Model for end-stage liver disease (MELD) exception guidelines
Model for end-stage liver disease (MELD) exception guidelines
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DOI：
10.1002/lt.20961
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发表时间：
2006-12-01
影响因子：
4.6
通讯作者：
Gish, Robert G.
中科院分区：
文献类型：
--
作者：
Wiesner, Russell;Lake, John R.;Gish, Robert G.
20 世纪 80 年代初期，美国的器官分配最初基于轶事经验、自身利益和单中心意见，几乎没有科学证据、数学生存模型或验证来支持这些器官分配模式。随着肝移植（LT）越来越成功，等待名单上的患者数量与可用供体器官之间的差距由于等待名单上的死亡人数不断增加而成为一个问题，因此，有必要制定更合理的供体器官分配方案。 1987年，美国政府首次尝试建立器官分配政策，作为《移植法》的一部分，建立了器官采购和移植网络。器官采购移植网络根据与器官共享联合网络（UNOS）的联邦合同运作。自器官采购移植网络形成以来，改进和标准化器官分配的尝试一直在持续和发展。肝脏分配政策最初是基于患者的护理地点。需要持续重症监护的患者，包括对内镜治疗无反应的急性食管静脉曲张出血患者；患有肝肾综合征的患者；顽固性腹水或插管的4期门体性脑病患者优先考虑。器官分配优先于需要持续住院的患者，最后是在家接受护理的患者。 1 然而，随着等待名单不断增加，等待时间成为决定谁接受捐赠器官的主要因素。 2002 年 2 月之前，肝脏分配根据 UNOS 定义的 4 个类别确定优先顺序：状态 1、2A、
In the early 1980s, organ allocation in the United States was initially based on anecdotal experience, self-interest, and single-center opinions with little in the way of scientific evidence, mathematical survival modeling, or validation to support these patterns of organ allocation. As liver transplantation (LT) became more successful, the disparity between the number of patients on the waiting list and available donor organs became an issue as a result of increasing wait-list deaths, and thus, a more justifiable donor organ allocation scheme became necessary. An initial attempt at establishing organ allocation policy came in 1987 when the US government established the Organ Procurement and Transplantation Network as part of the Transplantation Act. The Organ Procurement Transplantation Network operates under federal contract with the United Network for Organ Sharing (UNOS). Since the formation of the Organ Procurement Transplantation Network, attempts to improve and standardize organ allocation have been ongoing and evolving.Liver allocation policy was initially based on patients’ location of care. Patients requiring continuous intensive care, including patients with acute esophageal variceal bleeding not responding to endoscopic therapy; patients who developed hepatorenal syndrome; and patients with intractable ascites or intubated with stage 4 portosystemic encephalopathy received first priority. Organ allocation was prioritized next to patients requiring continuous hospitalization, and finally to patients who were cared for at home. 1 However, as the waiting list continued to grow, waiting time became a major factor in determining who received a donor organ. Before February 2002, liver allocation was prioritized according to 4 UNOS-defined categories: status 1, 2A,