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Contents I. Introduction II. Background A. The MELD System of Donor Liver Allocation B. The Introduction of SLT 1. SLT for One Pediatric and One Adult Patient 2. Hemiliver SLT [...], Liver transplantation is different from transplanting other solid organs because some recipients can achieve good long-term outcomes with only half of a donor's liver (or less). This means that some deceased donor livers can be split, saving two lives instead of one. However, although more than 10 percent of cadaveric livers meet the criteria for splitting, only about 1.5 percent are actually split in the United States. This article identifies a set of ethical, legal, and logistical challenges to a more extensive use of split liver transplantation (SLT) within existing legal frameworks. We then discuss how each of these challenges can be overcome with a set of realistic clarifications and changes to the current liver transplant architecture. Three guiding values shape liver allocation policy in the United States: maximizing expected outcomes, ensuring broad access, and prioritizing the sickest patients. While the last value is in tension with SLT (because the sickest patients often need a whole liver), we maintain that greater adoption of SLT is consistent with this normative balance. In addition, the distribution infrastructure is not designed to facilitate splitting. When a surgical team is offered a liver for a specific patient, they feel duty-bound to give that specific patient the whole organ. Further discouraging SLT, performance metrics, including those used to determine a transplant program's eligibility for Medicare and Medicaid funding, focus on surgical outcomes rather than waitlist mortality. Our preferred remedies entail clarifying the informed consent requirements for SLT, using a national clearinghouse to identify livers that are prime candidates for splitting, offering these livers to qualifying programs for SLT only, and establishing a separate regulatory reporting and outcomes evaluation pathway for SLT. Together, these reforms, many of which have precedents in the transplant field, will support the expansion of SLT in carefully controlled conditions and save more lives.

[NC PD] 1.3 contact hours Dialysis providers and patients have become familiar with Dialysis Facility Compare as the official source for data on the quality of dialysis facilities in the [...], The Scientific Registry of Transplant Recipients (SRTR) provides extensive data regarding the performance of various aspects of the national transplant system and a tier rating system that can aid patients in selecting their transplant center. The role of the SRTR is to provide clear, accurate, and timely information to regulatory agencies and transplant professionals, candidates, and recipients; live organ donors; donor families; and the general public. This overview provides basic information on the history and role of the SRTR, as well as changes made in response to the COVID-19 pandemic. Key Words: Transplant, Scientific Registry of Transplant Recipients, quality, performance.

ABSTRACT In a world of readily-available home genetics tests, donor anonymity can no longer exist. Recognizing this reality, the United Kingdom has implemented a national controlling system, which oversees and [...]

'... The entire organ donation system .. . sorely is in need of reform, but the ultimate issue with U.S. organ donation is that there is a supply shortage caused [...]

Kidney chains are a recent and novel method of increasing the number of available kidneys for transplantation and have the potential to save thousands of lives. However, because they are [...]

The current system of matching organ donors to recipients has been in place since the National Organ Transplant Act (NOTA) of 1984 called for an Organ Procurement Transplant Network (OPTN) [...], The national deceased donor kidney allocation system has not been changed since 1986. After many years of study and collaboration, a new policy to revise the system goes into effect on December 4, 2014. This new system is intended to increase access to kidney transplantation and improve the overall success rates. Although the majority of candidates will not be significantly affected by the changes, certain populations of patients are projected to have decreased waiting times. Transplant candidates expected to need a kidney the longest are also more likely to receive a kidney predicted to last the longest. Many educational resources have been provided to transplant centers and have also been made available to patients and referring physicians. Key Words: Kidney donor allocation system, kidney transplant.

I INTRODUCTION Increasing the number of kidney donations is an urgent matter. There is a disparity between the number of patients in the United States who are in need of [...]

I INTRODUCTION Our current transplant regime is a qualified failure. Transplant operations have been basically flat for the last eight years. In 2013, over 4300 people died while waiting and [...]

I INTRODUCTION In this article, we propose a novel form of kidney transplantation involving cross-border kidney-paired donation, which we refer to as reverse transplant tourism (RTT). Although RTT is currently [...]

I INTRODUCTION There are about 100,000 people on the waiting list for a deceased donor-kidney transplant in the United States, a number that grows from year to year despite advances [...]

I. Introduction In a momentous December 2011 opinion, Flynn v. Holder, the United States Court of Appeals for the Ninth Circuit unanimously held that the ban on compensation for bone [...]

HEALTH LAW--ORGAN COMPENSATION--NINTH CIRCUIT HOLDS THAT COMPENSATION FOR BLOOD STEM CELL TRANSPLANT PROCEDURE DOES NOT VIOLATE THE NATIONAL ORGAN TRANSPLANT ACT.--Flynn v. Holder, No. 10-55643, 2012 WL 1001300 (9th Cir. [...]

Ninth Circuit Rules Donors May Receive Compensation for Blood-Based Bone Marrow Transplant Donations--Flynn v. Holder (1)--The Court of Appeals for the Ninth Circuit held that the 1984 National Organ Transplant [...]

I. INTRODUCTION II. HISTORY OF ORGAN DONATION IN THE UNITED STATES A. The Uniform Anatomical Gift Act B. The National Organ Transplantation Act C. Consequences of the Acts 1. Organ [...]

EXECUTIVE SUMMARY More than 100,000 individuals are on the waiting list to receive a lifesaving transplant, but many of them will not receive the organ they need. Legislation has been [...]

THE LAST DAYS of Alistair Cooke were painful and difficult--'what we all go through, really,' says his daughter, Susan Kittredge--but Cooke carried on with typical English fortitude. In his final [...]

Congress created the National Organ Procurement and Transplantation Network (OPTN) to direct the policies needed to allocate human organs to proper recipients. The regulators within the OPTN, however, have become a hindrance to efficient distribution. The Secretary of the Dept of Health and Human Services issued new rules in July 1998, that essentially retained the OPTN's management structure but did reorganize the criteria for organ allocation from a regional focus to a national focus.

The Organ Procurement and Transplantation Network ("OPTN") is responsible for coordinating organ transplantation policies on a national scale. In particular, the OPTN sets the criteria for the distribution of available organs to potential recipients. The kidney allocation criteria currently adopted is unfair to minority recipients since it results in a racially disparate allocation of organs. This Article argues that certain OPTN allocation policies constitute state action and are thus constrained by equal protection principles. This state action question is significant because federal civil rights laws are not applicable to the OPTN's allocation policies. The Author concludes that because the OPTN allocation policies constitute a covert racial classification, they must withstand strict scrutiny analysis or be struck down.