Equalizing MELD Scores Over Broad Geographies Is Not the Most Efficacious Way to Allocate a Scarce Resource in a Value-based Environment. Issue 2 (August 2015)

• Record Type: Journal Article
• Authors: Reed, Alan; Chapman, William C.; Knechtle, Stuart; Chavin, Kenneth; Gilroy, Richard; Klintmalm, Goran B. G.
• Is Part Of: Annals of surgery. Volume 262:Issue 2(2015:Aug.)
• Publication Date: 2015-08
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000001331
• Languages: English
• ISSNs: 0003-4932

Abstract

<abstract abstract-type="PRECIS"> <title> <x xml:space="preserve">Abstract</x> </title> <p>The proposed redistricting policy, meant to equalize MELD at transplant across broad geographies in the belief that this will equalize wait list and post-transplant mortality rates, ignores the concept of resource management. Choosing to allocate livers primarily to the "sickest first, " no matter where they live, will impact transplantation in a number of ways, some not yet tested. The <italic>Final Rule</italic>, however, emphasizes utility in its many elements and not only geography. The geographic focus leaves post-transplant outcomes, costs, and other critical issues undefined. We present some counterpoints to the redistricting proposal.</p> </abstract>