What are three different methods we might consider for allocating liver transpla!
Question: What method out of these three options would you consider to be the best one and why?
Answers: What method out of these three options would you consider to be the best one and why?
The existing method is MELD/PELD -- these are formulas that take into consideration a patient's age and stage of disease. (MELD for adults, PELD for kids.) The idea is that the higher the score the more urgent a transplant is needed.
The problem is that life isn't math. Different liver diseases cause symptoms in different degrees. so severity of symptoms doesn't always translate to severity of disease.
Another problem is different numbers mean different things at different centers. A very busy transplant center, for example, may not accept anyone with a MELD lower than 20. While a less active center might happily transplant someone at at 12.
And, there's a constant debate between whether scarce livers should go to the sickest patients, or the ones most likely to survive.
So -- there's the current method of assigning "points" based on clinical status.
Another method often suggested is free market -- whoever can pay for a new liver gets one. And a counterpoint to that would be -- whoever finds a living donor can get a transplant.
A third method might be to revert to the "old days," which were pretty much first-come-first-served. People were put on the list, and transplanted as their number hit the top. Others could be bounced to the top because of worsening disease, but wait times were heavily weighted.
The best of these still seems to be the current MELD/PELD. It's not a perfect system, but it's the most equitable.
For more, check out
www.unos.org
The calculators are here
http://www.unos.org/resources/meldPeldCa...
Amiri:
This is rather unusual question for you to post?
What are the three options to consider?
Why are you asking this question?
The question is fine - just unusual, and I want to know why you are asking it. I will answer it and tell you which option I think is best if you will tell me the options.
Okay, it's personal - I understand. I recently had a childhood friend who died of a genetic liver disease. At first, she was way down on the waiting list. However, when her health took a turn for the worse, she was moved up to #1. She was only 50 years old. I don't know the specific guidelines, but I do know that if someone is healthy enough to be sustained on medications, they are not priorty for a liver transplant. Age and prognosis are also part of the criteria for determining what position on the list one is placed.
Prognosis is expected medical outcome.
Out of 1.current medical sustainability, 2.age and 3. prognosis, I would have to say.... I don't know, and I can't answer this......it's too intense. I'm sorry.
Good, I'm glad I could help.
There are already guidelines in place for deciding on viable candidates for transplantation.
The United Network of Organ Sharing
is set up so that those in a certain region
or area will receive the organ if it is
in that locality. This is because the organ
only has a certain amount of time to be
transplanted before it may not function
once it is in the patient. Each transplant center has a transplant list...people are placed on that list according to their blood type and also their (1)MELD or (2) PELD score which is derived from blood work they have done.
They use the Bilirubin, INR, and Albumin
levels mostly to determine where to place
the patient because they show how the
liver is functioning. The creatinine level is
also a part of this since it shows them
how the kidneys are functioning. The
kidneys try to remove the toxins from
the body that the liver is no longer able to
handle and can go into failure themselves.
A person who is fairly heathly, according to this blood work, would be placed at the bottom of the list and a person who doesn't have very long to live without a transplant, would be at the top of the list. I like it, cause
it is based on the patients "need" for the
transplant and health, not on anything else.
The PELD score is very similar as the
MELD score...it is just that it is for those
of a younger age, up to 12 years old.
http://www.liverdisease.com/meld._hepati...
On this link, this hepatologist mentions the
old system compared to the new system.
The old system was the (3)Child Pugh score.
http://en.wikipedia.org/wiki/Child-Pugh_...
With the child pugh score, they included
the encephalopathy and the ascites.
This has been of no help in determining
how long a person has to live without a
transplant, so they removed it as
a criteria to follow for transplantation
because it could not be measured and
have any real value in the decision making.
(4) Living donation are the very best method
to having a transplant, especially if they
are a relative with the same blood type.
This is because there is less chance of
rejection afterwards, the organ is taken
directly from the donor to the patient without
it being outside the body for an extended
period and their is decreased damage that
can occur to the organ because the donor
is tested to be very healthy before they
can donate the organ and it has the best
oxygen supply. However, it can become
complicated because the risks for the
donor are about the same for the patient,
even though, the donor would have a
better chance of recuperating because of
his health.
So, I would list it as Living donation as
number one. Second is the transplant
list with the MELD/PELD score.
And the third would be the Child Pugh Score.