A Multistep, Consensus-Based Approach to Organ Allocation in Liver Transplantation: Toward a "Blended Principle Model".
Am J Transplant
; 15(10): 2552-61, 2015 10.
Article
in En
| MEDLINE
| ID: mdl-26274338
ABSTRACT
Since Italian liver allocation policy was last revised (in 2012), relevant critical issues and conceptual advances have emerged, calling for significant improvements. We report the results of a national consensus conference process, promoted by the Italian College of Liver Transplant Surgeons (for the Italian Society for Organ Transplantation) and the Italian Association for the Study of the Liver, to review the best indicators for orienting organ allocation policies based on principles of urgency, utility, and transplant benefit in the light of current scientific evidence. MELD exceptions and hepatocellular carcinoma were analyzed to construct a transplantation priority algorithm, given the inequity of a purely MELD-based system for governing organ allocation. Working groups of transplant surgeons and hepatologists prepared a list of statements for each topic, scoring their quality of evidence and strength of recommendation using the Centers for Disease Control grading system. A jury of Italian transplant surgeons, hepatologists, intensivists, infectious disease specialists, epidemiologists, representatives of patients' associations and organ-sharing organizations, transplant coordinators, and ethicists voted on and validated the proposed statements. After carefully reviewing the statements, a critical proposal for revising Italy's current liver allocation policy was prepared jointly by transplant surgeons and hepatologists.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Health Care Rationing
/
Liver Transplantation
/
Patient Selection
Type of study:
Diagnostic_studies
/
Guideline
/
Prognostic_studies
Aspects:
Equity_inequality
/
Ethics
Limits:
Humans
Country/Region as subject:
Europa
Language:
En
Journal:
Am J Transplant
Journal subject:
TRANSPLANTE
Year:
2015
Document type:
Article
Affiliation country:
Italia