Does the United States do it better? A comparative analysis of liver allocation protocols in the United Kingdom and the United States

Cambridge Quarterly of Healthcare Ethics

Volumn 20, Issue 3, 2011, Pages 418-433

  Cherkassky, Lisa ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; COMPARATIVE STUDY; ETHICS; HEALTH CARE POLICY; HOSPITALIZATION; HUMAN; LEGAL ASPECT; LIVER TRANSPLANTATION; ORGANIZATION AND MANAGEMENT; PRACTICE GUIDELINE; RESOURCE ALLOCATION; STANDARD; TRANSPLANTATION; UNITED KINGDOM; UNITED STATES;

GREAT BRITAIN; GUIDELINES AS TOPIC; HEALTH POLICY; HUMANS; LIVER TRANSPLANTATION; RESOURCE ALLOCATION; SEVERITY OF ILLNESS INDEX; TISSUE AND ORGAN PROCUREMENT; UNITED STATES;

EID: 79959241304     PISSN: 09631801     EISSN: 14692147     Source Type: Journal    
DOI: 10.1017/S0963180111000107     Document Type: Article

References (53)

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.
3. Pediatric liver allocation is outside of the ambit of this article, but both countries include pediatric allocation policies within their adult protocols.
4. 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).
5. See http://www.unos.org under "Who we are" (last accessed 11. Mar 2011).
6. Statistic correct in March 2011.
7. 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).
8. 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.
9. See note 3, The National Liver Transplant Standards 2005, at Standards 3.11. and 3.13.
10. See note 3, The National Liver Transplant Standards 2005, at Standard 3.19.
11. 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).
12. 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).
13. See note 12, NHS Blood and Transplant Protocols and Guidelines 2009, Part 4: Selection Criteria, paragraph 4.1.2.
14. See note 12, NHS Blood and Transplant Protocols and Guidelines 2009, Summary, p. 1; and Introduction, p. 2, paragraph 1.5.
15. See note 12, NHS Blood and Transplant Protocols and Guidelines 2009, Summary, p. 1.
16. See also: Part 2: The Need for Transplantation. P. 3, paragraph 2.2;
17. and Part 3: Assessment. P. 6, paragraph 3.3.
18. See note 12, NHS Blood and Transplant Protocols and Guidelines 2009, Summary, p. 1.
19. See note 3, The National Liver Transplant Standards 2005, at Standards 3.11. and 3.13.
20. See note 13, Liver Organ Sharing Principles 2005.
21. See note 13, Liver Organ Sharing Principles 2005, paragraph B.4. Super Urgent Liver Scheme Ranking, part 4.1. Emphasis added.
22. See note 3, The National Liver Transplant Standards 2005, Introduction.
23. See note 13, Liver Organ Sharing Principles 2005, Paragraph E: Liver Allocation Sequence (added in April 2006).
24. 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.
25. 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.
26. See note 12, NHS Blood and Transplant Protocols and Guidelines 2009, Part 6: Allocation of Donor Livers. Paragraph 6.2. Pp. 11-12.
27. See note 12, NHS Blood and Transplant Protocols and Guidelines 2009, Paragraph 6.3. P. 12.
28. Statistic correct in March 2011.
29. See UNOS's official Web site for transplantation statistics from their Data section: http://optn.transplant.hrsa.gov/latestData/rptData.asp.
30. 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.
31. See note 29, The National Organ Transplant Act 1984. Section 274: Organ procurement and Transplantation network. Part (b) (2) (D) & (N).
32. 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.
33. See note 31, Title 42 1999, section 121.8. Allocation of organs. Parts (a) (1), (2), and (5).
34. See note 31, Title 42 1999, Parts (b) (1), (2), and (3).
35. See note 31, Title 42 1999, Part (c) (3).
36. 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).
37. See note 35, UNOS 2009, Paragraph 3.6.4.1.
38. See note 35, UNOS 2009, Paragraph 3.6 (p. 1).
39. See note 35, UNOS 2009, Paragraph 3.6.2.
40. See note 35, UNOS 2009, Paragraph 3.6.3.
41. See note 35, UNOS 2009, Paragraph 3.6.1. This includes both Status 1A candidates and MELD candidates.
42. The MELD/PELD scoring system has been in effect since February 2002.
43. 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.
44. See note 35, UNOS 2009, Policy 3.6, Paragraph 3.6 (p. 1) and paragraph 3.6.3.
45. See note 35, UNOS 2009, Paragraph 3.6 (pp. 1. and 2).
46. See note 35, UNOS 2009, Paragraph 3.6.2.
47. See note 35, UNOS 2009, Paragraph 3.6.3. See also note 42, Questions & Answers document, p. 3.
48. 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.
49. Also see note 13, Liver Organ Sharing Principles 1999, Paragraph B: Super Urgent Liver Scheme (added in October 2005).
50. See note 3, The National Liver Transplant Standards 2005, Introduction.
51. See note 31, Title 42, Section 121.8. Allocation of organs. Parts (a) (1), (2), and (5).
52. 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.
53. See note 12, NHS Blood and Transplant Protocols and Guidelines 2009, Summary, p. 1.