Share 35 and Liver Allocation


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How are livers allocated?


UNOS (United Network for Organ Sharing) is the governing body that decides who receives a donor's organs. All transplant centers must follow UNOS rules. UNOS has made some recent changes in the way that livers will be given to patients, effective on June 18, 2013. The new UNOS policy is called Share 35.


Liver allocation refers to how livers are given to people on the waiting list. It has been based on the model for end-stage liver disease (MELD) and pediatric end-stage liver disease (PELD) scores since 2002. The MELD score is a number value that indicates the severity of a person's liver disease, based on blood tests. The higher the MELD score, the sicker the person is, and the higher they are on the waiting list. The MELD score ranges from 6 to 40.


Prior to June 18, 2013, liver allocation was based on the MELD score and the donor's blood type. And, for the most part, livers were allocated locally. This meant that typically if the University of Wisconsin Organ and Tissue Donation (OTD) center had a donor, the liver went to a patient listed at the University of Wisconsin Transplant Center. Only rarely was the liver sent for a patient at another transplant center.


What is Share 35?


Starting on June 18, 2013, UNOS will be changing the way livers are allocated. The policy change, called Share 35, offers livers to both local and regional patients on the wait list with MELD scores of 35 or higher. That is, all patients on the liver waitlist with a MELD score of 35 or higher in our region (Wisconsin, Illinois, Minnesota, North Dakota and South Dakota) are on one shared list.


What does this mean for patients at UW Hospital?


The policy is expected to impact critically-ill patients (those with MELD scores of 35 or higher) by directing livers to those most in need. This will hopefully result in fewer patients dying while waiting for a liver. However, this means that if there are patients on waiting lists at other transplant centers in our region, such as Chicago and Minnesota, with MELD scores of 35 or higher, UW Organ and Tissue Donation will have to send the liver to those transplant centers. Prior to this change, these livers would have gone to patients on the UW Hospital transplant wait list.


We think that this change may result in patients here at UW waiting longer for a liver. It is hard to predict how much this new policy will impact the UW Liver Transplant program but we will track these changes closely.


Why did UNOS make this change?


The goal of this change is to reduce waiting list deaths. Data shows that patients with MELD scores of 35 or higher have a 33.7 percent risk of death at one year after listing, compared to 17.4 percent risk of death for those in the MELD range of 17-34, and 8.8 percent risk of death for those with MELD scores less than 15.


Are there any other options to get a transplant sooner?

  • Living donation: More patients may choose to think about live donor transplant if they have a family member or friend willing to donate. Please talk to your doctors and transplant coordinators about whether this is a good option for you.
  • Donation after Circulatory Death (DCD) organs: We have patients sign a specific consent form for these types of organs. Talk to your doctors and transplant coordinator about your current status. You can change your mind about this at any time.