Allocating donor livers

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7088.1140 (Published 19 April 1997) Cite this as: BMJ 1997;314:1140

Should be given to patients most likely to benefit, irrespective of cause

  1. James Neuberger, Consultant physiciana,
  2. John Lake, Medical directorb
  1. a The Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH
  2. b UCSF Liver Transplantation Unit, Box 0708, San Francisco, CA 94143, USA

    The furore over new proposals for allocating donor livers in the United States highlights the problems associated with rationing.1 The changes, proposed by the United Network for Organ Sharing (UNOS), arose out of a recognition that the existing system was unfair and not the most effective use of a scarce resource. The principles of justice for all and optimal medical use were not being fulfilled. The proposed changes are modest, limited to redefining which patients should have the highest priority and setting criteria for entry on to the waiting list.

    Despite greater use of split livers (two liver grafts from one donor) and those from marginal donors (such as those over 60 years, those with hypotension, and non-heart beating donors), the supply of donor livers has remained constant. With more patients being referred for transplantation, the numbers waiting for livers have increased progressively in Europe and North America. Moreover, the wait for a liver has increased, resulting in increased mortality while on the waiting list and a potential increase in perioperative morbidity and mortality. Xenografts may help, but it will some time before they become a clinical reality.

    Britain has only seven centres designated by …

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