The previous Korean organ allocation system, which was introduced in 2000, was based on medical urgency and Child-Turcotte-Pugh scores (CTP scores). On the other hand, in Asia the focus has been on living donor liver transplantation (LDLT) 5, and the development of organ allocation system has been relatively neglected because deceased donation rates have been extremely low. In the West, efforts have focused on promoting deceased donor organ donation, and a model for end-stage liver disease score (MELD score) system has been implemented to enable equitable liver graft distribution 1, 2, 3, 4. Liver transplantation is the treatment of choice for end-stage liver disease, fulminant hepatic failure, and for selected cases of hepatocellular carcinoma (HCC), but the demand for liver grafts vastly exceeds supply worldwide. Based on these results, the Korean Network for Organ Sharing implemented the MELD allocation system in 2016. HCC patients with MELD ≤ 20 need additional MELD points to allow them equitable access to transplantation.
Considering the lack of donor organs and geographic disparities in Korea, we proposed the use of a national broader sharing of liver for the sickest patients (MELD ≥ 38) to reduce waitlist mortality. The 90-day waitlist survival rates of patients with MELD scores of 31–40, 21–30, and ≤20 were 16.2%, 64.1%, and 95.9%, respectively ( P 20, presence of HCC did not affect waitlist survival ( P = 0.405). CART analysis indicated several MELD scores significantly predicted waitlist survival. Of the 2702 patients that registered for liver transplantation, 2248 chronic liver disease patients were eligible.
Classification and regression tree (CART) analysis was used to stratify MELD score ranges according to waitlist survival. A nationwide, multicenter, retrospective cohort study of candidates registered for liver transplantation from January 2009 to December 2011 was conducted at 11 transplant centers. The previous Korean liver allocation system was based on Child-Turcotte-Pugh scores, but increasing numbers of deceased donors created a pressing need to develop an equitable, objective allocation system based on model for end-stage liver disease scores (MELD scores).