From Indiana U: Ethical considerations surrounding survival benefit-based liver allocation

Liver Transpl. 2013 Oct 26. doi: 10.1002/lt.23780. [Epub ahead of print]

Ethical considerations surrounding survival benefit-based liver allocation.

Keller EJ, Kwo PY, Helft PR.

Source

Indiana University School of Medicine, Department of Medicine, Charles Warren Fairbanks Center for Medical Ethics, Indianapolis, Indiana, USA.

Abstract

The disparity between the demand for and supply of donor livers has continued to grow over the last two decades, placing greater weight on the need for efficient and effective liver allocation. Although the use of extended criteria donors has shown great potential, it remains unregulated. Schaubel et al. have recently proposed the Survival Benefit-Based Model to answers calls to increase efficiency and reduce futile transplants. However, it was previously determined that the current allocation system was not in need of modification, but rather, geographic disparities should be addressed. In contrast, we believe that a significant need exists to replace the current allocation system, complementing efforts to improve donor liver distribution. We illustrate this need by first identifying major ethical concerns shaping liver allocation and using them to identify strengths and shortcomings of the MELD/PELD system and Survival Benefit-Based Model. The latter model is found to be a promising means of improving liver allocation, incorporating a greater number of ethical principles, using a sophisticated statistical model to increase efficiency and reduce waste, minimizing bias, and paralleling developments in the allocation of other organs. However, it remains limited in its post-transplant predictive accuracy and may raise potential issues regarding informed consent. In addition, the proposed model fails to include quality of life concerns and prioritize younger patients. We feel it is time to take the next steps toward better liver allocation through not only reducing geographic disparities but also adopting a model better equipped to balance the many ethical concerns shaping organ allocation. Thus we support the development of a similar model, with suggested amendments.