MELD and PELD: Application of survival models to liver allocation

摘要: In 1998, the Department of Health and Human Services (DHHS) issued final rule,1 in which principles organ allocation were defined, to govern operation Organ Procurement Transplant Network (OPTN). This rule included following guidelines for allocation: (1) organs should be allocated transplant candidates order medical urgency; (2) role waiting times minimized, (3) attempts made avoid futile transplants promote efficient use our scarce donor organs. The consensus opinion minimize time was based on 2 recent reports that analyzed impact survival liver patients United Sharing (UNOS) list: one from Institute Medicine2 a second report Freeman et al.3 Both studies concluded did not correlate with death list therefore de-emphasized developing new algorithm. challenge put forth by this conclusion create an policy most effective especially making them available, whenever feasible, medically urgent who are appropriate transplantation. accepted UNOS Liver Intestinal Committee, whose task it make assessment current including Child-Turcotte-Pugh (CTP) score, evaluate number previously published models developed estimate end-stage disease, develop disease severity index utilized allocate future. After careful deliberation extensive input hepatologists surgeons, established creating chronic disease. By consensus, determined such rely few, readily objective variables would generally applicable heterogeneous group determine risk dying. Finally, clinically statistically validated able predict probability groups demographically diverse varying etiology severity. There agreement among committee introduced without prospective evaluation potential model may have gravely ill awaiting transplant.