Children on the transplant lists often miss out on livers because of a program that underestimates their risk of dying, according to the findings of a new study.
Researchers with the Perelman School of Medicine at the University of Pennsylvania report that children who need life-saving liver transplants are dying because the organs are going to adults on the transplant list instead. The findings were published this week in the medical journal JAMA Pediatrics.
In 2002, the United Network for Organ Sharing (UNOS) adopted the Pediatric End-Stage Liver Disease (PELD) and Model for End-stage Liver Disease (MELD) score programs for children and adults to prioritize waitlisted patients for a liver transplant. The system scores the patient’s need for the organ and the likelihood of dying in the next 90 days.
The study involved an analysis of 400 cases involving children listed for liver transplants from 2002 to 2014. The cases were followed up through 2016.
Researchers concluded the scoring method of the UNOS programs underestimates the risk of death for children with liver disease, prioritizing adults on the transplant list. This has resulted in at least 400 deaths.
More than 114,000 people are waiting for an organ transplant in the United States. Nearly 24,000 have been given that needed transplant so far this year. The transplants came from 11,622 donors.
Roughly 500 liver transplants are performed on children every year, with organs coming from deceased donors. That number has remained constant over the past 20 years.
Comparatively, adults receive transplants at ten times the rate of children, giving adults access to tens of thousands of transplants every year. The rate is also increasing by 10% each year for adults and the majority of adults who receive transplants are older than 65.
About 80% of children are able to only receive organs transplanted from child donors. However, adults can receive organs from both child and adult donors. This also puts children at a disadvantage for organ transplants and increases their risk of missing out on a life-saving transplant.
The UNOS policy mandates pediatric donor organs are allocated to adults locally and regionally first before being allocated to critically ill children nationwide. This is in contrast to other countries, which prioritize children for liver transplants over adults. Those programs are largely successful.
The waiting list for liver transplants is long because so few people sign up to be organ donors, researchers noted. Often, the family is reluctant to release a loved one’s organs in time and under the right circumstances for the organs to be useful to the recipients.
UNOS indicates it plans to reevaluate the liver transplant policy for children and adults and will have a new proposal for the policy ready by December 2019.