Regional variations in peer reviewed liver allocation under the MELD system

Hector Rodriguez-Luna, Hugo E. Vargas, Adyr Moss, Kunam S. Reddy, Richard B. Freeman, David Mulligan

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


The Model for End-Stage Liver Disease (MELD) is used to assign priority for liver transplantation candidates. The Organ Procurement and Transplantation Network (OPTN) approved recognized exceptional diagnoses (RED's) for which MELD fails to accurately measure priority. Centers can request increased MELD points in cases not recognized by this policy (non-RED's). Our aim was to compare regional practices to justify non-RED requests for MELD adjustments. The UNOS/OPTN database was queried to extract all adult cases for which a non-RED MELD adjustment was requested from 2/27/02 until 8/27/03. The data were stratified by region and justification. Data for 29510 listings were available. 26947 had complete diagnosis information. There were 827 non-RED requests of which 477 (57.7%) petitions were approved by the regional review boards (RRBs). The approval rate varied significantly among regions (range: 28-75%, p < 0.0001). The most common non-RED's were complications of portal hypertension (48%). The percentage of patients listed with non-RED's varied significantly among regions (0.7-8.3%, p < 0.0001), as did the proportion of patients transplanted with non-RED's (2.1-31.9%, p < 0.0001). Demographics did not differ among regions requesting non-REDs. Widespread regional variations exist in the handling of requests for non-REDs. These variations point to the need for reform to standard exception criteria.

Original languageEnglish (US)
Pages (from-to)2244-2247
Number of pages4
JournalAmerican Journal of Transplantation
Issue number9
StatePublished - Sep 2005


  • Allocation
  • Liver transplantation
  • MELD

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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