November 26, 2001

UNOS Adopts New System for Ranking Patients

Patients waiting for a liver transplant will no longer receive donated livers on a first come, first serve basis.

The United Network for Organ Sharing (UNOS) voted unanimously last Thursday in favor of changing that system to one that ranks patients on the basis of need.

The new system will be based on a formula for adults known as the Model for End-Stage Liver Disease and a companion formula for children called the Pediatric End-Stage Liver Disease model. The formulas use laboratory findings to calculate patients' short-term mortality risk if they do not receive a transplant.

Patients already are categorized into urgency groups under the current system. However, the present system uses the amount of time patients spend on the waiting list as a tiebreaker.

The revised system would put those in the most critical condition at the top of the transplant list, regardless of how long they have been waiting.

The change comes at a time when the transplant network faces growing criticism for failing to distribute organs to the most needy patients. Critics have said this system allows a patient in one city to die, while a healthier patient in another area receives a transplant.

Scoring for liver transplants will continue under the new plan, but will be compared within preset geographic borders, not across regions. Despite this, UNOS says the adopted changes would create a fairer system.

UNOS is the non-profit organization that maintains the national Organ Procurement and Transplantation Network under a contract with the Department of Health and Human Services (HHS).

"We believe this new system is objective, it will save lives on the waiting list, and it allows for additional enhancements," UNOS President Dr. Jeremiah G. Turcotte said in a statement.

UNOS added that the new system would take effect in 2002, pending approval from HHS and a transition period to allow patients who have been on the waiting list for a long time a chance to receive an organ.

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