Pediatric Livers Bypassing Needy Children

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A recent study (J Ge, EK Hsu, J Bucuvalas, JC Lai. Hepatology 2019; 69: 1231-41) provides data showing that current liver allocation policy allow pediatric donor organs to bypass desperately ill children in favor of adult liver transplant recipients. The authors utilized national registry data over a 5-year period to follow the allocation of pediatric liver donor organs.

Key points:

  • About 60 children (~12% of waitlist candidates) die awaiting liver transplantation each year
  • From 2010-2014, 3318 pediatric donor livers were transplanted; 45% of these organs went to adults.
  • 390 of the 1569 adult recipients received a pediatric organ that was NEVER offered to a child
  • In this group of 390, 71% of these adults were lower acuity with MELD <35 and non-status 1A.

These data identify a deviation from the policy goal that pediatric organs are offered first to pediatric recipients.

My take: this study adds more data showing that children <12 years of age are disadvantaged with current allocation policies.  This is despite the fact that children have lower posttransplant mortality, indicating that organ transplantation is more likely to be truly life-saving in children.

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