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Share 35 linked to changing behavior among liver transplant centers
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BOSTON — In the post-Share 35 era, liver donation acceptance rates decreased while refusals of increased, according to data presented at The Liver Meeting 2016.
“Organ acceptance behavior changed after Share 35. Despite decreased organ offer acceptances, organ quality of acceptances and declines was unchanged pre and post share 35,” David Goldberg, MD, of the University of Pennsylvania, said during his presentation. “Behavioral changes in organ acceptances were not uniform across transplant centers, and these behavioral changes should be considered in simulating the impact and outcomes of broader sharing and also in understanding the potential behavioral changes and their impact in organ placement under broader sharing.”
Goldberg and colleagues looked at match run data for all organ offers to adult patients from January 1, 2011, to December 31, 2015, and analyzed only offers of livers that were transplanted.
“In six major categories, there were increases in the number of refusals, but most interestingly, there was nearly a fivefold increase in organ offers being declined because the person offered the organ was being transplanted, transplant in progress or had other offers being considered,” Goldberg said.
Liver acceptance rates decreased significantly for patients with an allocation MELD at 35 or higher; pre-Share 35, acceptance odds ratio for these livers was at 1.19 (95% CI, 1.11-1.28) and post-Share 35, it dropped to 0.76 (95% CI, 0.76-0.81). In contrast, there was no change in acceptance rates for Status 1 patients and minimal change for patients with MELD less than 35.
“For patients with allocation MELD score greater than or equal to 35, in the pre-Share 35 era, organ offers were significantly more likely to be accepted for them as these were the sickest patients on the list. However, directly as a result of Share 35, behavior flip flopped and organ offers were much less likely to be accepted for these patients,” Goldberg said.
Center-by-center, Goldberg showed that there were distinct differences. For MELD less than 35, 80% of centers had some decrease in their acceptance rates for these organ offers. However, for MELD greater than 35, all but one center had a decrease in their organ offer acceptance rate.
“Clearly, centers respond quite differently to this change in policy,” Goldberg said.
Looking at the organ offers and the organs that were accepted or declined pre- or post-Share 35, with a MELD score less than or equal to 35, there was no difference, Goldberg said.
“Ultimately, they were declining and accepting organs of the same quality,” he said. – by Katrina Altersitz
Reference:
Goldberg D. Abstract 5. Presented at: The Liver Meeting; Nov. 11-15, 2016; Boston.
Disclosures: Goldberg reports no relevant financial disclosures.