Survival rates after liver transplantation are currently around 85%, 69% and 61% at 1, 5 and 10 years, respectively. Most current organ allocation systems are based on the principle that the sickest patients should be treated first. Models have been developed to estimate the risk of death, considering the underlying disease and urgency of the receiving patient assuming that all donor livers carry the same risk of failure. This, however, is not the case: it has been shown in recent years that the risk of graft failure, and even patient death, after transplantation differs among recipients. While some patients may “tolerate” and overcome the initial poor function of a compromised donor organ, others may not have the same reserve. Increasing awareness of the diversity in donor organ quality has stimulated the debate on matching between specific recipient and donor factors to avoid futility, but also to avoid personal and institutional differences in organ acceptance. Allocation policies must serve the patients most in need as well as achieve the best post-transplant results. This approach is a balance between individual justice (serving individuals in need) and population utility (getting the best results for the entire population at risk). As will be discussed in this paper, it is time to consider and develop allocation systems that are not only based on the likelihood of dying without a transplant, but also on the likelihood of surviving with a given donor liver.

Should donors and recipients be matched in liver transplantation?

BURRA, PATRIZIA;
2006

Abstract

Survival rates after liver transplantation are currently around 85%, 69% and 61% at 1, 5 and 10 years, respectively. Most current organ allocation systems are based on the principle that the sickest patients should be treated first. Models have been developed to estimate the risk of death, considering the underlying disease and urgency of the receiving patient assuming that all donor livers carry the same risk of failure. This, however, is not the case: it has been shown in recent years that the risk of graft failure, and even patient death, after transplantation differs among recipients. While some patients may “tolerate” and overcome the initial poor function of a compromised donor organ, others may not have the same reserve. Increasing awareness of the diversity in donor organ quality has stimulated the debate on matching between specific recipient and donor factors to avoid futility, but also to avoid personal and institutional differences in organ acceptance. Allocation policies must serve the patients most in need as well as achieve the best post-transplant results. This approach is a balance between individual justice (serving individuals in need) and population utility (getting the best results for the entire population at risk). As will be discussed in this paper, it is time to consider and develop allocation systems that are not only based on the likelihood of dying without a transplant, but also on the likelihood of surviving with a given donor liver.
2006
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/1560484
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