{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T13:24:01Z","timestamp":1788355441081,"version":"build-2803163510"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"\n Importance<\/jats:title>\n Small waitlist candidates are significantly less likely than larger candidates to receive a liver transplant.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To investigate the magnitude of the size disparity and test potential policy solutions.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n A decision analytical model was generated to match liver transplant donors to waitlist candidates based on predefined body surface area (BSA) ratio limits (donor BSA divided by recipient BSA). Participants included adult deceased liver transplant donors and waitlist candidates in the Organ Procurement and Transplantation Network database from June 18, 2013, to March 20, 2020. Data were analyzed from January 2021 to September 2021.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Candidates were categorized into 6 groups according to BSA from smallest (group 1) to largest (group 6). Waitlist outcomes were examined. A match run was created for each donor under the current acuity circle liver allocation policy, and the proportion of candidates eligible for a liver based on BSA ratio was calculated. Novel allocation models were then tested.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Time on the waitlist, assigned Model for End-Stage Liver Disease (MELD) score, and proportion of patients undergoing a transplant were compared by BSA group. Modeling under the current allocation policies was used to determine baseline access to transplant by group. Simulation of novel allocation policies was performed to examine change in access.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n There were 41\u202f341 donors (24\u202f842 [60.1%] male and 16\u202f499 [39.9%] female) and 84\u202f201 waitlist candidates (53\u202f724 [63.8%] male and 30\u202f477 [36.2%] female) in the study. The median age of the donors was 42 years (IQR, 28-55) and waitlist candidates, 57 years (IQR, 50-63). Females were overrepresented in the 2 smallest BSA groups (7100 [84.0%] and 7922 [61.1%] in groups 1 and 2, respectively). For each increase in group number, waitlist time decreased (234 days [IQR, 48-700] for group 1 vs 179 days [IQR, 26-503] for group 6;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and the proportion of the group undergoing transplant likewise improved (3890 [46%] in group 1 vs 4932 [57%] in group 6;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). The smallest 2 groups of candidates were disadvantaged under the current acuity circle allocation model, with 37% and 7.4% fewer livers allocated relative to their proportional representation on the waitlist. Allocation of the smallest 10% of donors (by BSA) to the smallest 15% of candidates overcame this disparity, as did performing split liver transplants.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this study, liver waitlist candidates with the smallest BSAs had a disadvantage due to size. Prioritizing allocation of smaller liver donors to smaller candidates may help overcome this disparity.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2023.0191","type":"journal-article","created":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T12:38:34Z","timestamp":1680093514000},"page":"610","source":"Crossref","is-referenced-by-count":18,"title":["Association of Body Surface Area With Access to Deceased Donor Liver Transplant and Novel Allocation Policies"],"prefix":"10.1001","volume":"158","author":[{"given":"Catherine E.","family":"Kling","sequence":"first","affiliation":[{"name":"Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle"},{"name":"Clinical and Bio-Analytics Transplant Laboratory (CBATL), University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott W.","family":"Biggins","sequence":"additional","affiliation":[{"name":"Clinical and Bio-Analytics Transplant Laboratory (CBATL), University of Washington, Seattle"},{"name":"Division of Gastroenterology and Hepatology, Liver Care Line, University of Washington Medical Center, Seattle"},{"name":"Center for Liver Investigation Fostering Discovery (C-LIFE), University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran M.","family":"Bambha","sequence":"additional","affiliation":[{"name":"Clinical and Bio-Analytics Transplant Laboratory (CBATL), University of Washington, Seattle"},{"name":"Division of Gastroenterology and Hepatology, Liver Care Line, University of Washington Medical Center, Seattle"},{"name":"Center for Liver Investigation Fostering Discovery (C-LIFE), University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren D.","family":"Feld","sequence":"additional","affiliation":[{"name":"Clinical and Bio-Analytics Transplant Laboratory (CBATL), University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John H.","family":"Perkins","sequence":"additional","affiliation":[{"name":"Clinical and Bio-Analytics Transplant Laboratory (CBATL), University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge D.","family":"Reyes","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle"},{"name":"Clinical and Bio-Analytics Transplant Laboratory (CBATL), University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James D.","family":"Perkins","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle"},{"name":"Clinical and Bio-Analytics Transplant Laboratory (CBATL), University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"10","key":"soi230006r1","doi-asserted-by":"publisher","first-page":"1710","DOI":"10.1097\/TP.0000000000002196","article-title":"Reduced access to liver transplantation in women: role of height, MELD exception scores, and renal function underestimation.","volume":"102","author":"Allen","year":"2018","journal-title":"Transplantation"},{"issue":"12","key":"soi230006r2","doi-asserted-by":"publisher","first-page":"2658","DOI":"10.1111\/j.1600-6143.2010.03326.x","article-title":"Height contributes to the gender difference in wait-list mortality under the MELD-based liver allocation system.","volume":"10","author":"Lai","year":"2010","journal-title":"Am J Transplant"},{"issue":"7","key":"soi230006r3","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1001\/jamasurg.2020.1126","article-title":"Time for action to address the persistent sex-based disparity in liver transplant 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