MELD—Moving steadily towards equality, equity, and fairness

摘要: Background and aims: A consensus has been reached that liver donor allocation should be based primarily on disease severity waiting time not a major determining factor. Our aim was to assess the capability of Model for End-Stage Liver Disease (MELD) score correctly rank potential recipients according their mortality risk OPTN list. Methods: The MELD model predicts serum creatinine, total bilirubin, INR shown useful in predicting patients with compensated decompensated cirrhosis. In this study, we prospectively applied estimate 3-month 3437 adult transplant candidates chronic who were added list at 2A or 2B status between November, 1999, December, 2001. Results: study cohort disease, 412 (12%) died during follow-up period. Waiting increased directly proportion listing score. Patients having =40 had rate 71.3%. Using c-statistic as end point, area under receiver operating characteristic (ROC) curve 0.83 compared 0.76 Child-Turcotte-Pugh (CTP) (P < 0.001). Conclusions: These data suggest is able accurately predict among can livers.(Gastroenterology 2003;124:91–96.) Context: Endstage serves basis distribution deceased-donor (DD) livers developed response “the final rule” mandate, whose stated principle allocate patient's medical need, less emphasis keeping organs local procurement area. However, selected areas United States, are kept organ organizations (OPOs) small lists transplanted into less-sick instead being allocated sicker nearby centers OPOs large lists. Objective: To determine whether there difference scores receiving transplants vs OPOs. Design setting: Retrospective review US Scientific Registry Transplant Recipients February 28, 2002, March 31, 2003. (N = 4798) end-stage received DD livers. Main outcome measures: (range, 6–40), graft survival, patient survival ( =100 list) RESULTS: same OPOs; 92% 18 less, 7% 19 24, only 2% listed higher than 24 .85). significantly lower (19% 49%; P 24). This disparity does reflect goals current policy, which distribute (JAMA 2004;291:1871–1874.)