announced it has ... is led by Innova Memphis, followed by Angel ... investors.  Arkis, new financing will accelerate the commercialization ... release of its in-licensed Endexo® technology. ...
Breaking Medicine Technology: