Transplantation and Liver Disease
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Transplantation is the accepted treatment for patients with end stage liver disease, and because of an increasing number of patients being referred for transplantation, the gap between donate livers and recipients on the waiting list is ever increasing (Neuberger and James (1999). This shortage has encouraged the splitting of livers and the use of marginal organs for transplantation, but the gap still remains significant. There are substantial differences between countries in donation rates. Figures from 1996 show 26.8 cadaveric donors per million population in Spain, 21.2 in the United States, 14.6 in the United Kingdom and Republic of Ireland, 15.1 in France, and 11.0 in Italy. The high rate of donation in Spain is attributed to well-resourced and organized donor awareness programs. The Council of Europe has estimated that as many as 50 donors per million are required to meet the clinical need for liver transplants. The United Network for Organ Sharing (UNOS) in North America has adopted minimum criteria for patients to be accepted onto the waiting list for a liver transplant because too many patients were being put onto the list at an early stage (Neuberger and James, 1999). The World Health Organization believes that organs should be allocated on the basis of medical need, and UNOS has stated that allocation should balance medical usefulness and justice. The American Medical Association Committee on Ethical Issues has outlined as criteria for acceptance of a pat
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save lives by identifying patients in the greatest need for transplantation within the next three months and giving them the highest priority (UNOS, 2002). The MELD system has been assessed by various committees of OPTN and UNOS which included patients, donors, and their family members, and has been discussed at public meetings. The system will give individual urgency status instead of lumping patients into groups, and will more accurately indicate which patients are most in need of a liver transplant. As a patientĘs MELD score increase, they will be moved up the list in terms of priority. Length of time on the waiting list will only come into play if two patients with the same MELD score are offered an organ.
After one year of using the MELD system, the number of new registrations on the liver transplant waiting list has gone down from 10,579 in the preceding year to 9,317 (Tucker, 2003). The reduction reflects the elimination of the need to put patients on the waiting list early to gain priority for them. The data show that the use of MELD and PELD have reduced the degree of subjectivity involved in placing patients on the waiting list. However, it is recognized that adjustments will have to be made to the system with
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Some common words found in the essay are:
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Approximate Word count = 2606
Approximate Pages = 10 (250 words per page)
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