for Liver Transplantation
Oscar Bronsther, John J. Fung,
Andreas Izakis, David Van Thiel,
and Thomas E. Starzl
The current policies for cadaver kidney distribution were recently discussed in The Journal. 1 Questions about liver allocation are even more important, because there is not the option of artificial organ support. 2 Two principles of liver deployment have been advocated: efficiency of organ use and urgency of need.
Patients with this disease have been stratified retrospectively into low-, medium-, and high-risk categories, and their actual survival after liver transplantation has been compared with the outcome expected without such intervention.3 This comparison depended on a Mayo hazard prediction model of the natural history of primary biliary cirrhosis (Table 1). 4 Before the National Institutes of Health Consensus Development Conference of 1983, 5 we reserved liver transplantation candidacy for patients with chronic disease whose life expectancy was a few months. 6 The effect of this restrictive policy could be seen in liver recipients' treated for primary biliary cirrhosis between March 1980 and June 1987. Even in the low-risk group, the bilirubin level____________________