Liver Transplantation: Candidate Selection and Organ Allocation in the United States

Once a potential candidate is chosen, and all of the above workup is performed, the patient can then be placed on the waiting list. A MELDNa will be calculated and used to stratify the patient according to how acutely the patient needs the donor organ. From here, organ allocation will proceed as described above, with the ultimate goal of getting the donor organs to the patients who need it the most and will benefit the most from it. Nuances and challenges to the allocation system exist, including MELD exceptions for those with HCC, as well as geographic disparities in transplant rate and waiting list mortality. Ongoing research efforts seek to improve the allocation system to best balance the principles of justice and utility.