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首页> 外文期刊>Current opinion in gastroenterology >New paradigms for organ allocation and distribution in liver transplantation
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New paradigms for organ allocation and distribution in liver transplantation

机译：肝移植器官分配和分布的新范式

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Purpose of review The ‘Final Rule,’ issued by the Health Resources and Service Administration in 2000, mandated that liver allocation policy should be based on disease severity and probability of death, and – among other factors – should be independent of a candidate's residence or listing. As a result, the Organ Procurement Transplantation Network/United Network for Organ Sharing (UNOS) has explored policy changes addressing geographic disparities without compromising outcomes. Recent findings Major paradigm shifts are underway in U.S. liver allocation policy. New hepatocellular carcinoma exception policy incorporates tumor characteristics associated with posttransplantation outcomes, whereas a National Liver Review Board will promote a standardized process for awarding exception points. Meanwhile, following extensive debate, new allocation policy aims to reduce geographic disparity by broadening sharing to the UNOS region and 150-mile circle around the donor hospital for liver transplant candidates with a calculated model for end-stage liver disease score at least 32. Unnecessary organ travel will be reduced by granting 3 ‘proximity points’ to candidates within the same donation service area (DSA) as a liver donor or within 150 nautical miles of the donor hospital, regardless of DSA or UNOS region. Summary This review provides an evaluation of major policy changes in liver allocation from 2016 to 2018.
机译：审查2000年卫生资源和服务管理局发布的“最终规则”的目的，要求肝脏分配政策应基于疾病严重程度和死亡概率，以及其他因素 - 应与候选人的住所无关清单。因此，器官采购移植网络/机构分享联合网络（UNOS）已经探索了解决地理差距的政策变更，而不会损害结果。最近的发现在美国肝脏分配政策中正在进行主要范式转变。新的肝细胞癌异常政策包括与后翻境结果相关的肿瘤特征，而国家肝脏审查委员会将促进标准化的授权异常点。同时，在广泛的辩论之后，新的分配政策旨在通过扩大到欧洲联盟地区和150英里的局部医院围绕肝脏移植候选人的肝脏移植候选人的终端肝病得分至少为32型，以减少地理差异。不必要当DSA或欧洲联盟地区，通过将3个“接近点”授予与捐赠服务区（DSA）的候选人提供3个“邻近点”，将其作为肝脏捐赠者或在捐助者医院的150海里范围内。发明内容本综述对2016至2018年肝脏分配的重大政策变化进行了评估。

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