THE CURRENT policies for cadaver kidney distribution were recently discussed in The Journal.1 Questions about liver allocation are even more important, because there is not the option of artificial organ support.2 Two principles of liver deployment have been advocated: efficiency of organ use and urgency of need.
THE EFFICIENCY PRINCIPLE
Single Disease Studies
Primary Biliary Cirrhosis.
—Patients with this disease have been stratified retrospectively into low-, medium-, and high-risk categories, and their actual survival after liver transplantation has been compared with the outcome expected without such intervention.3 This comparison depended on a Mayo hazard prediction model of the natural history of primary biliary cirrhosis (Table 1).4 Before the National Institutes of Health Consensus Development Conference of 1983,5 we reserved liver transplantation candidacy for patients with chronic disease whose life expectancy was a few months.6 The effect of this restrictive policy could be seen in
Bronsther O, Fung JJ, Izakis A, Van Thiel D, Starzl TE. Prioritization and Organ Distribution for Liver Transplantation. JAMA. 1994;271(2):140-143. doi:10.1001/jama.1994.03510260072031