{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T11:13:12Z","timestamp":1789729992133,"version":"4.0.1"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","license":[{"start":{"date-parts":[[2013,12,1]],"date-time":"2013-12-01T00:00:00Z","timestamp":1385856000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2013,10,10]],"date-time":"2013-10-10T00:00:00Z","timestamp":1381363200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:sec>\n            <jats:title\/>\n            <jats:p>The Model for End-Stage Liver Disease (MELD) score is an imperfect prognosticator of waitlist dropout, so transplant centers may apply for exception points to increase a waitlist candidate's priority on the waitlist. Exception applications are categorized as recognized exceptional diagnoses (REDs; eg, hepatocellular carcinoma) and non-REDs (eg, cholangitis). Although prior work has demonstrated regional variation in the use of exceptions, no work has examined the between-center variability. We analyzed all new waitlist candidates from February 27, 2002 to June 3, 2011 to explore variations in the use of non-REDs, for which no strict exception criteria exist. There were 58,641 new waitlist candidates, and 4356 (7.4%) applied for a non-RED exception. The number of applications increased steadily over time, as did the approval rates for such applications: from &lt;50% in 2002 to nearly 75% in 2010. When we adjusted for patient factors, there was significant variability (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001) in the use of non-RED exceptions in 8 of 11 United Network for Organ Sharing (UNOS) regions and in the approval of these exceptions in 6 of 11 UNOS regions. The variability in the use and approval of non-REDs was clinically significant: waitlist candidates with approved exceptions were significantly more likely to undergo transplantation (68.3% versus 53.4%, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001) and were less likely to be removed for death or clinical deterioration (10.4% versus 16.2%, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001). Increased median MELD score at transplantation within a donor service area was the only center factor associated with increased odds of applying for exceptions, while no center factors were associated with having non-RED exceptions approved. Further work is needed to identify other sources of variation to ensure the appropriate and equitable use of non-RED exceptions. <jats:italic toggle=\"yes\">Liver Transpl 19:1330\u20131342, 2013<\/jats:italic>. \u00a9 2013 AASLD.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/lt.23732","type":"journal-article","created":{"date-parts":[[2013,8,27]],"date-time":"2013-08-27T15:18:54Z","timestamp":1377616734000},"page":"1330-1342","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":31,"title":["Center variation in the use of nonstandardized model for end-stage liver disease exception points"],"prefix":"10.1097","volume":"19","author":[{"given":"David S.","family":"Goldberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Makar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Therese","family":"Bittermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"French","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R2-8-20250124","doi-asserted-by":"crossref","first-page":"464470","DOI":"10.1053\/jhep.2001.22172","article-title":"A model to predict survival in patients with endstage liver disease.","volume":"33","author":"Kamath","year":"2001","journal-title":"Hepatology"},{"key":"R3-8-20250124","doi-asserted-by":"crossref","first-page":"13021309","DOI":"10.1002\/lt.23537","article-title":"Exception point applications for 15 points: an unintended consequence of the share 15 policy.","volume":"18","author":"Bittermann","year":"2012","journal-title":"Liver Transpl"},{"key":"R4-8-20250124","doi-asserted-by":"crossref","first-page":"16031609","DOI":"10.1111\/j.1600-6143.2011.03969.x","article-title":"Lack of standardization in exception points for patients with primary sclerosing cholangitis and bacterial cholangitis.","volume":"12","author":"Goldberg","year":"2012","journal-title":"Am J Transplant"},{"issue":"suppl 3","key":"R5-8-20250124","first-page":"S128S136","article-title":"Model for EndStage Liver Disease (MELD) exception guidelines: results and recommendations from the MELD Exception Study Group and Conference (MESSAGE) for the approval of patients who need liver transplantation with diseases not considered by the standard MELD formula.","volume":"12","author":"Freeman","year":"2006","journal-title":"Liver Transpl"},{"key":"R6-8-20250124","doi-asserted-by":"crossref","first-page":"23622371","DOI":"10.1111\/j.1600-6143.2011.03735.x","article-title":"MELD exceptions and rates of waiting list outcomes.","volume":"11","author":"Massie","year":"2011","journal-title":"Am J Transplant"},{"key":"R7-8-20250124","doi-asserted-by":"crossref","first-page":"666674","DOI":"10.1002\/lt.20116","article-title":"New national liver transplant allocation policy: is the regional review board process fair?","volume":"10","author":"Voigt","year":"2004","journal-title":"Liver Transpl"},{"key":"R9-8-20250124","first-page":"22442247","article-title":"Regional variations in peer reviewed liver allocation under the MELD system.","volume":"5","author":"RodriguezLuna","year":"2005","journal-title":"Am J Transplant"},{"key":"R10-8-20250124","doi-asserted-by":"crossref","first-page":"206226","DOI":"10.1214\/088342307000000096","article-title":"Statistical and clinical aspects of hospital outcomes profiling.","volume":"22","author":"Normand","year":"2007","journal-title":"Stat Sci"},{"key":"R11-8-20250124","doi-asserted-by":"crossref","first-page":"958964","DOI":"10.1111\/j.1600-6143.2011.03487.x","article-title":"Variation in organ quality between liver transplant centers.","volume":"11","author":"Volk","year":"2011","journal-title":"Am J Transplant"},{"key":"R12-8-20250124","doi-asserted-by":"crossref","first-page":"96104","DOI":"10.1002\/lt.23561","article-title":"Center competition and outcomes following liver transplantation.","volume":"19","author":"Halldorson","year":"2013","journal-title":"Liver Transpl"},{"key":"R13-8-20250124","doi-asserted-by":"crossref","first-page":"21132118","DOI":"10.1111\/j.1600-6143.2009.02744.x","article-title":"Geographic variation in organ availability is responsible for disparities in liver transplantation between Hispanics and Caucasians.","volume":"9","author":"Volk","year":"2009","journal-title":"Am J Transplant"},{"key":"R14-8-20250124","doi-asserted-by":"crossref","first-page":"479486","DOI":"10.1097\/TP.0b013e3182066275","article-title":"Geographic inequity in access to livers for transplantation.","volume":"91","author":"Yeh","year":"2011","journal-title":"Transplantation"},{"key":"R16-8-20250124","doi-asserted-by":"crossref","first-page":"250258","DOI":"10.1002\/lt.23587","article-title":"Risk of waitlist mortality in patients with primary sclerosing cholangitis and bacterial cholangitis.","volume":"19","author":"Goldberg","year":"2013","journal-title":"Liver Transpl"},{"key":"R17-8-20250124","doi-asserted-by":"crossref","first-page":"369378","DOI":"10.1111\/j.1600-6143.2011.03888.x","article-title":"Racial disparities in pediatric access to kidney transplantation: does socioeconomic status play a role?","volume":"12","author":"Patzer","year":"2012","journal-title":"Am J Transplant"}],"container-title":["Liver 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