Published online Mar 14, 2016. doi: 10.3748/wjg.v22.i10.2922
Peer-review started: October 31, 2015
First decision: December 11, 2015
Revised: December 26, 2015
Accepted: January 17, 2016
Article in press: January 18, 2016
Published online: March 14, 2016
Processing time: 125 Days and 17.4 Hours
With the growing number of patients in need of liver transplantation, there is a need for adopting new and modifying existing allocation policies that prioritize patients for liver transplantation. Policy should ensure fair allocation that is reproducible and strongly predictive of best pre and post transplant outcomes while taking into account the natural history of the potential recipients liver disease and its complications. There is wide acceptance for allocation policies based on urgency in which the sickest patients on the waiting list with the highest risk of mortality receive priority. Model for end-stage liver disease and Child-Turcotte-Pugh scoring system, the two most universally applicable systems are used in urgency-based prioritization. However, other factors must be considered to achieve optimal allocation. Factors affecting pre-transplant patient survival and the quality of the donor organ also affect outcome. The optimal system should have allocation prioritization that accounts for both urgency and transplant outcome. We reviewed past and current liver allocation systems with the aim of generating further discussion about improvement of current policies.
Core tip: This manuscript is a review on the different allocation systems developed in the field of liver transplantation. The review includes an overview of the past and current policies with critical discussion. It also reviews specific studies and suggested allocation models developed with the aim of improving current systems.