Many physicians are unhappy with the current liver transplantation allocation system.  A recent article (A Cucchetti et al. Liver Transl 2015; 21: 1241-49, editorial  LB Vanwagner, AI Skaro. Liver Transpl 2015; 21: 1235-37) suggests that there should be adjustments to consider age in liver organ allocation. While this issue is not new, the article does suggest the idea of “age-mapping” which is a different twist on this subject.

The editorial notes that the current MELD system as been a poor predictor of post transplant outcomes and “does little to promote utility in organ allocation.”  Because age is not a factor in MELD, “there is a subsequent loss of equity in the current system because younger recipients receive fewer opportunities to achieve a full lifespan compared with older recipients.” However, age matching is prohibited by discrimination laws.

“Age mapping differs from age matching.” With age mapping, all candidates would have an “equal chance of getting a liver” but the probability of receiving a ‘better organ’ (donor ≤35 years) would be more likely for younger recipients.

My take: The scarcity of organ availability compounded with the possible decline in organ quality leads to these discussions.  Who really can balance unfair against unfortunate?

Related blog posts:

• EXCEPTIONal Outcomes and Liver Allocation | gutsandgrowth
• Picking winners and losers with liver transplantation …
• It is a Question of Fairness | gutsandgrowth
• Geographic Inequity for Liver Transplantation | gutsandgrowth