Organ scarcity remains a big problem for liver transplantation. Use of the Model for End-Stage Liver Disease (MELD) score was intended to address inequity in liver transplantation allocation. However, it has not been successful. One recent study which examines donation after cardiac death versus brain death (Liver Transpl 2012; 18: 630-40) also yields some insight into liver transplantation allocation across the U.S.
In Figure 3, the thirty-day probability of receiving a liver transplantation (brain death donation) for patients with MELD score >20 was compared across UNOS regions. In regions 3 and 11 (Southeastern U.S. extending to Kentucky and Virginia), the rate was ≥40%. In region 1 (Northeastern U.S) and region 5 (Southewestern U.S.) , the rates were 9.6% and 11.8% respectively. Thus, some patients with the exact same MELD score have a 4-fold higher probability of receiving a liver transplant.