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Does the United States Do It Better? A Comparative Analysis of Liver Allocation Protocols in the United Kingdom and the United States

Published online by Cambridge University Press:  20 May 2011

LISA CHERKASSKY
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Extract

NHS Blood and Transplant (NHSBT) is responsible for the procurement and allocation of human organs in the United Kingdom. Its main role is to “ensure that organs donated for transplant are matched and allocated to patients in a fair and unbiased way.” NHSBT’s liver allocation policies are underpinned by the National Liver Transplant Standards, a document published by the Department of Health in 2005 to oversee patient care, patient assessment, liver allocation and transplantation, education and training, and research and development. NHSBT has developed its own liver allocation protocols under the powers assigned to it by the Department of Health, which include a “super-urgent” liver allocation policy, a Liver Allocation Sequence, and pediatric candidate liver allocation protocols.

Type
Special Section: Bioethics beyond Borders 2011
Information
Cambridge Quarterly of Healthcare Ethics , Volume 20 , Issue 3 , July 2011 , pp. 418 - 433
Copyright
Copyright © Cambridge University Press 2011

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References

1. See http://www.organdonation.nhs.uk—the official Web site—for up-to-date policies, current practices, self-help guides, statistics, and transplantation and donation information.

2. See note 1, under “about us.”

3. The Department of Health. National Liver Transplant Standards. National Specialist Commissioning Advisory Group (NSCAG); August 2005; available at http://www.dh.gov.uk/en/publicationsandstatistics/publicationspolicyandguidance/DH_4117844.

4. Pediatric liver allocation is outside of the ambit of this article, but both countries include pediatric allocation policies within their adult protocols.

5. See http://www.unos.org and http://optn.transplant.hrsa.gov/—the official Web sites—for further information regarding federal guidelines and organ allocation policies (last accessed 11 Mar 2011).

6. See http://www.unos.org under “Who we are” (last accessed 11 Mar 2011).

7. Statistic correct in March 2011.

8. See NHSBT’s official Web site for donation and transplantation statistics from their Transplant Activity report: http://www.organdonation.nhs.uk/ukt/statistics/transplant_activity_report/transplant_activity_report.jsp (last accessed 11 Mar 2011).

9. See note 3, The National Liver Transplant Standards 2005, at Introduction and Topic 3: Assessment, Access to the Waiting List and Organ Allocation. Standards 3.5 and 3.20.

10. See note 3, The National Liver Transplant Standards 2005, at Standards 3.11 and 3.13.

11. See note 3, The National Liver Transplant Standards 2005, at Standard 3.19.

12. NHS Blood and Transplant and the Liver Advisory Group. Protocols and Guidelines for Adults Undergoing Deceased Donor Liver Transplantation in the UK. Protocols and Guidelines. September 2009. Part 4: Selection Criteria, paragraph 4.1; available at http://www.organdonation.nhs.uk/ukt/about_transplants/organ_allocation/liver/liver.jsp (last accessed 11 Mar 2011).

13. See note 12, NHS Blood and Transplant and the Liver Advisory Group 2009, confirmed by paragraph B Part 4.1.1 of UK Transplant’s Organ Sharing Principles. Operating Principles for Liver Transplant Units in the UK and Republic of Ireland. July 1999. Paragraph B: Super Urgent Liver Scheme (added in October 2005); available at http://www.organdonation.nhs.uk/ukt/about_transplants/organ_allocation/liver/liver.jsp (last accessed 11 Mar 2011).

14. See note 12, NHS Blood and Transplant Protocols and Guidelines 2009, Part 4: Selection Criteria, paragraph 4.1.2.

15. See note 12, NHS Blood and Transplant Protocols and Guidelines 2009, Summary, p. 1; and Introduction, p. 2, paragraph 1.5.

16. See note 12, NHS Blood and Transplant Protocols and Guidelines 2009, Summary, p. 1. See also: Part 2: The Need for Transplantation. P. 3, paragraph 2.2; and Part 3: Assessment. P. 6, paragraph 3.3.

17. See note 12, NHS Blood and Transplant Protocols and Guidelines 2009, Summary, p. 1.

18. See note 3, The National Liver Transplant Standards 2005, at Standards 3.11 and 3.13.

19. See note 13, Liver Organ Sharing Principles 2005.

20. See note 13, Liver Organ Sharing Principles 2005, paragraph B.4. Super Urgent Liver Scheme Ranking, part 4.1. Emphasis added.

21. See note 3, The National Liver Transplant Standards 2005, Introduction.

22. See note 13, Liver Organ Sharing Principles 2005, Paragraph E: Liver Allocation Sequence (added in April 2006).

23. A “designated centre” is a center designated by the NSCAG to carry out particular grafts. They are headed by “zonal retrieval centres” for the purpose of the Sequence.

24. See note 13, Liver Organ Sharing Principles 2005, Paragraph C.4: The Liver Centre Rota (added in April 2006). Parts 4.1, 4.1.1, 4.1.2, and 4.1.3. Emphasis added.

25. See note 12, NHS Blood and Transplant Protocols and Guidelines 2009, Part 6: Allocation of Donor Livers. Paragraph 6.2. Pp. 11–12.

26. See note 12, NHS Blood and Transplant Protocols and Guidelines 2009, Paragraph 6.3. P. 12.

27. Statistic correct in March 2011.

28. See UNOS’s official Web site for transplantation statistics from their Data section: http://optn.transplant.hrsa.gov/latestData/rptData.asp.

29. The National Organ Transplant Act. 1984. Section 273: Organ procurement organisations. Part (b) (3) (E); and section 274: Organ procurement and Transplantation Network. Part (b) (2) (B); available at http://optn.transplant.hrsa.gov.policiesandbylaws/nota.asp.

30. See note 29, The National Organ Transplant Act 1984. Section 274: Organ procurement and Transplantation network. Part (b) (2) (D) & (N).

31. Title 42–Public Health. Chapter I–Public Health Service, Department of Health and Human Services. Part 121–Organ Procurement and Transplantation Network. 1999; available at http://optn.transplant.hrsa.gov.policiesandbylaws/final_rule.asp.

32. See note 31, Title 42 1999, section 121.8. Allocation of organs. Parts (a) (1), (2), and (5).

33. See note 31, Title 42 1999, Parts (b) (1), (2), and (3).

34. See note 31, Title 42 1999, Part (c) (3).

35. UNOS. Policy 3.6: Allocation of Livers. Updated November 2009. Paragraph 3.6 (p. 1); available at http://optn.transplant.hrsa.gov/PoliciesandBylaws2/policies/pdfs/policy_8.pdf (last accessed 11 Mar 2011).

36. See note 35, UNOS 2009, Paragraph 3.6.4.1.

37. See note 35, UNOS 2009, Paragraph 3.6 (p. 1).

38. See note 35, UNOS 2009, Paragraph 3.6.2.

39. See note 35, UNOS 2009, Paragraph 3.6.3.

40. See note 35, UNOS 2009, Paragraph 3.6.1. This includes both Status 1A candidates and MELD candidates.

41. The MELD/PELD scoring system has been in effect since February 2002.

42. UNOS has created an informative MELD/PELD brochure for transplant candidates that provides information about the blood tests, calculations, and liver allocation. See Questions & Answers for Transplant Candidates about MELD and PELD; available at http://www.unos.org/donation/index/php?topic=patient_brochures.

43. See note 35, UNOS 2009, Policy 3.6, Paragraph 3.6 (p. 1) and paragraph 3.6.3.

44. See note 35, UNOS 2009, Paragraph 3.6 (pp. 1 and 2).

45. See note 35, UNOS 2009, Paragraph 3.6.2.

46. See note 35, UNOS 2009, Paragraph 3.6.3. See also note 42, Questions & Answers document, p. 3.

47. Including paracetamol poisoning and Wilson’s disease. See note 12, NHS Blood and Transplant Protocols and Guidelines 2009, Part 4: Selection Criteria, paragraph 4.1. Also see note 13, Liver Organ Sharing Principles 1999, Paragraph B: Super Urgent Liver Scheme (added in October 2005).

48. See note 3, The National Liver Transplant Standards 2005, Introduction.

49. See note 31, Title 42, Section 121.8. Allocation of organs. Parts (a) (1), (2), and (5).

50. See note 3, The National Liver Transplant Standards 2005, Introduction and Topic 3: Assessment, Access to the Waiting List and Organ Allocation. Standards 3.11 and 3.13.

51. See note 12, NHS Blood and Transplant Protocols and Guidelines 2009, Summary, p. 1.