{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T21:34:24Z","timestamp":1771364064990,"version":"3.50.1"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":577,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2014,2]]},"abstract":"<jats:sec>\n            <jats:title\/>\n            <jats:p>The disparity between the demand for and supply of donor livers has continued to grow over the last 2 decades, and this has placed greater weight on the need for efficient and effective liver allocation. Although the use of extended criteria donors has shown great potential, it remains unregulated. A survival benefit\u2013based model was recently proposed to answer calls to increase efficiency and reduce futile transplants. However, it was previously determined that the current allocation system was not in need of modification and that instead geographic disparities should be addressed. In contrast, we believe that there is a significant need to replace the current allocation system and complement efforts to improve donor liver distribution. We illustrate this need first by identifying major ethical concerns shaping liver allocation and then by using these concerns to identify strengths and shortcomings of the Model for End-Stage Liver Disease\/Pediatric End-Stage Liver Disease system and a survival benefit\u2013based model. The latter model is a promising means of improving liver allocation: it incorporates a greater number of ethical principles, uses a sophisticated statistical model to increase efficiency and reduce waste, minimizes bias, and parallels developments in the allocation of other organs. However, it remains limited in its posttransplant predictive accuracy and may raise potential issues regarding informed consent. In addition, the proposed model fails to include quality-of-life concerns and prioritize younger patients. We feel that it is time to take the next steps toward better liver allocation not only through reductions in geographic disparities but also through the adoption of a model better equipped to balance the many ethical concerns shaping organ allocation. Thus, we support the development of a similar model with suggested amendments. <jats:italic toggle=\"yes\">Liver Transpl 20:140-146, 2014<\/jats:italic>. \u00a9 2013 AASLD.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/lt.23780","type":"journal-article","created":{"date-parts":[[2013,10,26]],"date-time":"2013-10-26T09:24:46Z","timestamp":1382779486000},"page":"140-146","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":41,"title":["Ethical Considerations Surrounding Survival Benefit\u2013Based Liver Allocation"],"prefix":"10.1097","volume":"20","author":[{"given":"Eric J.","family":"Keller","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul Y.","family":"Kwo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul 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infection.","volume":"80","author":"Condron","year":"2005","journal-title":"Transplantation"},{"key":"R8-3-20250124","doi-asserted-by":"crossref","first-page":"273277","DOI":"10.1001\/archsurg.140.3.273","article-title":"Impact of donor, technical, and recipient risk factors on survival and quality of life after liver transplantation.","volume":"140","author":"Moore","year":"2005","journal-title":"Arch Surg"},{"key":"R9-3-20250124","doi-asserted-by":"crossref","first-page":"11391147","DOI":"10.1111\/j.1600-6143.2004.00472.x","article-title":"Liver transplantation from donors aged 80 years and over: pushing the limit.","volume":"4","author":"Nardo","year":"2004","journal-title":"Am J Transplant"},{"key":"R10-3-20250124","doi-asserted-by":"crossref","first-page":"529534","DOI":"10.1016\/j.transproceed.2006.12.002","article-title":"Extended donor criteria have no negative impact on early outcome after liver transplantation: a singlecenter multivariate analysis.","volume":"39","author":"Schemmer","year":"2007","journal-title":"Transplant Proc"},{"key":"R11-3-20250124","doi-asserted-by":"crossref","first-page":"14681475","DOI":"10.1002\/lt.20304","article-title":"Expanded criteria donor grafts for deceased donor liver transplantation under the MELD system: a decision analysis.","volume":"10","author":"Amin","year":"2004","journal-title":"Liver Transpl"},{"key":"R12-3-20250124","doi-asserted-by":"crossref","first-page":"419425","DOI":"10.1111\/j.1600-6143.2007.02086.x","article-title":"The survival benefit of deceased donor liver transplantation as a function of candidate disease severity and donor quality.","volume":"8","author":"Schaubel","year":"2008","journal-title":"Am J Transplant"},{"key":"R13-3-20250124","doi-asserted-by":"crossref","first-page":"439450","DOI":"10.1097\/01.sla.0000234896.18207.fa","article-title":"Use of extended criteria livers decreases wait time for liver transplantation without adversely impacting posttransplant survival.","volume":"244","author":"Tector","year":"2006","journal-title":"Ann Surg"},{"key":"R14-3-20250124","doi-asserted-by":"crossref","first-page":"723728","DOI":"10.1097\/TP.0b013e3181b2a01b","article-title":"No difference in transplant outcomes for local and import pancreas allografts.","volume":"88","author":"Fridell","year":"2009","journal-title":"Transplantation"},{"key":"R15-3-20250124","doi-asserted-by":"crossref","first-page":"975979","DOI":"10.1016\/j.transproceed.2009.02.016","article-title":"Extended criteria donors in liver transplantation: adapting donor quality and recipient.","volume":"41","author":"Gastaca","year":"2009","journal-title":"Transplant Proc"},{"issue":"suppl 8","key":"R16-3-20250124","first-page":"viii29viii36","article-title":"Utilization of extended donor criteria in liver transplantation: a comprehensive review of the literature.","volume":"22","author":"Nickkholgh","year":"2007","journal-title":"Nephrol Dial 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The use of responsibility as the tie breaker.","volume":"35","author":"Thornton","year":"2009","journal-title":"J Med Ethics"},{"key":"R32-3-20250124","doi-asserted-by":"crossref","first-page":"418433","DOI":"10.1017\/S0963180111000107","article-title":"Does the United States do it better? A comparative analysis of liver allocation protocols in the United Kingdom and the United States.","volume":"20","author":"Cherkassky","year":"2011","journal-title":"Camb Q Healthc Ethics"},{"key":"R33-3-20250124","doi-asserted-by":"crossref","first-page":"816","DOI":"10.2307\/3528040","article-title":"Justice and managed care. 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