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September 21, 1994

The Distribution of Organs for Liver Transplantation

Author Affiliations

Houston, Tex

JAMA. 1994;272(11):849. doi:10.1001/jama.1994.03520110026013

To the Editor.  —I was disturbed by the article by Dr Bronsther and colleagues1 regarding the prioritization of livers for transplantation. Rather than manufacture a rationale to justify their claim to a greater share of the limited pool of donor livers, the authors would better serve the transplant community by addressing the donor shortage. Alexander and Vaughn2 showed that 25% of the patients awaiting transplantation died because of the lack of a donor liver. Any discussion of liver distribution must be tempered by the fact that there are too few livers available for all potential recipients, and even if all transplants were carried out at one center, there would still be a substantial mortality rate for patients on the waiting list. As long as the number of potential recipients exceeds the supply of donor livers, any revision of the present allocation system would accomplish nothing more than changing

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