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Update on Organ Allocation and Liver Transplantation.
Gastroenterol Hepatol (N Y)
July 2025
Division of Digestive Health and Liver Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida.
Liver transplantation remains a lifesaving intervention for patients with end-stage liver disease; however, organ demand continues to far exceed the supply. The core ethical principles that guide scarce resource allocation include utility, equity, and prioritization of the sickest patients. Implementation of national organ allocation and distribution policy updates over the years have led to several positive changes, including earlier transplant of livers from sicker patients and decreased waitlist mortality rates.
View Article and Find Full Text PDFOptimising clinical governance and risk management in resource-limited hospitals: A family medicine model.
Afr J Prim Health Care Fam Med
April 2025
Department of Family Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban.
In resource-constrained healthcare settings, clinical governance and risk management are critical to improving patient outcomes and efficiently using limited resources. This article describes an innovative strategy implemented at a South African district hospital led by family physicians to optimise admissions and care prioritisation. The protocol established a designated high-care unit and admissions ward, ensuring that all new admissions were seen by a family physician, allowing family physicians to focus on the sickest patients requiring immediate intervention.
View Article and Find Full Text PDFAn ethical allocation scheme for scarce gene therapies in sickle cell disease and transfusion-dependent β-thalassemia.
Blood Adv
September 2025
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
Novel gene therapies (GTs) for sickle cell disease (SCD) and transfusion-dependent β-thalassemia (TDT) are severely limited by manufacturing, intensive care delivery, and high costs, requiring an ethically justified framework for allocating treatment within GT programs. Using an Accountability for Reasonableness process, we worked with a multidisciplinary committee to develop our program's initial GT allocation framework. This defines the population eligible for GT among patients with SCD and TDT, balancing inclusivity and safety.
View Article and Find Full Text PDFSimulating the impact of survival benefit-based liver transplant organ allocation.
Hepatology
April 2025
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Background And Aims: In the United States and much of the world, prioritization for a deceased donor liver transplant focuses on sickest-first, based on allocating organs using the MELD score. There have been calls to instead allocate organs based on transplant survival benefit, but the impact of such a system on the broader waitlist population is unknown.
Approach And Results: We performed a simulation study using the Liver Simulated Allocation Model to compare the current US system of liver allocation to the one using different time horizons, focused on pretransplant survival only, posttransplant survival only, and survival benefit (difference of posttransplant survival and pretransplant survival).
The Impact of Ethics and Resources on the Allocation of Traumatic Brain Injury Surgery: A Survey of Neurosurgeons Within Low- and Middle-Income Countries and High-Income Countries.
World Neurosurg
May 2025
Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
Background: Scarce resource allocation in traumatic brain injury (TBI) care is ethically challenging. We surveyed neurosurgeons about their views on surgical decision-making in TBI in resource-limited settings.
Methods: Neurosurgeons and trainees completed an online survey about surgical decision-making for TBI when neurosurgical capacity is limited.