This contract does not permit the redistribution or sharing of the data publicly. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ĭata Availability: Data were made available by the Organ Procurement and Transplantation Network (OPTN) per the Health Resources and Services Administration contract 234-2005-370011C. Received: JanuAccepted: SeptemPublished: October 3, 2019Ĭopyright: © 2019 Brock et al. PLoS ONE 14(10):Įditor: Mercedes Susan Mandell, University of Colorado, UNITED STATES Use of the ΔMELD 30 to add additional points or serve as a potential tiebreaker for patients with rapid deterioration may extend the benefit of Share 35 to better include those in most critical need.Ĭitation: Brock GN, Washburn K, Marvin MR (2019) Use of rapid Model for End-Stage Liver Disease (MELD) increases for liver transplant registrant prioritization after MELD-Na and Share 35, an evaluation using data from the United Network for Organ Sharing. However, the adoption of Share 35 has potentially resulted in discrepancies in waitlist dropout for patients with sharp MELD increases at higher MELD scores. After the change to MELD-Na, increased dropout associated with ΔMELD 30 jumps is no longer evident at MELD scores below 30. Predictive accuracy was evaluated using the C-index for model discrimination and by comparing observed and predicted waitlist dropout probabilities for model calibration. Two composite scores were constructed and then evaluated on UNOS data spanning the current policy era ( to ). Current MELD and ΔMELD 30 were evaluated using cause-specific hazards models for waitlist dropout based on US liver transplant registrants added to the waitlist between and. We explored the potential of a registrant’s change in 30-day MELD scores (ΔMELD 30) to improve allocation both before and after these policy changes. ![]() The United Network for Organ Sharing (UNOS)/Organ Procurement Transplantation Network (OPTN) allocation policy has evolved over the years, and notable recent changes include Share 35, inclusion of serum sodium in the MELD score, and a ‘delay and cap’ policy for hepatocellular carcinoma (HCC) patients. The Model for End-Stage Liver Disease (MELD) score has been successfully used to prioritize patients on the United States liver transplant waiting list since its adoption in 2002.
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