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Oscar Bronsther, MD; John J. Fung, MD, PhD; Andreas Izakis, MD; David Van Thiel, MD; Thomas E. Starzl, MD, PhD

JAMA. 1994;271(2):140-143.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

THE CURRENT policies for cadaver kidney distribution were recently discussed in THE JOURNAL.¹ Questions about liver allocation are even more important, because there is not the option of artificial organ support.² Two principles of liver deployment have been advocated: efficiency of organ use and urgency of need.

THE EFFICIENCY PRINCIPLE

Single Disease Studies

Primary Biliary Cirrhosis.

—Patients with this disease have been stratified retrospectively into low-, medium-, and high-risk categories, and their actual survival after liver transplantation has been compared with the outcome expected without such intervention.³ This comparison depended on a Mayo hazard prediction model of the natural history of primary biliary cirrhosis (Table 1).⁴ Before the National Institutes of Health Consensus Development Conference of 1983,⁵ we reserved liver transplantation candidacy for patients with chronic disease whose life expectancy was a few months.⁶ The effect of this restrictive policy could be seen in . . . [Full Text PDF of this Article]

Author Affiliations
From the Pittsburgh Transplant Institute, University of Pittsburgh (Pa) Medical Center. Dr Van Thiel is now with the Oklahoma Transplantation Institute, Baptist Medical Center, Oklahoma City.

Footnotes
The authors are affiliated with a major transplant center that might benefit from changes in the United Network for Organ Sharing liver allocation system.

Reprint requests to Department of Surgery, 5C Falk Clinic, University of Pittsburgh, 3601 Fifth Ave, Pittsburgh, PA 15213 (Dr Starzl).

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