1. A Multistep, Consensus-Based Approach to Organ Allocation in Liver Transplantation: Toward a 'Blended Principle Model'
- Author
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Cillo, U, Burra, P, Mazzaferro, V, Belli, L, Pinna, Ad, Spada, M, Nanni Costa, A, Toniutto, P, Avolio, A, Cescon, M, Romagnoli, Renato, Santaniello, W, Rossi, M, Corno, V, Caraceni, P, Coco, B, Fraquelli, M, Rendina, M, Angelico, M, Fagiuoli, S, Bruno, R, Costa, An, Ridolfi, L, R, Pretagostini, R, Amoroso, Antonio, Biancofiore, G, De Gasperi, A, Rocca, Gd, Feltracco, P, Colli, A, Sacchini, D, Pegoraro, R, Gardini, I, Pipit, P, Maffeo, C, Rossellini, S. r., Cillo, U, Burra, P, Mazzaferro, V, Belli, L, Pinna, A, Spada, M, Nanni Costa, A, Toniutto, P, Avolio, A, Cescon, M, Regalia, E, Romagnoli, R, Santaniello, W, Rossi, M, Corno, V, Caraceni, P, Coco, B, Fraquelli, M, Rendina, M, Angelico, M, Fagiuoli, S, Bruno, R, Costa, A, De Feo, T, Ridolfi, L, Pretagostini, R, Amoroso, A, Biancofiore, G, De Gasperi, A, Della Rocca, G, Feltracco, P, Colli, A, Sacchini, D, Pegoraro, R, Gardini, I, Cillo U, Burra P, Mazzaferro V, Belli L, Pinna AD, Spada M, Nanni Costa A, Toniutto P, Avolio A, Cescon M, Romagnoli R, Santaniello W, Rossi M, Corno V, Caraceni P, Coco B, Fraquelli M, Rendina M, Angelico M, Fagiuoli S, Bruno R, Costa AN, Ridolfi L, Pretagostini R, Amoroso A, Biancofiore G, De Gasperi A, Rocca GD, Feltracco P, Colli A, Sacchini D, Pegoraro R, Gardini I, Pipit P, Maffeo C, and Rossellini SR
- Subjects
medicine.medical_specialty ,organ allocation ,medicine.medical_treatment ,media_common.quotation_subject ,MEDLINE ,Liver transplantation, allocation, consensus ,Liver transplantation ,Severity of Illness Index ,Organ transplantation ,Scientific evidence ,Decision Support Techniques ,Health care rationing ,Jury ,medicine ,Algorithms ,Health Care Rationing ,Humans ,Italy ,Liver Diseases ,Liver Transplantation ,Patient Selection ,Immunology and Allergy ,Pharmacology (medical) ,media_common ,Settore MED/12 - Gastroenterologia ,Transplantation ,liver transplantation ,business.industry ,liver transplantation, organ allocation ,Surgery ,Settore MED/18 - Chirurgia Generale ,surgical procedures, operative ,Family medicine ,business ,Working group - Abstract
Since Italian liver allocation policy was last revised (in 2012), relevant critical issues and conceptual advances have emerged, calling for significant improvements. We report the results of a national consensus conference process, promoted by the Italian College of Liver Transplant Surgeons (for the Italian Society for Organ Transplantation) and the Italian Association for the Study of the Liver, to review the best indicators for orienting organ allocation policies based on principles of urgency, utility, and transplant benefit in the light of current scientific evidence. MELD exceptions and hepatocellular carcinoma were analyzed to construct a transplantation priority algorithm, given the inequity of a purely MELD-based system for governing organ allocation. Working groups of transplant surgeons and hepatologists prepared a list of statements for each topic, scoring their quality of evidence and strength of recommendation using the Centers for Disease Control grading system. A jury of Italian transplant surgeons, hepatologists, intensivists, infectious disease specialists, epidemiologists, representatives of patients' associations and organ-sharing organizations, transplant coordinators, and ethicists voted on and validated the proposed statements. After carefully reviewing the statements, a critical proposal for revising Italy's current liver allocation policy was prepared jointly by transplant surgeons and hepatologists.
- Published
- 2015