The new lung allocation system in the United States

Basic principles of liver allocation and development over the years

PURPOSE OF REVIEW

Prior to the enactment of the National Organ Transplant Act in 1984, there was no organized system to allocate donor organs in the United States. The process of liver allocation has come a long way since then, including the development and implementation of the Model for End-stage Liver Disease, which is an objective estimate of risk of mortality among candidates awaiting liver transplantation.

RECENT FINDINGS

The Liver Transplant Community is constantly working to optimize the distribution and allocation of scare organs, which is essential to promote equitable access to a life-saving procedure in the setting of clinical advances in the treatment of liver disease. Over the past 17 years, many changes have been made. Most recently, liver distribution changed such that deceased donor livers will be distributed based on units established by geographic circles around a donor hospital rather than the current policy, which uses donor service areas as the unit of distribution. In addition, a National Liver Review Board was created to standardize the process of determining liver transplant priority for candidates with exceptional medical conditions. The aim of these changes is to allocate and distribute organs in an efficient and equitable fashion.

SUMMARY

The current review provides a historical perspective of liver allocation and the changing landscape in the United States.

[The role of the French Agence de la biomédecine in lung transplantation]

The Agence de la biomédecine is a public institution in charge of organs tissues cells transplantation, reproduction, embryology and genetics. It interacts with the hospital coordinators and the transplant teams and ensure the regulation of organ retrieval and allocation. Its strategic missions are the revision of the graft allocation rules and the optimization of transplant organization. These last years, after redefining the graft selection criteria, the activity of lung transplantation increased drastically. The lung procurement efficacy must be still improved, while various machines of perfusion are going to be available. In July 2007, a national priority status for the patients with a life-threatening condition in the very short-term was put in place. The use of a graft allocation score taking into account the urgency and the individual benefit from transplantation is in evaluation. The optimization of the patient access to the waiting list needs a network approach of the end-stage lung diseases.