Navigation Links
Mayo Clinic Proceedings Contributors Discuss Impact of Donor Organ Allocation System
Date:2/6/2008

ROCHESTER, Minn., Feb. 6 /PRNewswire-USNewswire/ -- Liver transplant is a life saving treatment option for people with end-stage liver disease. Unfortunately, the need for donor livers far exceeds the supply. Each year only about one-third of people who need a donor liver will receive one, and some patients die while waiting. In the February issue of Mayo Clinic Proceedings, physicians explore how the current system for allocating donor organs in the United States affects outcomes for patients with end-stage liver disease.

In the United States, the United Network for Organ Sharing (UNOS) oversees the allocation of donor organs. With the goal of giving available donor organs to the most critically-ill transplant candidates, UNOS adopted a scoring system called the Model for End-Stage Liver Disease (MELD) in February 2002. Unlike past evaluation systems, the MELD score de-emphasizes the length of time a patient has been waiting for a donor organ.

A patient's MELD score is calculated from the results of three laboratory tests. Scores range between 6 and 40, with higher numbers reflecting a more urgent need for transplantation. Research has shown that although the donor liver shortage persists, implementing this allocation system has decreased the number of patients who die while waiting for donor organs.

"Early referral to a liver transplant center no longer provides an advantage for organ allocation. However, it is unclear whether it offers other advantages, or if alternative strategies should be developed regarding timing of referral for liver transplant," writes Jaime Aranda-Michel, M.D., a member of the Mayo Clinic Jacksonville liver transplant team and lead researcher for a Mayo study on this topic.

The Mayo study examined the evaluation practices and denial and acceptance criteria for liver transplant used by the Mayo Clinic Jacksonville Transplant Center after the MELD system was implemented.

"Obtaining a clearer understanding of these issues could result in changes in the approach to referrals for liver transplant," writes Dr. Aranda-Michel.

Mayo researchers examined medical records from 555 patients referred for liver transplant at Mayo Clinic Jacksonville Transplant Center from Jan. 1 through Dec. 31, 2005. A transplant selection committee typically determines patient eligibility for liver transplant using a variety of criteria, including a patient's MELD score. From these 555 patients, 260 were accepted for liver transplant at their first review, and 295 (53 percent) were denied. Among those denied for transplant, 150 (51 percent) were considered too early for liver transplant while the rest were excluded due to other medical conditions and psychosocial issues that affected their eligibility. Patients seeking referral for liver transplant often undergo repeated assessments by selection committees, as their eligibility can change over time or following treatment and/or changes in conditions that led to their initial exclusion.

Significance of the findings

According to Dr. Aranda-Michel, the data from the Mayo study suggest that even though the current donor organ allocation system favors the most critically-ill patients, a broad range of patients could benefit from early referral for liver transplant evaluation.

"Our study suggests that early referral for liver transplant evaluation offers other advantages unrelated to the time patients spend on the liver transplant waiting list. If patients too early for liver transplant were evaluated but not listed, a liver transplant center could initiate management of end-stage liver disease and address psychosocial issues in a subgroup of patients who could also ultimately benefit from liver transplant. Early referral could also lead to the earlier detection and treatment of liver cancer tumors called hepatocellular carcinomas that accompany some forms of chronic liver disease. If these tumors become too large, they can make a patient ineligible for transplant," says Dr. Aranda-Michel.

In an editorial that follows, author Gennaro Selvaggi, M.D., from Miami Transplant Institute at the University of Miami, agrees that while the MELD system has proven to be valuable, those who are responsible for placing patients on transplant lists face many challenges.

"One could argue that keeping a long list of active patients with low MELD scores could burden the system. However, many patients can experience a sudden decompensation of their liver disease, which would rapidly increase their MELD score," writes Dr. Selvaggi.

"In the end, the most important concept advanced by Aranda-Michel is that patients should be referred early and followed up by a team of liver transplant specialists," writes Dr. Selvaggi.

A peer-review journal, Mayo Clinic Proceedings publishes original articles, reviews and editorials dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 80 years and has a circulation of 130,000 nationally and internationally. Articles are available online at http://www.mayoclinicproceedings.com.

To obtain the latest news releases from Mayo Clinic, go to http://www.mayoclinic.org/news. MayoClinic.com (http://www.mayoclinic.com) is available as a resource for your health stories.


'/>"/>
SOURCE Mayo Clinic
Copyright©2008 PR Newswire.
All rights reserved

Related medicine technology :

1. Dendreon Announces Publication of Phase 1 Study Highlighting Immunologic and Clinical Activity of Lapuleucel-T (Neuvenge(R)) in Advanced Breast Cancer Patients
2. EDAP Announces Launch of Clinical Study Combining HIFU and Chemotherapy for Localized Aggressive High Risk Prostate Cancer
3. EpiCept Reports Expansion of Clinical Development For Licensed Cancer Compound
4. Auxilium Pharmaceuticals, Inc. Receives Clearance to Resume Clinical Trials for XIAFLEX(TM)
5. Romark Initiates Clinical Trial of Alinia(R) for Chronic Hepatitis C in the United States
6. The Multiple Myeloma Research Consortium (MMRC) and Proteolix Initiate Phase 2 Clinical Trial Investigating Carfilzomib for the Treatment of Multiple Myeloma
7. Millennium Initiates Clinical Trial to EVOLVE the Treatment of Patients with Newly Diagnosed Multiple Myeloma
8. Potential Safety Issue Identified in Ongoing Phase 2 Clinical Study of HCV-796
9. Clinical Trial Effectiveness: How Pharmas & Biotechs Save Cost with Savvy Investigator Management
10. Callisto Pharmaceuticals Opens Additional Sites for Phase II Clinical Trial of Atiprimod in Advanced Carcinoid Cancer Patients
11. Phosphagenics Announces Positive Phase 1b Transdermal Insulin Clinical Trial Results
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:4/20/2017)... , April 20, 2017 Research ... America Pharmaceutical Contract Manufacturing Services Market Analysis By Service (Manufacturing, ... Segment Forecasts, 2014 - 2025" report to their offering. ... The Latin American ... 21.0 billion by 2025 Low drug registration cost ...
(Date:4/19/2017)... Calif. , April 19, 2017  IRIDEX Corporation ... will release financial results for the first quarter 2017 ... 2017.  The Company,s management team will host a corresponding ... p.m. ET. Investors interested in listening to ... 707-0665 for domestic callers or (703) 326-3030 for international ...
(Date:4/19/2017)... 19, 2017 The Global Effective Microorganisms ... 2022 report has covered and analysed the potential of Global ... market size, shares and growth factors. The report identifies and ... opportunities in the global market. ... Browse 152 Tables and Figures, 6 Major Company Profiles, ...
Breaking Medicine Technology:
(Date:4/25/2017)... ... April 25, 2017 , ... Lake Park Dental is now accepting ... Invisalign® in Lutz, FL. With the help of this highly-effective, yet convenient system, ... potential complications, more discretion and less pain. , Drs. Sarah Jockin, Nicole Morganti, ...
(Date:4/25/2017)... ... April 25, 2017 , ... As pharmaceutical companies are held ... with process innovation in drug formulation and manufacturing. CoreRx offers its clients ... equipment in support of their development and manufacturing goals. , The company ...
(Date:4/25/2017)... ... 2017 , ... Back Pain Centers of America (BPC), which connects ... in their area, announces the launch of a new and proprietary customer relationship management ... for reputable physicians to help them with back or neck pain and helps to ...
(Date:4/25/2017)... (PRWEB) , ... April 25, 2017 , ... Saad B. Chaudhary, MD is committed to ... of acute or chronic problems, I focus on preventative care with all my patients to ... have any questions, always feel free to contact my office and my trained staff will ...
(Date:4/25/2017)... ... April 25, 2017 , ... Emergency Physician and Distinguished ... the Outlier Leadership Series, Outliers in Writing, set to publish in summer 2017. ... Medicine at the University of Arizona College of Medicine. He also serves as Medical ...
Breaking Medicine News(10 mins):